|
hydrochlorothiazide-triamterene 25 MG-37.5 MG
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
HYDROcodone - acetaminophen 5 mg-325 mg Tab
|
Facility
IP
|
$4.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43730317
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of IA Commercial |
$3.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.82
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.19
|
| Rate for Payer: Medical Associates Commercial |
$3.19
|
| Rate for Payer: Midlands Choice Commercial |
$2.98
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
|
|
HYDROcodone - acetaminophen 5 mg-325 mg Tab
|
Facility
OP
|
$4.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43730317
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of IA Commercial |
$3.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.82
|
| Rate for Payer: Aetna of IA Medicare |
$2.42
|
| Rate for Payer: Amerigroup Medicaid |
$2.14
|
| Rate for Payer: Amerigroup Medicare |
$2.15
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.12
|
| Rate for Payer: Medical Associates Commercial |
$3.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.12
|
| Rate for Payer: Midlands Choice Commercial |
$2.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.19
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.51
|
|
|
hydrocodone/apap 7.5-325mg tab
|
Facility
IP
|
$4.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna of IA Commercial |
$3.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.70
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.08
|
| Rate for Payer: Medical Associates Commercial |
$3.08
|
| Rate for Payer: Midlands Choice Commercial |
$2.88
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
|
|
hydrocodone/apap 7.5-325mg tab
|
Facility
OP
|
$4.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna of IA Commercial |
$3.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.70
|
| Rate for Payer: Aetna of IA Medicare |
$2.34
|
| Rate for Payer: Amerigroup Medicaid |
$2.07
|
| Rate for Payer: Amerigroup Medicare |
$2.08
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.05
|
| Rate for Payer: Medical Associates Commercial |
$3.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.06
|
| Rate for Payer: Midlands Choice Commercial |
$2.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.08
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.42
|
|
|
hydrocortisone 100 mg PF Pow SDV inj
|
Facility
OP
|
$96.60
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
43702731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna of IA Commercial |
$86.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.94
|
| Rate for Payer: Aetna of IA Medicare |
$55.06
|
| Rate for Payer: Amerigroup Medicaid |
$48.75
|
| Rate for Payer: Amerigroup Medicare |
$48.78
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.28
|
| Rate for Payer: Medical Associates Commercial |
$72.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.30
|
| Rate for Payer: Midlands Choice Commercial |
$67.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.45
|
| Rate for Payer: United Healthcare Commercial |
$86.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.99
|
|
|
hydrocortisone 100 mg PF Pow SDV inj
|
Facility
IP
|
$96.60
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
43702731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna of IA Commercial |
$86.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.94
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.45
|
| Rate for Payer: Medical Associates Commercial |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$67.62
|
| Rate for Payer: United Healthcare Commercial |
$86.94
|
|
|
hydrocortisone 10 mg Tab
|
Facility
IP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702732
|
|
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
|
|
|
hydrocortisone 10 mg Tab
|
Facility
OP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702732
|
|
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
|
|
|
hydrocortisone 250 mg Inj
|
Facility
OP
|
$155.68
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
43700208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$140.11 |
| Rate for Payer: Aetna of IA Commercial |
$140.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.11
|
| Rate for Payer: Aetna of IA Medicare |
$88.74
|
| Rate for Payer: Amerigroup Medicaid |
$78.57
|
| Rate for Payer: Amerigroup Medicare |
$78.62
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.81
|
| Rate for Payer: Medical Associates Commercial |
$116.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.84
|
| Rate for Payer: Midlands Choice Commercial |
$108.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$116.76
|
| Rate for Payer: United Healthcare Commercial |
$140.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.85
|
|
|
hydrocortisone 250 mg Inj
|
Facility
IP
|
$155.68
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
43700208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$140.11 |
| Rate for Payer: Aetna of IA Commercial |
$140.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.11
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.76
|
| Rate for Payer: Medical Associates Commercial |
$116.76
|
| Rate for Payer: Midlands Choice Commercial |
$108.98
|
| Rate for Payer: United Healthcare Commercial |
$140.11
|
|
|
hydrocortisone 25 mg Supp
|
Facility
IP
|
$9.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of IA Commercial |
$8.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.74
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.28
|
| Rate for Payer: Medical Associates Commercial |
$7.28
|
| Rate for Payer: Midlands Choice Commercial |
$6.80
|
| Rate for Payer: United Healthcare Commercial |
$8.74
|
|
|
hydrocortisone 25 mg Supp
|
Facility
OP
|
$9.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of IA Commercial |
$8.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.74
|
| Rate for Payer: Aetna of IA Medicare |
$5.53
|
| Rate for Payer: Amerigroup Medicaid |
$4.90
|
| Rate for Payer: Amerigroup Medicare |
$4.90
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.85
|
| Rate for Payer: Medical Associates Commercial |
$7.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.86
|
| Rate for Payer: Midlands Choice Commercial |
$6.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.28
|
| Rate for Payer: United Healthcare Commercial |
$8.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.73
|
|
|
hydrocortisone/neomycin/polymyxin B otic
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna of IA Commercial |
$261.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.90
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.25
|
| Rate for Payer: Medical Associates Commercial |
$218.25
|
| Rate for Payer: Midlands Choice Commercial |
$203.70
|
| Rate for Payer: United Healthcare Commercial |
$261.90
|
|
|
hydrocortisone/neomycin/polymyxin B otic
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna of IA Commercial |
$261.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.90
|
| Rate for Payer: Aetna of IA Medicare |
$165.87
|
| Rate for Payer: Amerigroup Medicaid |
$146.87
|
| Rate for Payer: Amerigroup Medicare |
$146.96
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$145.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$145.44
|
| Rate for Payer: Medical Associates Commercial |
$218.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.50
|
| Rate for Payer: Midlands Choice Commercial |
$203.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$218.25
|
| Rate for Payer: United Healthcare Commercial |
$261.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.69
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus
|
Facility
OP
|
$345.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.71 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of IA Commercial |
$311.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.00
|
| Rate for Payer: Aetna of IA Medicare |
$196.97
|
| Rate for Payer: Amerigroup Medicaid |
$174.40
|
| Rate for Payer: Amerigroup Medicare |
$174.51
|
| Rate for Payer: Cash Price |
$276.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$172.71
|
| Rate for Payer: Medical Associates Commercial |
$259.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.78
|
| Rate for Payer: Midlands Choice Commercial |
$241.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$175.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$259.17
|
| Rate for Payer: United Healthcare Commercial |
$311.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$203.88
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus
|
Facility
IP
|
$345.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.89 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of IA Commercial |
$311.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.00
|
| Rate for Payer: Cash Price |
$276.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.17
|
| Rate for Payer: Medical Associates Commercial |
$259.17
|
| Rate for Payer: Midlands Choice Commercial |
$241.89
|
| Rate for Payer: United Healthcare Commercial |
$311.00
|
|
|
hydrocortisone Top 2.5% Crm
|
Facility
OP
|
$15.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna of IA Commercial |
$13.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.64
|
| Rate for Payer: Aetna of IA Medicare |
$8.64
|
| Rate for Payer: Amerigroup Medicaid |
$7.65
|
| Rate for Payer: Amerigroup Medicare |
$7.66
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.58
|
| Rate for Payer: Medical Associates Commercial |
$11.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.58
|
| Rate for Payer: Midlands Choice Commercial |
$10.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.37
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.94
|
|
|
hydrocortisone Top 2.5% Crm
|
Facility
IP
|
$15.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna of IA Commercial |
$13.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.64
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.37
|
| Rate for Payer: Medical Associates Commercial |
$11.37
|
| Rate for Payer: Midlands Choice Commercial |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
|
|
Hydrocortisone Topical 1% Cream 28gm
|
Facility
IP
|
$12.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of IA Commercial |
$11.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.27
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.39
|
| Rate for Payer: Medical Associates Commercial |
$9.39
|
| Rate for Payer: Midlands Choice Commercial |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$11.27
|
|
|
Hydrocortisone Topical 1% Cream 28gm
|
Facility
OP
|
$12.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of IA Commercial |
$11.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.27
|
| Rate for Payer: Aetna of IA Medicare |
$7.14
|
| Rate for Payer: Amerigroup Medicaid |
$6.32
|
| Rate for Payer: Amerigroup Medicare |
$6.32
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.26
|
| Rate for Payer: Medical Associates Commercial |
$9.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.26
|
| Rate for Payer: Midlands Choice Commercial |
$8.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$11.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.39
|
|
|
HYDROmorphone 10 mg/mL Inj Sol
|
Facility
IP
|
$62.16
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
43700227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Aetna of IA Commercial |
$55.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.94
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.62
|
| Rate for Payer: Medical Associates Commercial |
$46.62
|
| Rate for Payer: Midlands Choice Commercial |
$43.51
|
| Rate for Payer: United Healthcare Commercial |
$55.94
|
|
|
HYDROmorphone 10 mg/mL Inj Sol
|
Facility
OP
|
$62.16
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
43700227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Aetna of IA Commercial |
$55.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.94
|
| Rate for Payer: Aetna of IA Medicare |
$35.43
|
| Rate for Payer: Amerigroup Medicaid |
$31.37
|
| Rate for Payer: Amerigroup Medicare |
$31.39
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.07
|
| Rate for Payer: Medical Associates Commercial |
$46.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.08
|
| Rate for Payer: Midlands Choice Commercial |
$43.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.62
|
| Rate for Payer: United Healthcare Commercial |
$55.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.67
|
|
|
HYDROmorphone 2 mg/mL Sol 20mL
|
Facility
OP
|
$108.56
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
43761054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$97.70 |
| Rate for Payer: Aetna of IA Commercial |
$97.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.70
|
| Rate for Payer: Aetna of IA Medicare |
$61.88
|
| Rate for Payer: Amerigroup Medicaid |
$54.79
|
| Rate for Payer: Amerigroup Medicare |
$54.82
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$81.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.28
|
| Rate for Payer: Midlands Choice Commercial |
$75.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.42
|
| Rate for Payer: United Healthcare Commercial |
$97.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.05
|
|
|
HYDROmorphone 2 mg/mL Sol 20mL
|
Facility
IP
|
$108.56
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
43761054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$97.70 |
| Rate for Payer: Aetna of IA Commercial |
$97.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.70
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.42
|
| Rate for Payer: Medical Associates Commercial |
$81.42
|
| Rate for Payer: Midlands Choice Commercial |
$75.99
|
| Rate for Payer: United Healthcare Commercial |
$97.70
|
|
