|
fentaNYL 0.05 mg/mL 1 ml SDV [VDMC]
|
Facility
|
IP
|
$42.42
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
25027621
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$42.42
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
25027621
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$21.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$31.82
|
| 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 [VDMC]
|
Facility
|
IP
|
$45.54
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388295
|
|
Hospital Revenue Code
|
259
|
| 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 2mL SDV [VDMC]
|
Facility
|
OP
|
$45.54
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388295
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$23.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.16
|
| 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 Inj Sol 10mL [VDMC]
|
Facility
|
OP
|
$50.58
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
24401615
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$25.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$37.94
|
| 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 [VDMC]
|
Facility
|
IP
|
$50.58
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
24401615
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388366
|
|
Hospital Revenue Code
|
259
|
| 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 0.05 mg/mL Inj Sol 20mL [VDMC]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388366
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$24.09
|
| Rate for Payer: Oscar Health of IA Commercial |
$35.62
|
| 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 100 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$24.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388508
|
|
Hospital Revenue Code
|
259
|
| 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 100 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$24.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388508
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$12.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.70
|
| 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 12 mcg/hr TD film, ER [VDMC]
|
Facility
|
IP
|
$20.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388573
|
|
Hospital Revenue Code
|
259
|
| 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 12 mcg/hr TD film, ER [VDMC]
|
Facility
|
OP
|
$20.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388573
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$10.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.56
|
| 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 25 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388638
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388638
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$11.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$16.71
|
| 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 [VDMC]
|
Facility
|
OP
|
$28.65
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388703
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$14.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.49
|
| 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
|
|
|
fentaNYL 50 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$28.65
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388703
|
|
Hospital Revenue Code
|
259
|
| 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/mL 5ml amp [VDMC]
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
14208570
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna of IA Commercial |
$39.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.19
|
| Rate for Payer: Aetna of IA Medicare |
$24.82
|
| Rate for Payer: Amerigroup Medicaid |
$21.97
|
| Rate for Payer: Amerigroup Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.76
|
| Rate for Payer: Medical Associates Commercial |
$32.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.77
|
| Rate for Payer: Midlands Choice Commercial |
$30.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$32.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.66
|
| Rate for Payer: United Healthcare Commercial |
$39.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.69
|
|
|
fentaNYL 50 mcg/mL 5ml amp [VDMC]
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
14208570
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna of IA Commercial |
$39.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.19
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.66
|
| Rate for Payer: Medical Associates Commercial |
$32.66
|
| Rate for Payer: Midlands Choice Commercial |
$30.48
|
| Rate for Payer: United Healthcare Commercial |
$39.19
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$38.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$34.74 |
| Rate for Payer: Aetna of IA Commercial |
$34.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.74
|
| Rate for Payer: Aetna of IA Medicare |
$22.00
|
| Rate for Payer: Amerigroup Medicaid |
$19.48
|
| Rate for Payer: Amerigroup Medicare |
$19.49
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.29
|
| Rate for Payer: Medical Associates Commercial |
$28.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.30
|
| Rate for Payer: Midlands Choice Commercial |
$27.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$19.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$28.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.95
|
| Rate for Payer: United Healthcare Commercial |
$34.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.77
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$38.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$34.74 |
| Rate for Payer: Aetna of IA Commercial |
$34.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.74
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.95
|
| Rate for Payer: Medical Associates Commercial |
$28.95
|
| Rate for Payer: Midlands Choice Commercial |
$27.02
|
| Rate for Payer: United Healthcare Commercial |
$34.74
|
|
|
Fentanyl PCA 1500mcg/30mL [VDMC]
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
24392489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
Fentanyl PCA 1500mcg/30mL [VDMC]
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
24392489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$33.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
|
|
Fentanyl PCA 250mcg/25mL [VDMC]
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
22396464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
Fentanyl PCA 250mcg/25mL [VDMC]
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
22396464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$33.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
|
|
fentaNYL-ropivacaine 2 mcg/mL-0.2%-NaCl 0.9% Sol[VDMC]
|
Facility
|
IP
|
$294.64
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
11346054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$265.18 |
| Rate for Payer: Aetna of IA Commercial |
$265.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.18
|
| Rate for Payer: Cash Price |
$235.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$220.98
|
| Rate for Payer: Medical Associates Commercial |
$220.98
|
| Rate for Payer: Midlands Choice Commercial |
$206.25
|
| Rate for Payer: United Healthcare Commercial |
$265.18
|
|
