|
megestrol 40 mg Tab [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
megestrol 40 mg Tab [VDMC]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
melatonin 3 mg Tab [VDMC]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.83
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
melatonin 3 mg Tab [VDMC]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV [VDMC]
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS J1738
|
| Hospital Charge Code |
22582257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$251.30 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV [VDMC]
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS J1738
|
| Hospital Charge Code |
22582257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$161.55 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Aetna of IA Medicare |
$204.63
|
| Rate for Payer: Amerigroup Medicaid |
$207.07
|
| Rate for Payer: Amerigroup Medicare |
$163.17
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$161.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$205.06
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$161.55
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$208.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$185.78
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
meloxicam 7.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
meloxicam 7.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
memantine 10 mg Tab [VDMC]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Aetna of IA Medicare |
$1.15
|
| Rate for Payer: Amerigroup Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Medicare |
$0.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.91
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.19
|
|
|
memantine 10 mg Tab [VDMC]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
|
|
meningococcal conjugate vaccine - Pow[VDMC]
|
Facility
|
IP
|
$220.93
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
23286480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$154.65 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
|
|
meningococcal conjugate vaccine - Pow[VDMC]
|
Facility
|
OP
|
$220.93
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
23286480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$400.65 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Aetna of IA Medicare |
$125.93
|
| Rate for Payer: Amerigroup Medicaid |
$127.43
|
| Rate for Payer: Amerigroup Medicare |
$100.41
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.20
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.42
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.33
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$363.72
|
| Rate for Payer: Wellmark IA PPO |
$400.65
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS [VDMC]
|
Facility
|
OP
|
$329.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
20550418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$148.13 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Aetna of IA Commercial |
$296.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.25
|
| Rate for Payer: Aetna of IA Medicare |
$187.63
|
| Rate for Payer: Amerigroup Medicaid |
$189.86
|
| Rate for Payer: Amerigroup Medicare |
$149.61
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.02
|
| Rate for Payer: Medical Associates Commercial |
$246.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.13
|
| Rate for Payer: Midlands Choice Commercial |
$230.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$190.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.34
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.21
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS [VDMC]
|
Facility
|
IP
|
$329.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
20550418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Aetna of IA Commercial |
$296.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.25
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.88
|
| Rate for Payer: Medical Associates Commercial |
$246.88
|
| Rate for Payer: Midlands Choice Commercial |
$230.42
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
|
|
MENISCAL CINCH
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$295.90
|
| Rate for Payer: Amerigroup Medicare |
$233.16
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.03
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.85
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$265.48
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
MENISCAL CINCH
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$7,532.79
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$7,423.61 |
| Max. Negotiated Rate |
$7,532.79 |
| Rate for Payer: Amerigroup Medicaid |
$7,496.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,423.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,532.79
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$4,341.77
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$4,278.84 |
| Max. Negotiated Rate |
$4,341.77 |
| Rate for Payer: Amerigroup Medicaid |
$4,320.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,278.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,341.77
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm [VDMC]
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20114761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna of IA Commercial |
$11.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.95
|
| Rate for Payer: Aetna of IA Medicare |
$7.57
|
| Rate for Payer: Amerigroup Medicaid |
$7.66
|
| Rate for Payer: Amerigroup Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.59
|
| Rate for Payer: Medical Associates Commercial |
$9.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.98
|
| Rate for Payer: Midlands Choice Commercial |
$9.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.84
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm [VDMC]
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20114761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna of IA Commercial |
$11.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.95
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.96
|
| Rate for Payer: Medical Associates Commercial |
$9.96
|
| Rate for Payer: Midlands Choice Commercial |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
|
|
menthol topical 4% Gel 89ml [VDMC]
|
Facility
|
IP
|
$36.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19495881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna of IA Commercial |
$32.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.83
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.36
|
| Rate for Payer: Medical Associates Commercial |
$27.36
|
| Rate for Payer: Midlands Choice Commercial |
$25.54
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
|
|
menthol topical 4% Gel 89ml [VDMC]
|
Facility
|
OP
|
$36.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19495881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna of IA Commercial |
$32.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.83
|
| Rate for Payer: Aetna of IA Medicare |
$20.79
|
| Rate for Payer: Amerigroup Medicaid |
$21.04
|
| Rate for Payer: Amerigroup Medicare |
$16.58
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.84
|
| Rate for Payer: Medical Associates Commercial |
$27.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.42
|
| Rate for Payer: Midlands Choice Commercial |
$25.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.88
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.52
|
|
|
menthol-zinc oxide Top 0.44%-20.625% Oint [VDMC]
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403035
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna of IA Commercial |
$24.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.84
|
| Rate for Payer: Aetna of IA Medicare |
$15.73
|
| Rate for Payer: Amerigroup Medicaid |
$15.92
|
| Rate for Payer: Amerigroup Medicare |
$12.54
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.76
|
| Rate for Payer: Medical Associates Commercial |
$20.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.42
|
| Rate for Payer: Midlands Choice Commercial |
$19.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.28
|
| Rate for Payer: United Healthcare Commercial |
$24.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.28
|
|
|
menthol-zinc oxide Top 0.44%-20.625% Oint [VDMC]
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403035
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna of IA Commercial |
$24.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.84
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.70
|
| Rate for Payer: Medical Associates Commercial |
$20.70
|
| Rate for Payer: Midlands Choice Commercial |
$19.32
|
| Rate for Payer: United Healthcare Commercial |
$24.84
|
|
|
mepivacaine 2% 20 ml SDV PF Inj Sol [VDMC]
|
Facility
|
OP
|
$59.88
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
28919314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$53.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.89
|
| Rate for Payer: Aetna of IA Medicare |
$34.13
|
| Rate for Payer: Amerigroup Medicaid |
$34.54
|
| Rate for Payer: Amerigroup Medicare |
$27.21
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.20
|
| Rate for Payer: Medical Associates Commercial |
$44.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.95
|
| Rate for Payer: Midlands Choice Commercial |
$41.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.99
|
| Rate for Payer: United Healthcare Commercial |
$53.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.33
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
