|
FEMORAL POSTERIOR STABILIZED
|
Facility
|
OP
|
$7,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,227.85 |
| 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 |
$4,137.39
|
| Rate for Payer: Amerigroup Medicare |
$3,260.13
|
| 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 |
$3,227.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,097.22
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,227.85
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,157.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,712.03
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
|
FEMORAL POSTERIOR STABILIZED #5
|
Facility
|
IP
|
$7,814.00
|
|
|
Service Code
|
HCPCS 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 #5
|
Facility
|
OP
|
$7,814.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,516.30 |
| 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 |
$4,507.12
|
| Rate for Payer: Amerigroup Medicare |
$3,551.46
|
| 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 |
$3,516.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,463.36
|
| Rate for Payer: Medical Associates Commercial |
$5,860.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,516.30
|
| Rate for Payer: Midlands Choice Commercial |
$5,469.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,528.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,043.74
|
| Rate for Payer: United Healthcare Commercial |
$7,032.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,610.26
|
|
|
FEMORAL POSTERIOR STABILIZED #8 LFT
|
Facility
|
IP
|
$7,318.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8046839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.10 |
| 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 |
$4,221.02
|
| Rate for Payer: Amerigroup Medicare |
$3,326.03
|
| 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 |
$3,293.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,180.04
|
| Rate for Payer: Medical Associates Commercial |
$5,488.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,293.10
|
| Rate for Payer: Midlands Choice Commercial |
$5,122.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,241.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,787.06
|
| Rate for Payer: United Healthcare Commercial |
$6,586.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,317.62
|
|
|
fenofibrate 145 mg Tab [VDMC]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10607876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
fenofibrate 145 mg Tab [VDMC]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10607876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
fenofibrate 54 mg Tab [VDMC]
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27357881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna of IA Commercial |
$3.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.81
|
| Rate for Payer: Aetna of IA Medicare |
$2.41
|
| Rate for Payer: Amerigroup Medicaid |
$2.44
|
| Rate for Payer: Amerigroup Medicare |
$1.92
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.42
|
| Rate for Payer: Medical Associates Commercial |
$3.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.91
|
| Rate for Payer: Midlands Choice Commercial |
$2.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.19
|
| Rate for Payer: United Healthcare Commercial |
$3.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.50
|
|
|
fenofibrate 54 mg Tab [VDMC]
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27357881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna of IA Commercial |
$3.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.81
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.18
|
| Rate for Payer: Medical Associates Commercial |
$3.18
|
| Rate for Payer: Midlands Choice Commercial |
$2.96
|
| Rate for Payer: United Healthcare Commercial |
$3.81
|
|
|
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 |
$38.17 |
| Rate for Payer: Aetna of IA Commercial |
$38.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.17
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.81
|
| Rate for Payer: Medical Associates Commercial |
$31.81
|
| Rate for Payer: Midlands Choice Commercial |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$38.17
|
|
|
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 |
$19.09 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$38.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.17
|
| Rate for Payer: Aetna of IA Medicare |
$24.18
|
| Rate for Payer: Amerigroup Medicaid |
$24.47
|
| Rate for Payer: Amerigroup Medicare |
$19.28
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.09
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.23
|
| Rate for Payer: Medical Associates Commercial |
$31.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.09
|
| Rate for Payer: Midlands Choice Commercial |
$29.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.95
|
| Rate for Payer: United Healthcare Commercial |
$38.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.03
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
fentaNYL 0.05 mg/mL 2mL SDV [VDMC]
|
Facility
|
OP
|
$42.35
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$38.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.11
|
| Rate for Payer: Aetna of IA Medicare |
$24.14
|
| Rate for Payer: Amerigroup Medicaid |
$24.42
|
| Rate for Payer: Amerigroup Medicare |
$19.25
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.19
|
| Rate for Payer: Medical Associates Commercial |
$31.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.06
|
| Rate for Payer: Midlands Choice Commercial |
$29.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.91
|
| Rate for Payer: United Healthcare Commercial |
$38.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.98
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
fentaNYL 0.05 mg/mL 2mL SDV [VDMC]
|
Facility
|
IP
|
$42.35
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
10388295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$38.11 |
| Rate for Payer: Aetna of IA Commercial |
$38.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.11
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.76
|
| Rate for Payer: Medical Associates Commercial |
$31.76
|
| Rate for Payer: Midlands Choice Commercial |
$29.64
|
| Rate for Payer: United Healthcare Commercial |
$38.11
|
|
|
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 |
$18.71
|
| Rate for Payer: Medical Associates Commercial |
$18.71
|
| 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 |
$11.22 |
| 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 |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$11.34
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.25
|
| Rate for Payer: Medical Associates Commercial |
$18.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.22
|
| Rate for Payer: Midlands Choice Commercial |
$17.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$22.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.72
|
|
|
fentaNYL 12 mcg/hr TD film, ER [VDMC]
|
Facility
|
OP
|
$34.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388573
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna of IA Commercial |
$31.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.46
|
| Rate for Payer: Aetna of IA Medicare |
$19.92
|
| Rate for Payer: Amerigroup Medicaid |
$20.16
|
| Rate for Payer: Amerigroup Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.96
|
| Rate for Payer: Medical Associates Commercial |
$26.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.73
|
| Rate for Payer: Midlands Choice Commercial |
$24.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.09
|
| Rate for Payer: United Healthcare Commercial |
$31.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.62
|
|
|
fentaNYL 12 mcg/hr TD film, ER [VDMC]
|
Facility
|
IP
|
$34.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388573
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna of IA Commercial |
$31.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.46
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.21
|
| Rate for Payer: Medical Associates Commercial |
$26.21
|
| Rate for Payer: Midlands Choice Commercial |
$24.47
|
| Rate for Payer: United Healthcare Commercial |
$31.46
|
|
|
fentaNYL 25 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna of IA Commercial |
$25.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.06
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.89
|
| Rate for Payer: Medical Associates Commercial |
$20.89
|
| Rate for Payer: Midlands Choice Commercial |
$19.49
|
| Rate for Payer: United Healthcare Commercial |
$25.06
|
|
|
fentaNYL 25 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna of IA Commercial |
$25.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.06
|
| Rate for Payer: Aetna of IA Medicare |
$15.87
|
| Rate for Payer: Amerigroup Medicaid |
$16.06
|
| Rate for Payer: Amerigroup Medicare |
$12.66
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.91
|
| Rate for Payer: Medical Associates Commercial |
$20.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.53
|
| Rate for Payer: Midlands Choice Commercial |
$19.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.41
|
| Rate for Payer: United Healthcare Commercial |
$25.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.43
|
|
|
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 |
$20.05 |
| 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 |
$20.05
|
| Rate for Payer: United Healthcare Commercial |
$25.78
|
|
|
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 |
$12.89 |
| 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 |
$16.52
|
| Rate for Payer: Amerigroup Medicare |
$13.02
|
| 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 |
$12.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.36
|
| Rate for Payer: Medical Associates Commercial |
$21.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.89
|
| Rate for Payer: Midlands Choice Commercial |
$20.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.83
|
| Rate for Payer: United Healthcare Commercial |
$25.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.90
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$23.65
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10388768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
Fentanyl PCA 1500mcg/30mL [VDMC]
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
24392489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$25.38
|
| Rate for Payer: Amerigroup Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$35.20
|
| 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 |
$19.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.13
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.80
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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
|
|
