|
FEMORAL HEAD HIP CERAMIC V40 36MMX-5MM
|
Facility
IP
|
$4,419.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,093.30 |
| Max. Negotiated Rate |
$3,977.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,977.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,977.10
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: United Healthcare Commercial |
$3,977.10
|
|
|
FEMORAL POSTERIOR STABILIZED
|
Facility
OP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.07 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Aetna of IA Medicare |
$4,088.61
|
| Rate for Payer: Amerigroup Medicaid |
$3,620.21
|
| Rate for Payer: Amerigroup Medicare |
$3,622.36
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,586.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,585.07
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,586.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,640.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,379.75
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
|
FEMORAL POSTERIOR STABILIZED
|
Facility
IP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,021.10 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
|
|
FEMORAL POSTERIOR STABILIZED #5
|
Facility
OP
|
$7,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.44 |
| Max. Negotiated Rate |
$7,032.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,032.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,032.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,453.98
|
| Rate for Payer: Amerigroup Medicaid |
$3,943.73
|
| Rate for Payer: Amerigroup Medicare |
$3,946.07
|
| Rate for Payer: Cash Price |
$6,251.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,860.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,907.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,905.44
|
| Rate for Payer: Medical Associates Commercial |
$5,860.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,907.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,469.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,965.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,860.50
|
| Rate for Payer: United Healthcare Commercial |
$7,032.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,610.26
|
|
|
FEMORAL POSTERIOR STABILIZED #5
|
Facility
IP
|
$7,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,469.80 |
| Max. Negotiated Rate |
$7,032.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,032.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,032.60
|
| Rate for Payer: Cash Price |
$6,251.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,860.50
|
| Rate for Payer: Medical Associates Commercial |
$5,860.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,469.80
|
| Rate for Payer: United Healthcare Commercial |
$7,032.60
|
|
|
FEMORAL POSTERIOR STABILIZED #8 LFT
|
Facility
IP
|
$7,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,122.60 |
| Max. Negotiated Rate |
$6,586.20 |
| Rate for Payer: Aetna of IA Commercial |
$6,586.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,586.20
|
| Rate for Payer: Cash Price |
$5,854.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,488.50
|
| Rate for Payer: Medical Associates Commercial |
$5,488.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,122.60
|
| Rate for Payer: United Healthcare Commercial |
$6,586.20
|
|
|
FEMORAL POSTERIOR STABILIZED #8 LFT
|
Facility
OP
|
$7,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.54 |
| Max. Negotiated Rate |
$6,586.20 |
| Rate for Payer: Aetna of IA Commercial |
$6,586.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,586.20
|
| Rate for Payer: Aetna of IA Medicare |
$4,171.26
|
| Rate for Payer: Amerigroup Medicaid |
$3,693.39
|
| Rate for Payer: Amerigroup Medicare |
$3,695.59
|
| Rate for Payer: Cash Price |
$5,854.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,488.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,659.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,657.54
|
| Rate for Payer: Medical Associates Commercial |
$5,488.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,122.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,713.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,488.50
|
| Rate for Payer: United Healthcare Commercial |
$6,586.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,317.62
|
|
|
fenofibrate 145 mg Tab
|
Facility
OP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
fenofibrate 145 mg Tab
|
Facility
IP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
fentaNYL 0.05 mg/mL 1 ml SDV
|
Facility
IP
|
$42.42
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43799924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$38.18 |
| Rate for Payer: Aetna of IA Commercial |
$38.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.18
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.82
|
| Rate for Payer: Medical Associates Commercial |
$31.82
|
| Rate for Payer: Midlands Choice Commercial |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$38.18
|
|
|
fentaNYL 0.05 mg/mL 1 ml SDV
|
Facility
OP
|
$42.42
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43799924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$38.18 |
| Rate for Payer: Aetna of IA Commercial |
$38.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.18
|
| Rate for Payer: Aetna of IA Medicare |
$24.18
|
| Rate for Payer: Amerigroup Medicaid |
$21.41
|
| Rate for Payer: Amerigroup Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.20
|
| Rate for Payer: Medical Associates Commercial |
$31.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.21
|
| Rate for Payer: Midlands Choice Commercial |
$29.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.82
|
| Rate for Payer: United Healthcare Commercial |
$38.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.03
|
|
|
fentaNYL 0.05 mg/mL 2mL SDV
|
Facility
OP
|
$45.54
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43784518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$40.99 |
| Rate for Payer: Aetna of IA Commercial |
$40.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.99
|
| Rate for Payer: Aetna of IA Medicare |
$25.96
|
| Rate for Payer: Amerigroup Medicaid |
$22.98
|
| Rate for Payer: Amerigroup Medicare |
$23.00
|
| Rate for Payer: Cash Price |
$36.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.76
|
| Rate for Payer: Medical Associates Commercial |
$34.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.77
|
| Rate for Payer: Midlands Choice Commercial |
$31.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.16
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.87
|
|
|
fentaNYL 0.05 mg/mL 2mL SDV
|
Facility
IP
|
$45.54
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43784518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$40.99 |
| Rate for Payer: Aetna of IA Commercial |
$40.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.99
|
| Rate for Payer: Cash Price |
$36.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.16
|
| Rate for Payer: Medical Associates Commercial |
$34.16
|
| Rate for Payer: Midlands Choice Commercial |
$31.88
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
|
|
fentaNYL 0.05 mg/mL Inj Sol 10mL
|
Facility
OP
|
$50.58
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43702487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$45.52 |
| Rate for Payer: Aetna of IA Commercial |
$45.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.52
|
| Rate for Payer: Aetna of IA Medicare |
$28.83
|
| Rate for Payer: Amerigroup Medicaid |
$25.53
|
| Rate for Payer: Amerigroup Medicare |
$25.54
|
| Rate for Payer: Cash Price |
$40.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.28
|
| Rate for Payer: Medical Associates Commercial |
$37.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.29
|
| Rate for Payer: Midlands Choice Commercial |
$35.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.94
|
| Rate for Payer: United Healthcare Commercial |
$45.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.84
|
|
|
fentaNYL 0.05 mg/mL Inj Sol 10mL
|
Facility
IP
|
$50.58
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43702487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$45.52 |
| Rate for Payer: Aetna of IA Commercial |
$45.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.52
|
| Rate for Payer: Cash Price |
$40.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.94
|
| Rate for Payer: Medical Associates Commercial |
$37.94
|
| Rate for Payer: Midlands Choice Commercial |
$35.41
|
| Rate for Payer: United Healthcare Commercial |
$45.52
|
|
|
fentaNYL 0.05 mg/mL Inj Sol 20mL
|
Facility
OP
|
$47.50
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43719859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna of IA Commercial |
$42.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.75
|
| Rate for Payer: Aetna of IA Medicare |
$27.08
|
| Rate for Payer: Amerigroup Medicaid |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.99
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.74
|
| Rate for Payer: Medical Associates Commercial |
$35.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.75
|
| Rate for Payer: Midlands Choice Commercial |
$33.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.62
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.02
|
|
|
fentaNYL 0.05 mg/mL Inj Sol 20mL
|
Facility
IP
|
$47.50
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43719859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna of IA Commercial |
$42.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.75
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.62
|
| Rate for Payer: Medical Associates Commercial |
$35.62
|
| Rate for Payer: Midlands Choice Commercial |
$33.25
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
|
|
fentaNYL 100 mcg/hr Transderm ER Film
|
Facility
OP
|
$24.94
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna of IA Commercial |
$22.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.45
|
| Rate for Payer: Aetna of IA Medicare |
$14.22
|
| Rate for Payer: Amerigroup Medicaid |
$12.59
|
| Rate for Payer: Amerigroup Medicare |
$12.59
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.47
|
| Rate for Payer: Medical Associates Commercial |
$18.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.47
|
| Rate for Payer: Midlands Choice Commercial |
$17.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$22.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.71
|
|
|
fentaNYL 100 mcg/hr Transderm ER Film
|
Facility
IP
|
$24.94
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna of IA Commercial |
$22.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.45
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.70
|
| Rate for Payer: Medical Associates Commercial |
$18.70
|
| Rate for Payer: Midlands Choice Commercial |
$17.46
|
| Rate for Payer: United Healthcare Commercial |
$22.45
|
|
|
fentaNYL 12 mcg/hr TD film, ER
|
Facility
OP
|
$20.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700237
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: Aetna of IA Commercial |
$18.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.67
|
| Rate for Payer: Aetna of IA Medicare |
$11.82
|
| Rate for Payer: Amerigroup Medicaid |
$10.47
|
| Rate for Payer: Amerigroup Medicare |
$10.47
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.37
|
| Rate for Payer: Medical Associates Commercial |
$15.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.37
|
| Rate for Payer: Midlands Choice Commercial |
$14.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.56
|
| Rate for Payer: United Healthcare Commercial |
$18.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.24
|
|
|
fentaNYL 12 mcg/hr TD film, ER
|
Facility
IP
|
$20.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700237
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: Aetna of IA Commercial |
$18.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.67
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.56
|
| Rate for Payer: Medical Associates Commercial |
$15.56
|
| Rate for Payer: Midlands Choice Commercial |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$18.67
|
|
|
fentaNYL 25 mcg/hr Transderm ER Film
|
Facility
IP
|
$22.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of IA Commercial |
$20.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.05
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.71
|
| Rate for Payer: Medical Associates Commercial |
$16.71
|
| Rate for Payer: Midlands Choice Commercial |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$20.05
|
|
|
fentaNYL 25 mcg/hr Transderm ER Film
|
Facility
OP
|
$22.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of IA Commercial |
$20.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.05
|
| Rate for Payer: Aetna of IA Medicare |
$12.70
|
| Rate for Payer: Amerigroup Medicaid |
$11.24
|
| Rate for Payer: Amerigroup Medicare |
$11.25
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.14
|
| Rate for Payer: Medical Associates Commercial |
$16.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.14
|
| Rate for Payer: Midlands Choice Commercial |
$15.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.71
|
| Rate for Payer: United Healthcare Commercial |
$20.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.15
|
|
|
fentaNYL 50 mcg/hr Transderm ER Film
|
Facility
IP
|
$28.65
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43703121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$25.78 |
| Rate for Payer: Aetna of IA Commercial |
$25.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.78
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.49
|
| Rate for Payer: Medical Associates Commercial |
$21.49
|
| Rate for Payer: Midlands Choice Commercial |
$20.06
|
| Rate for Payer: United Healthcare Commercial |
$25.78
|
|
|
fentaNYL 50 mcg/hr Transderm ER Film
|
Facility
OP
|
$28.65
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43703121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$25.78 |
| Rate for Payer: Aetna of IA Commercial |
$25.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.78
|
| Rate for Payer: Aetna of IA Medicare |
$16.33
|
| Rate for Payer: Amerigroup Medicaid |
$14.46
|
| Rate for Payer: Amerigroup Medicare |
$14.47
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.32
|
| Rate for Payer: Medical Associates Commercial |
$21.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.32
|
| Rate for Payer: Midlands Choice Commercial |
$20.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.49
|
| Rate for Payer: United Healthcare Commercial |
$25.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.90
|
|
