|
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
|
|
|
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 |
$27.20 |
| 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 |
$34.87
|
| Rate for Payer: Amerigroup Medicare |
$27.47
|
| 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 |
$27.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.53
|
| Rate for Payer: Medical Associates Commercial |
$45.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.20
|
| Rate for Payer: Midlands Choice Commercial |
$42.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.28
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.66
|
|
|
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 |
$42.31 |
| 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 |
$42.31
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
|
|
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 |
$21.72 |
| 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 |
$27.84
|
| Rate for Payer: Amerigroup Medicare |
$21.94
|
| 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 |
$21.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.57
|
| Rate for Payer: Medical Associates Commercial |
$36.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.72
|
| Rate for Payer: Midlands Choice Commercial |
$33.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.98
|
| Rate for Payer: United Healthcare Commercial |
$43.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.48
|
|
|
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 PF syringe [VDMC]
|
Facility
|
OP
|
$45.41
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
10407032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$26.19
|
| Rate for Payer: Amerigroup Medicare |
$20.64
|
| Rate for Payer: Cash Price |
$36.33
|
| 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 |
$20.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.94
|
| Rate for Payer: Medical Associates Commercial |
$34.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.44
|
| Rate for Payer: Midlands Choice Commercial |
$31.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.50
|
| Rate for Payer: United Healthcare Commercial |
$40.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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
|
$3.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna of IA Commercial |
$3.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.27
|
| Rate for Payer: Aetna of IA Medicare |
$2.07
|
| Rate for Payer: Amerigroup Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.08
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.63
|
| Rate for Payer: Midlands Choice Commercial |
$2.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.14
|
|
|
morphine 15 mg ER Tab [VDMC]
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna of IA Commercial |
$3.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.27
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Midlands Choice Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
|
|
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 |
$4.94 |
| Rate for Payer: Aetna of IA Commercial |
$4.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.94
|
| 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 |
$4.94
|
|
|
morphine 15 mg Tab [VDMC]
|
Facility
|
OP
|
$5.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407172
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of IA Commercial |
$4.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.94
|
| Rate for Payer: Aetna of IA Medicare |
$3.13
|
| Rate for Payer: Amerigroup Medicaid |
$3.16
|
| Rate for Payer: Amerigroup Medicare |
$2.49
|
| 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 |
$2.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.13
|
| Rate for Payer: Medical Associates Commercial |
$4.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.47
|
| Rate for Payer: Midlands Choice Commercial |
$3.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$4.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.24
|
|
|
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 |
$28.17 |
| 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 |
$36.10
|
| Rate for Payer: Amerigroup Medicare |
$28.45
|
| 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 |
$28.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.75
|
| Rate for Payer: Medical Associates Commercial |
$46.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.17
|
| Rate for Payer: Midlands Choice Commercial |
$43.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.39
|
| Rate for Payer: United Healthcare Commercial |
$56.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.93
|
|
|
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 20 mg/mL Oral Conc [VDMC]
|
Facility
|
IP
|
$46.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$42.08 |
| Rate for Payer: Aetna of IA Commercial |
$42.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.08
|
| Rate for Payer: Cash Price |
$37.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.07
|
| Rate for Payer: Medical Associates Commercial |
$35.07
|
| Rate for Payer: Midlands Choice Commercial |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$42.08
|
|
|
morphine 20 mg/mL Oral Conc [VDMC]
|
Facility
|
OP
|
$46.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$42.08 |
| Rate for Payer: Aetna of IA Commercial |
$42.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.08
|
| Rate for Payer: Aetna of IA Medicare |
$26.65
|
| Rate for Payer: Amerigroup Medicaid |
$26.97
|
| Rate for Payer: Amerigroup Medicare |
$21.25
|
| Rate for Payer: Cash Price |
$37.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.71
|
| Rate for Payer: Medical Associates Commercial |
$35.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.04
|
| Rate for Payer: Midlands Choice Commercial |
$32.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.20
|
| Rate for Payer: United Healthcare Commercial |
$42.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.59
|
|
|
morphine 2 mg/mL 1mL preservative-free Sol[VDMC]
|
Facility
|
IP
|
$46.33
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
29388211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.43 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna of IA Commercial |
$41.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.70
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.75
|
| Rate for Payer: Medical Associates Commercial |
$34.75
|
| Rate for Payer: Midlands Choice Commercial |
$32.43
|
| Rate for Payer: United Healthcare Commercial |
$41.70
|
|
|
morphine 2 mg/mL 1mL preservative-free Sol[VDMC]
|
Facility
|
OP
|
$46.33
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
29388211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna of IA Commercial |
$41.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.70
|
| Rate for Payer: Aetna of IA Medicare |
$26.41
|
| Rate for Payer: Amerigroup Medicaid |
$26.72
|
| Rate for Payer: Amerigroup Medicare |
$21.06
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.46
|
| Rate for Payer: Medical Associates Commercial |
$34.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.85
|
| Rate for Payer: Midlands Choice Commercial |
$32.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.98
|
| Rate for Payer: United Healthcare Commercial |
$41.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.33
|
|
|
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 |
$20.65 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$26.47
|
| Rate for Payer: Amerigroup Medicare |
$20.86
|
| Rate for Payer: Cash Price |
$36.71
|
| 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 |
$20.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.21
|
| Rate for Payer: Medical Associates Commercial |
$34.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.65
|
| Rate for Payer: Midlands Choice Commercial |
$32.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.75
|
| Rate for Payer: United Healthcare Commercial |
$41.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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 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 PF vial [VDMC]
|
Facility
|
OP
|
$46.52
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
14202827
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.93 |
| 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 |
$26.83
|
| Rate for Payer: Amerigroup Medicare |
$21.14
|
| 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 |
$20.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.57
|
| Rate for Payer: Medical Associates Commercial |
$34.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.93
|
| Rate for Payer: Midlands Choice Commercial |
$32.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$41.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.45
|
|
|
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 |
$31.81 |
| 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 |
$31.81
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
|
|
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 |
$20.45 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$26.21
|
| Rate for Payer: Amerigroup Medicare |
$20.66
|
| Rate for Payer: Cash Price |
$36.36
|
| 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 |
$20.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.96
|
| Rate for Payer: Medical Associates Commercial |
$34.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.45
|
| Rate for Payer: Midlands Choice Commercial |
$31.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.52
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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 |
$34.56 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$44.30
|
| Rate for Payer: Amerigroup Medicare |
$34.91
|
| Rate for Payer: Cash Price |
$61.44
|
| 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 |
$34.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.87
|
| Rate for Payer: Medical Associates Commercial |
$57.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.56
|
| Rate for Payer: Midlands Choice Commercial |
$53.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.74
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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
|
|
