|
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
|
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 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 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
|
|
|
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
|
|
|
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 |
$658.38 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$597.69
|
| Rate for Payer: Wellmark IA PPO |
$658.38
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
Methylmalonic Acid DMCL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
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
|
|
|
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
|
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
|
|
