|
methylene blue 5 mg/mL 10ml SDV inj [VDMC]
|
Facility
|
OP
|
$789.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
18569211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$355.37 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Aetna of IA Medicare |
$450.14
|
| Rate for Payer: Amerigroup Medicaid |
$455.51
|
| Rate for Payer: Amerigroup Medicare |
$358.92
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$355.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$451.08
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.37
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$457.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$408.68
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.93
|
|
|
methylene blue 5 mg/mL 10ml SDV inj [VDMC]
|
Facility
|
IP
|
$789.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
18569211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$552.80 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
|
|
methylergonovine 0.2 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10404634
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna of IA Commercial |
$73.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.62
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.35
|
| Rate for Payer: Medical Associates Commercial |
$61.35
|
| Rate for Payer: Midlands Choice Commercial |
$57.26
|
| Rate for Payer: United Healthcare Commercial |
$73.62
|
|
|
methylergonovine 0.2 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10404634
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna of IA Commercial |
$73.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.62
|
| Rate for Payer: Aetna of IA Medicare |
$46.62
|
| Rate for Payer: Amerigroup Medicaid |
$47.18
|
| Rate for Payer: Amerigroup Medicare |
$37.18
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.72
|
| Rate for Payer: Medical Associates Commercial |
$61.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.81
|
| Rate for Payer: Midlands Choice Commercial |
$57.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.33
|
| Rate for Payer: United Healthcare Commercial |
$73.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.26
|
|
|
Methylmalonic Acid DMCL
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
Methylmalonic Acid DMCL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$90.56
|
| Rate for Payer: Amerigroup Medicare |
$71.36
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.68
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.65
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
|
|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]
|
Facility
|
IP
|
$645.20
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
11224341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$580.68 |
| Rate for Payer: Aetna of IA Commercial |
$580.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.68
|
| Rate for Payer: Cash Price |
$516.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$483.90
|
| Rate for Payer: Medical Associates Commercial |
$483.90
|
| Rate for Payer: Midlands Choice Commercial |
$451.64
|
| Rate for Payer: United Healthcare Commercial |
$580.68
|
|
|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]
|
Facility
|
OP
|
$645.20
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
11224341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$290.34 |
| Max. Negotiated Rate |
$580.68 |
| Rate for Payer: Aetna of IA Commercial |
$580.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.68
|
| Rate for Payer: Aetna of IA Medicare |
$367.76
|
| Rate for Payer: Amerigroup Medicaid |
$372.15
|
| Rate for Payer: Amerigroup Medicare |
$293.24
|
| Rate for Payer: Cash Price |
$516.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$483.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$290.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$368.54
|
| Rate for Payer: Medical Associates Commercial |
$483.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$290.34
|
| Rate for Payer: Midlands Choice Commercial |
$451.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$373.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$333.89
|
| Rate for Payer: United Healthcare Commercial |
$580.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$380.67
|
|
|
methylphenidate 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna of IA Commercial |
$3.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.03
|
| Rate for Payer: Aetna of IA Medicare |
$1.92
|
| Rate for Payer: Amerigroup Medicaid |
$1.94
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.92
|
| Rate for Payer: Medical Associates Commercial |
$2.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.52
|
| Rate for Payer: Midlands Choice Commercial |
$2.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$3.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.99
|
|
|
methylphenidate 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna of IA Commercial |
$3.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.03
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.53
|
| Rate for Payer: Medical Associates Commercial |
$2.53
|
| Rate for Payer: Midlands Choice Commercial |
$2.36
|
| Rate for Payer: United Healthcare Commercial |
$3.03
|
|
|
methylPREDNISolone 125 mg preservative-free Pow [VDMC]
|
Facility
|
OP
|
$50.46
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10404839
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna of IA Commercial |
$45.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.42
|
| Rate for Payer: Aetna of IA Medicare |
$28.76
|
| Rate for Payer: Amerigroup Medicaid |
$29.11
|
| Rate for Payer: Amerigroup Medicare |
$22.94
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.83
|
| Rate for Payer: Medical Associates Commercial |
$37.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.71
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.12
|
| Rate for Payer: United Healthcare Commercial |
$45.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.77
|
|
|
methylPREDNISolone 125 mg preservative-free Pow [VDMC]
|
Facility
|
IP
|
$50.46
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10404839
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna of IA Commercial |
$45.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.42
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.85
|
| Rate for Payer: Medical Associates Commercial |
$37.85
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: United Healthcare Commercial |
$45.42
|
|
|
methylPREDNISolone 1gm PF SDV Pow [VDMC]
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10404772
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna of IA Commercial |
$218.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.59
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.16
|
| Rate for Payer: Medical Associates Commercial |
$182.16
|
| Rate for Payer: Midlands Choice Commercial |
$170.02
|
| Rate for Payer: United Healthcare Commercial |
$218.59
|
|
|
methylPREDNISolone 1gm PF SDV Pow [VDMC]
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10404772
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$109.30 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna of IA Commercial |
$218.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.59
|
| Rate for Payer: Aetna of IA Medicare |
$138.44
|
| Rate for Payer: Amerigroup Medicaid |
$140.09
|
| Rate for Payer: Amerigroup Medicare |
$110.39
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$109.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.73
|
| Rate for Payer: Medical Associates Commercial |
$182.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$109.30
|
| Rate for Payer: Midlands Choice Commercial |
$170.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.69
|
| Rate for Payer: United Healthcare Commercial |
$218.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$143.30
|
|
|
methylPREDNISolone 40 mg preservative-free Pow [VDMC]
|
Facility
|
OP
|
$37.92
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10405053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$34.13 |
| Rate for Payer: Aetna of IA Commercial |
$34.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.13
|
| Rate for Payer: Aetna of IA Medicare |
$21.62
|
| Rate for Payer: Amerigroup Medicaid |
$21.87
|
| Rate for Payer: Amerigroup Medicare |
$17.24
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.66
|
| Rate for Payer: Medical Associates Commercial |
$28.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.06
|
| Rate for Payer: Midlands Choice Commercial |
$26.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.62
|
| Rate for Payer: United Healthcare Commercial |
$34.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.37
|
|
|
methylPREDNISolone 40 mg preservative-free Pow [VDMC]
|
Facility
|
IP
|
$37.92
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10405053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$34.13 |
| Rate for Payer: Aetna of IA Commercial |
$34.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.13
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.44
|
| Rate for Payer: Medical Associates Commercial |
$28.44
|
| Rate for Payer: Midlands Choice Commercial |
$26.55
|
| Rate for Payer: United Healthcare Commercial |
$34.13
|
|
|
methylPREDNISolone 4 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
11518853
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
methylPREDNISolone 4 mg Tab [VDMC]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
11518853
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
|
|
methylPREDNISolone 80 mg/mL 1 ml Inj Susp [VDMC]
|
Facility
|
OP
|
$51.16
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
10405114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Aetna of IA Commercial |
$46.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.04
|
| Rate for Payer: Aetna of IA Medicare |
$29.16
|
| Rate for Payer: Amerigroup Medicaid |
$29.51
|
| Rate for Payer: Amerigroup Medicare |
$23.25
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.22
|
| Rate for Payer: Medical Associates Commercial |
$38.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.02
|
| Rate for Payer: Midlands Choice Commercial |
$35.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.48
|
| Rate for Payer: United Healthcare Commercial |
$46.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.18
|
|
|
methylPREDNISolone 80 mg/mL 1 ml Inj Susp [VDMC]
|
Facility
|
IP
|
$51.16
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
10405114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.81 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Aetna of IA Commercial |
$46.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.04
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.37
|
| Rate for Payer: Medical Associates Commercial |
$38.37
|
| Rate for Payer: Midlands Choice Commercial |
$35.81
|
| Rate for Payer: United Healthcare Commercial |
$46.04
|
|
|
metoclopramide 10mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
metoclopramide 10mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.67
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
metoclopramide 5 mg/5 mL Oral Syrup [VDMC]
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of IA Commercial |
$6.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.82
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.68
|
| Rate for Payer: Medical Associates Commercial |
$5.68
|
| Rate for Payer: Midlands Choice Commercial |
$5.31
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
|
|
metoclopramide 5 mg/5 mL Oral Syrup [VDMC]
|
Facility
|
OP
|
$7.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of IA Commercial |
$6.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.82
|
| Rate for Payer: Aetna of IA Medicare |
$4.32
|
| Rate for Payer: Amerigroup Medicaid |
$4.37
|
| Rate for Payer: Amerigroup Medicare |
$3.44
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.33
|
| Rate for Payer: Medical Associates Commercial |
$5.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.41
|
| Rate for Payer: Midlands Choice Commercial |
$5.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.47
|
|
|
metoclopramide 5 mg/mL 2 ML Inj Sol [VDMC]
|
Facility
|
IP
|
$23.86
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
10405183
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna of IA Commercial |
$21.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.48
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.90
|
| Rate for Payer: Medical Associates Commercial |
$17.90
|
| Rate for Payer: Midlands Choice Commercial |
$16.70
|
| Rate for Payer: United Healthcare Commercial |
$21.48
|
|
