|
montelukast 4 mg Chew Tab [VDMC]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10406821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
montelukast 4 mg Chew Tab [VDMC]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10406821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
|
morphine 0.5 mg/mL 10 ml preservative-free Sol [VDMC]
|
Facility
|
IP
|
$60.45
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
11225094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.32 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna of IA Commercial |
$54.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.40
|
| Rate for Payer: Cash Price |
$48.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.34
|
| Rate for Payer: Medical Associates Commercial |
$45.34
|
| Rate for Payer: Midlands Choice Commercial |
$42.32
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
|
|
morphine 0.5 mg/mL 10 ml preservative-free Sol [VDMC]
|
Facility
|
OP
|
$60.45
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
11225094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.21 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna of IA Commercial |
$54.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.40
|
| Rate for Payer: Aetna of IA Medicare |
$34.46
|
| Rate for Payer: Amerigroup Medicaid |
$30.51
|
| Rate for Payer: Amerigroup Medicare |
$30.53
|
| Rate for Payer: Cash Price |
$48.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.21
|
| Rate for Payer: Medical Associates Commercial |
$45.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.22
|
| Rate for Payer: Midlands Choice Commercial |
$42.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$45.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.34
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.67
|
|
|
morphine 10 mg/mL 1 ml PF vial [VDMC]
|
Facility
|
IP
|
$48.27
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15031446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Aetna of IA Commercial |
$43.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.44
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.20
|
| Rate for Payer: Medical Associates Commercial |
$36.20
|
| Rate for Payer: Midlands Choice Commercial |
$33.79
|
| Rate for Payer: United Healthcare Commercial |
$43.44
|
|
|
morphine 10 mg/mL 1 ml PF vial [VDMC]
|
Facility
|
OP
|
$48.27
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15031446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Aetna of IA Commercial |
$43.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.44
|
| Rate for Payer: Aetna of IA Medicare |
$27.51
|
| Rate for Payer: Amerigroup Medicaid |
$24.36
|
| Rate for Payer: Amerigroup Medicare |
$24.38
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.13
|
| Rate for Payer: Medical Associates Commercial |
$36.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.14
|
| Rate for Payer: Midlands Choice Commercial |
$33.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$24.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$36.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.20
|
| Rate for Payer: United Healthcare Commercial |
$43.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.48
|
|
|
morphine 10 mg/mL PF syringe [VDMC]
|
Facility
|
OP
|
$45.41
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Aetna of IA Commercial |
$40.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.87
|
| Rate for Payer: Aetna of IA Medicare |
$25.88
|
| Rate for Payer: Amerigroup Medicaid |
$22.92
|
| Rate for Payer: Amerigroup Medicare |
$22.93
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.70
|
| Rate for Payer: Medical Associates Commercial |
$34.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.70
|
| Rate for Payer: Midlands Choice Commercial |
$31.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$23.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.06
|
| Rate for Payer: United Healthcare Commercial |
$40.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.79
|
|
|
morphine 10 mg/mL PF syringe [VDMC]
|
Facility
|
IP
|
$45.41
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Aetna of IA Commercial |
$40.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.87
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.06
|
| Rate for Payer: Medical Associates Commercial |
$34.06
|
| Rate for Payer: Midlands Choice Commercial |
$31.79
|
| Rate for Payer: United Healthcare Commercial |
$40.87
|
|
|
morphine 15 mg ER Tab [VDMC]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of IA Commercial |
$3.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.36
|
| Rate for Payer: Aetna of IA Medicare |
$2.13
|
| Rate for Payer: Amerigroup Medicaid |
$1.88
|
| Rate for Payer: Amerigroup Medicare |
$1.88
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.86
|
| Rate for Payer: Medical Associates Commercial |
$2.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.86
|
| Rate for Payer: Midlands Choice Commercial |
$2.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$3.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.20
|
|
|
morphine 15 mg ER Tab [VDMC]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of IA Commercial |
$3.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.36
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.80
|
| Rate for Payer: Medical Associates Commercial |
$2.80
|
| Rate for Payer: Midlands Choice Commercial |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$3.36
|
|
|
morphine 15 mg Tab [VDMC]
|
Facility
|
OP
|
$5.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407172
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna of IA Commercial |
$4.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.93
|
| Rate for Payer: Aetna of IA Medicare |
$3.12
|
| Rate for Payer: Amerigroup Medicaid |
$2.77
|
| Rate for Payer: Amerigroup Medicare |
$2.77
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.74
|
| Rate for Payer: Medical Associates Commercial |
$4.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.74
|
| Rate for Payer: Midlands Choice Commercial |
$3.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$4.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.11
|
| Rate for Payer: United Healthcare Commercial |
$4.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.23
|
|
|
morphine 15 mg Tab [VDMC]
|
Facility
|
IP
|
$5.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407172
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna of IA Commercial |
$4.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.93
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.11
|
| Rate for Payer: Medical Associates Commercial |
$4.11
|
| Rate for Payer: Midlands Choice Commercial |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$4.93
|
|
|
morphine 1 mg/mL 10ml preservative-free Sol[VDMC]
|
Facility
|
IP
|
$62.59
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
11579463
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$56.33 |
| Rate for Payer: Aetna of IA Commercial |
$56.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.33
|
| Rate for Payer: Cash Price |
$50.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.94
|
| Rate for Payer: Medical Associates Commercial |
$46.94
|
| Rate for Payer: Midlands Choice Commercial |
$43.81
|
| Rate for Payer: United Healthcare Commercial |
$56.33
|
|
|
morphine 1 mg/mL 10ml preservative-free Sol[VDMC]
|
Facility
|
OP
|
$62.59
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
11579463
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$56.33 |
| Rate for Payer: Aetna of IA Commercial |
$56.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.33
|
| Rate for Payer: Aetna of IA Medicare |
$35.68
|
| Rate for Payer: Amerigroup Medicaid |
$31.59
|
| Rate for Payer: Amerigroup Medicare |
$31.61
|
| Rate for Payer: Cash Price |
$50.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.28
|
| Rate for Payer: Medical Associates Commercial |
$46.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.30
|
| Rate for Payer: Midlands Choice Commercial |
$43.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$31.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$46.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.94
|
| Rate for Payer: United Healthcare Commercial |
$56.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.93
|
|
|
morphine 20 mg/mL Oral Conc [VDMC]
|
Facility
|
IP
|
$27.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna of IA Commercial |
$24.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.34
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.28
|
| Rate for Payer: Medical Associates Commercial |
$20.28
|
| Rate for Payer: Midlands Choice Commercial |
$18.93
|
| Rate for Payer: United Healthcare Commercial |
$24.34
|
|
|
morphine 20 mg/mL Oral Conc [VDMC]
|
Facility
|
OP
|
$27.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna of IA Commercial |
$24.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.34
|
| Rate for Payer: Aetna of IA Medicare |
$15.41
|
| Rate for Payer: Amerigroup Medicaid |
$13.65
|
| Rate for Payer: Amerigroup Medicare |
$13.66
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.51
|
| Rate for Payer: Medical Associates Commercial |
$20.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.52
|
| Rate for Payer: Midlands Choice Commercial |
$18.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$13.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.28
|
| Rate for Payer: United Healthcare Commercial |
$24.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.95
|
|
|
morphine 2 mg/mL preservative-free Sol [VDMC]
|
Facility
|
IP
|
$45.89
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407243
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$41.30 |
| Rate for Payer: Aetna of IA Commercial |
$41.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.30
|
| Rate for Payer: Cash Price |
$36.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.42
|
| Rate for Payer: Medical Associates Commercial |
$34.42
|
| Rate for Payer: Midlands Choice Commercial |
$32.12
|
| Rate for Payer: United Healthcare Commercial |
$41.30
|
|
|
morphine 2 mg/mL preservative-free Sol [VDMC]
|
Facility
|
OP
|
$45.89
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407243
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$41.30 |
| Rate for Payer: Aetna of IA Commercial |
$41.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.16
|
| Rate for Payer: Amerigroup Medicaid |
$23.16
|
| Rate for Payer: Amerigroup Medicare |
$23.17
|
| Rate for Payer: Cash Price |
$36.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.94
|
| Rate for Payer: Medical Associates Commercial |
$34.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.94
|
| Rate for Payer: Midlands Choice Commercial |
$32.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$23.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.42
|
| Rate for Payer: United Healthcare Commercial |
$41.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.08
|
|
|
morphine 4 mg/mL PF vial [VDMC]
|
Facility
|
OP
|
$46.52
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
14202827
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna of IA Commercial |
$41.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.87
|
| Rate for Payer: Aetna of IA Medicare |
$26.52
|
| Rate for Payer: Amerigroup Medicaid |
$23.48
|
| Rate for Payer: Amerigroup Medicare |
$23.49
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.25
|
| Rate for Payer: Medical Associates Commercial |
$34.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.26
|
| Rate for Payer: Midlands Choice Commercial |
$32.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$23.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.89
|
| Rate for Payer: United Healthcare Commercial |
$41.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.45
|
|
|
morphine 4 mg/mL PF vial [VDMC]
|
Facility
|
IP
|
$46.52
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
14202827
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna of IA Commercial |
$41.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.87
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.89
|
| Rate for Payer: Medical Associates Commercial |
$34.89
|
| Rate for Payer: Midlands Choice Commercial |
$32.56
|
| Rate for Payer: United Healthcare Commercial |
$41.87
|
|
|
morphine 4 mg/mL preservative-free Sol [VDMC]
|
Facility
|
OP
|
$45.45
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna of IA Commercial |
$40.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.90
|
| Rate for Payer: Aetna of IA Medicare |
$25.91
|
| Rate for Payer: Amerigroup Medicaid |
$22.94
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.72
|
| Rate for Payer: Medical Associates Commercial |
$34.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.72
|
| Rate for Payer: Midlands Choice Commercial |
$31.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$23.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.09
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.82
|
|
|
morphine 4 mg/mL preservative-free Sol [VDMC]
|
Facility
|
IP
|
$45.45
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna of IA Commercial |
$40.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.90
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.09
|
| Rate for Payer: Medical Associates Commercial |
$34.09
|
| Rate for Payer: Midlands Choice Commercial |
$31.82
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
|
|
morphine PCA 1 mg/mL PF 30 ml Inj Sol [VDMC]
|
Facility
|
IP
|
$76.80
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
17338824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna of IA Commercial |
$69.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.12
|
| Rate for Payer: Cash Price |
$61.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.60
|
| Rate for Payer: Medical Associates Commercial |
$57.60
|
| Rate for Payer: Midlands Choice Commercial |
$53.76
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
|
|
morphine PCA 1 mg/mL PF 30 ml Inj Sol [VDMC]
|
Facility
|
OP
|
$76.80
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
17338824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna of IA Commercial |
$69.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.12
|
| Rate for Payer: Aetna of IA Medicare |
$43.78
|
| Rate for Payer: Amerigroup Medicaid |
$38.76
|
| Rate for Payer: Amerigroup Medicare |
$38.78
|
| Rate for Payer: Cash Price |
$61.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.38
|
| Rate for Payer: Medical Associates Commercial |
$57.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.40
|
| Rate for Payer: Midlands Choice Commercial |
$53.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$38.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.60
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.31
|
|
|
Mouth Procedures With CC/MCC
|
Facility
|
IP
|
$9,294.20
|
|
|
Service Code
|
MS-DRG 137
|
| Hospital Charge Code |
17
|
| Min. Negotiated Rate |
$9,159.50 |
| Max. Negotiated Rate |
$9,294.20 |
| Rate for Payer: Amerigroup Medicaid |
$9,249.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,159.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,294.20
|
|
