|
Mesh Surgical Bard Marlex 5.4x2.4in Pre-Shaped
|
Facility
|
OP
|
$714.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$321.73 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna of IA Commercial |
$643.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$643.46
|
| Rate for Payer: Aetna of IA Medicare |
$407.53
|
| Rate for Payer: Amerigroup Medicaid |
$412.39
|
| Rate for Payer: Amerigroup Medicare |
$324.95
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$536.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$321.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$408.39
|
| Rate for Payer: Medical Associates Commercial |
$536.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$321.73
|
| Rate for Payer: Midlands Choice Commercial |
$500.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$414.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$369.99
|
| Rate for Payer: United Healthcare Commercial |
$643.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$421.83
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.50 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.75 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Aetna of IA Medicare |
$567.15
|
| Rate for Payer: Amerigroup Medicaid |
$573.92
|
| Rate for Payer: Amerigroup Medicare |
$452.23
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$447.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$568.34
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$447.75
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$576.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$514.91
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$587.05
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.50 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.25 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,028.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,041.12
|
| Rate for Payer: Amerigroup Medicare |
$820.37
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$812.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,031.02
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$812.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,046.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$934.09
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,064.95
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
OP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$29.37
|
| Rate for Payer: Amerigroup Medicare |
$23.14
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.09
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.91
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.35
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
IP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
|
|
Metanephrine Fract Free Plasma DMCL
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
8519262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$34.03
|
| Rate for Payer: Amerigroup Medicare |
$26.82
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.70
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.55
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.53
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
|
|
Metanephrine Fract Free Plasma DMCL
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
8519262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
metaxalone 800 mg Tab [VDMC]
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403721
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
|
|
metaxalone 800 mg Tab [VDMC]
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403721
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.83
|
| Rate for Payer: Amerigroup Medicaid |
$1.85
|
| Rate for Payer: Amerigroup Medicare |
$1.46
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.83
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
metFORMIN 500 mg 24 HR ER Tab [VDMC]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of IA Commercial |
$2.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.14
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
|
|
metFORMIN 500 mg 24 HR ER Tab [VDMC]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of IA Commercial |
$2.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.14
|
| Rate for Payer: Aetna of IA Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicaid |
$1.37
|
| Rate for Payer: Amerigroup Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.36
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.40
|
|
|
metFORMIN 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna of IA Commercial |
$1.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.07
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.68
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.70
|
|
|
metFORMIN 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna of IA Commercial |
$1.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.07
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
|
|
methadone 5 mg Tab[VDMC]
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11512126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
|
|
methadone 5 mg Tab[VDMC]
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11512126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Aetna of IA Medicare |
$2.38
|
| Rate for Payer: Amerigroup Medicaid |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$1.89
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.38
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.88
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.46
|
|
|
methimazole 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna of IA Commercial |
$1.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.72
|
| Rate for Payer: Aetna of IA Medicare |
$1.09
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$0.87
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.13
|
|
|
methimazole 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna of IA Commercial |
$1.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.72
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
|
|
methocarbamol 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404145
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Aetna of IA Medicare |
$0.95
|
| Rate for Payer: Amerigroup Medicaid |
$0.96
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.98
|
|
|
methocarbamol 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404145
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV [VDMC]
|
Facility
|
OP
|
$58.08
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
12477553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Aetna of IA Medicare |
$33.11
|
| Rate for Payer: Amerigroup Medicaid |
$33.50
|
| Rate for Payer: Amerigroup Medicare |
$26.40
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.18
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.14
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.06
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.27
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV [VDMC]
|
Facility
|
IP
|
$58.08
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
12477553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
|
|
methotrexate 2.5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404216
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.83
|
| Rate for Payer: Amerigroup Medicaid |
$1.85
|
| Rate for Payer: Amerigroup Medicare |
$1.46
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.83
|
| Rate for Payer: Medical Associates Commercial |
$2.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
methotrexate 2.5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404216
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| Rate for Payer: Medical Associates Commercial |
$2.40
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
|
