Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 4.2X180MM AO SMALL

Facility

$214.00

Hospital Charge Code	8046331
Hospital Revenue Code	278
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$192.60
Rate for Payer: Aetna of IA Commercial	$192.60
Rate for Payer: Aetna of IA Medical Rental Products	$192.60
Rate for Payer: Cash Price	$171.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$160.50
Rate for Payer: Medical Associates Commercial	$160.50
Rate for Payer: Midlands Choice Commercial	$149.80
Rate for Payer: United Healthcare Commercial	$192.60

DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE

Facility

$198.00

Hospital Charge Code	8026375
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE

Facility

$198.00

Hospital Charge Code	8026375
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

DRILL PIN 2MM X 100MM

Facility

$441.00

Hospital Charge Code	8046948
Hospital Revenue Code	278
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of IA Commercial	$396.90
Rate for Payer: Aetna of IA Medical Rental Products	$396.90
Rate for Payer: Cash Price	$352.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$330.75
Rate for Payer: Medical Associates Commercial	$330.75
Rate for Payer: Midlands Choice Commercial	$308.70
Rate for Payer: United Healthcare Commercial	$396.90

DRILL PIN 2MM X 100MM

Facility

$441.00

Hospital Charge Code	8046948
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of IA Commercial	$396.90
Rate for Payer: Aetna of IA Medical Rental Products	$396.90
Rate for Payer: Aetna of IA Medicare	$251.37
Rate for Payer: Amerigroup Medicaid	$254.37
Rate for Payer: Amerigroup Medicare	$200.43
Rate for Payer: Cash Price	$352.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$330.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$198.45
Rate for Payer: Iowa Total Care Managed Medicaid	$251.90
Rate for Payer: Medical Associates Commercial	$330.75
Rate for Payer: Medical Associates Managed Medicare	$198.45
Rate for Payer: Midlands Choice Commercial	$308.70
Rate for Payer: Molina Healthcare Managed Medicaid	$255.60
Rate for Payer: Partners Health Alliance Commercial	$228.22
Rate for Payer: United Healthcare Commercial	$396.90
Rate for Payer: United Healthcare Managed Medicare	$260.19

DRILL PIN II

Facility

$207.00

Hospital Charge Code	8026406
Hospital Revenue Code	278
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of IA Commercial	$186.30
Rate for Payer: Aetna of IA Medical Rental Products	$186.30
Rate for Payer: Aetna of IA Medicare	$117.99
Rate for Payer: Amerigroup Medicaid	$119.40
Rate for Payer: Amerigroup Medicare	$94.08
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$155.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$93.15
Rate for Payer: Iowa Total Care Managed Medicaid	$118.24
Rate for Payer: Medical Associates Commercial	$155.25
Rate for Payer: Medical Associates Managed Medicare	$93.15
Rate for Payer: Midlands Choice Commercial	$144.90
Rate for Payer: Molina Healthcare Managed Medicaid	$119.98
Rate for Payer: Partners Health Alliance Commercial	$107.12
Rate for Payer: United Healthcare Commercial	$186.30
Rate for Payer: United Healthcare Managed Medicare	$122.13

DRILL PIN II

Facility

$207.00

Hospital Charge Code	8026406
Hospital Revenue Code	278
Min. Negotiated Rate	$144.90
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of IA Commercial	$186.30
Rate for Payer: Aetna of IA Medical Rental Products	$186.30
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$155.25
Rate for Payer: Medical Associates Commercial	$155.25
Rate for Payer: Midlands Choice Commercial	$144.90
Rate for Payer: United Healthcare Commercial	$186.30

DRILL SPEEDGUIDE AO DIA 2.6MM

Facility

$253.00

Hospital Charge Code	8046967
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: United Healthcare Commercial	$227.70

DRILL SPEEDGUIDE AO DIA 2.6MM

Facility

$253.00

Hospital Charge Code	8046967
Hospital Revenue Code	278
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Aetna of IA Medicare	$144.21
Rate for Payer: Amerigroup Medicaid	$145.93
Rate for Payer: Amerigroup Medicare	$114.99
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$113.85
Rate for Payer: Iowa Total Care Managed Medicaid	$144.51
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Medical Associates Managed Medicare	$113.85
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: Molina Healthcare Managed Medicaid	$146.64
Rate for Payer: Partners Health Alliance Commercial	$130.93
Rate for Payer: United Healthcare Commercial	$227.70
Rate for Payer: United Healthcare Managed Medicare	$149.27

DRILL SPEEDGUIDE AO DIA 2.6MM-1

Facility

$253.00

Hospital Charge Code	8046968
Hospital Revenue Code	278
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Aetna of IA Medicare	$144.21
Rate for Payer: Amerigroup Medicaid	$145.93
Rate for Payer: Amerigroup Medicare	$114.99
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$113.85
Rate for Payer: Iowa Total Care Managed Medicaid	$144.51
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Medical Associates Managed Medicare	$113.85
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: Molina Healthcare Managed Medicaid	$146.64
Rate for Payer: Partners Health Alliance Commercial	$130.93
Rate for Payer: United Healthcare Commercial	$227.70
Rate for Payer: United Healthcare Managed Medicare	$149.27

DRILL SPEEDGUIDE AO DIA 2.6MM-1

Facility

$253.00

Hospital Charge Code	8046968
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: United Healthcare Commercial	$227.70

DRILL TWIST 1.9 DIAM AO END 105MM L41MM

Facility

$70.00

Hospital Charge Code	8046887
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Aetna of IA Medicare	$39.90
Rate for Payer: Amerigroup Medicaid	$40.38
Rate for Payer: Amerigroup Medicare	$31.82
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.50
Rate for Payer: Iowa Total Care Managed Medicaid	$39.98
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Medical Associates Managed Medicare	$31.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: Molina Healthcare Managed Medicaid	$40.57
Rate for Payer: Partners Health Alliance Commercial	$36.22
Rate for Payer: United Healthcare Commercial	$63.00
Rate for Payer: United Healthcare Managed Medicare	$41.30

DRILL TWIST 1.9 DIAM AO END 105MM L41MM

Facility

$70.00

Hospital Charge Code	8046887
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: United Healthcare Commercial	$63.00

DRILL TWIST2.0 DIAM AO END 105MM L41MM

Facility

$70.00

Hospital Charge Code	8046888
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Aetna of IA Medicare	$39.90
Rate for Payer: Amerigroup Medicaid	$40.38
Rate for Payer: Amerigroup Medicare	$31.82
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.50
Rate for Payer: Iowa Total Care Managed Medicaid	$39.98
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Medical Associates Managed Medicare	$31.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: Molina Healthcare Managed Medicaid	$40.57
Rate for Payer: Partners Health Alliance Commercial	$36.22
Rate for Payer: United Healthcare Commercial	$63.00
Rate for Payer: United Healthcare Managed Medicare	$41.30

DRILL TWIST2.0 DIAM AO END 105MM L41MM

Facility

$70.00

Hospital Charge Code	8046888
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: United Healthcare Commercial	$63.00

DRUG SCREEN-TRIAGE

Facility

$148.00

Service Code	CPT 80305
Hospital Charge Code	4022799
Hospital Revenue Code	301
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of IA Commercial	$133.20
Rate for Payer: Aetna of IA Medical Rental Products	$133.20
Rate for Payer: Cash Price	$118.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.00
Rate for Payer: Medical Associates Commercial	$111.00
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: United Healthcare Commercial	$133.20

DRUG SCREEN-TRIAGE

Facility

$148.00

Service Code	CPT 80305
Hospital Charge Code	4022799
Hospital Revenue Code	301
Min. Negotiated Rate	$43.25
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of IA Commercial	$133.20
Rate for Payer: Aetna of IA Medical Rental Products	$133.20
Rate for Payer: Aetna of IA Medicare	$84.36
Rate for Payer: Amerigroup Medicaid	$85.37
Rate for Payer: Amerigroup Medicare	$67.27
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$66.60
Rate for Payer: Iowa Total Care Managed Medicaid	$84.54
Rate for Payer: Medical Associates Commercial	$111.00
Rate for Payer: Medical Associates Managed Medicare	$66.60
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: Molina Healthcare Managed Medicaid	$85.78
Rate for Payer: Partners Health Alliance Commercial	$76.59
Rate for Payer: United Healthcare Commercial	$133.20
Rate for Payer: United Healthcare Managed Medicare	$87.32
Rate for Payer: Wellmark IA HMO WHPI	$43.25
Rate for Payer: Wellmark IA PPO	$47.64

DRVVT LUPUS ANTICOAGULANT

Facility

$65.00

Service Code	CPT 85613
Hospital Charge Code	8093931
Hospital Revenue Code	305
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: United Healthcare Commercial	$58.50

DRVVT LUPUS ANTICOAGULANT

Facility

$65.00

Service Code	CPT 85613
Hospital Charge Code	8093931
Hospital Revenue Code	305
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Aetna of IA Medicare	$37.05
Rate for Payer: Amerigroup Medicaid	$37.49
Rate for Payer: Amerigroup Medicare	$29.54
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.25
Rate for Payer: Iowa Total Care Managed Medicaid	$37.13
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Medical Associates Managed Medicare	$29.25
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: Molina Healthcare Managed Medicaid	$37.67
Rate for Payer: Partners Health Alliance Commercial	$33.64
Rate for Payer: United Healthcare Commercial	$58.50
Rate for Payer: United Healthcare Managed Medicare	$38.35
Rate for Payer: Wellmark IA HMO WHPI	$29.07
Rate for Payer: Wellmark IA PPO	$32.02

DULoxetine 20 mg Cap [VDMC]

Facility

$3.51

Service Code	HCPCS A9270
Hospital Charge Code	10385145
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna of IA Commercial	$3.16
Rate for Payer: Aetna of IA Medical Rental Products	$3.16
Rate for Payer: Aetna of IA Medicare	$2.00
Rate for Payer: Amerigroup Medicaid	$2.02
Rate for Payer: Amerigroup Medicare	$1.60
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.63
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.58
Rate for Payer: Iowa Total Care Managed Medicaid	$2.01
Rate for Payer: Medical Associates Commercial	$2.63
Rate for Payer: Medical Associates Managed Medicare	$1.58
Rate for Payer: Midlands Choice Commercial	$2.46
Rate for Payer: Molina Healthcare Managed Medicaid	$2.03
Rate for Payer: Partners Health Alliance Commercial	$1.82
Rate for Payer: United Healthcare Commercial	$3.16
Rate for Payer: United Healthcare Managed Medicare	$2.07

DULoxetine 20 mg Cap [VDMC]

Facility

$3.51

Service Code	HCPCS A9270
Hospital Charge Code	10385145
Hospital Revenue Code	259
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna of IA Commercial	$3.16
Rate for Payer: Aetna of IA Medical Rental Products	$3.16
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.63
Rate for Payer: Medical Associates Commercial	$2.63
Rate for Payer: Midlands Choice Commercial	$2.46
Rate for Payer: United Healthcare Commercial	$3.16

DULoxetine DR 30 mg Cap [VDMC]

Facility

$3.43

Service Code	HCPCS A9270
Hospital Charge Code	10385214
Hospital Revenue Code	259
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna of IA Commercial	$3.09
Rate for Payer: Aetna of IA Medical Rental Products	$3.09
Rate for Payer: Cash Price	$2.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.58
Rate for Payer: Medical Associates Commercial	$2.58
Rate for Payer: Midlands Choice Commercial	$2.40
Rate for Payer: United Healthcare Commercial	$3.09

DULoxetine DR 30 mg Cap [VDMC]

Facility

$3.43

Service Code	HCPCS A9270
Hospital Charge Code	10385214
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna of IA Commercial	$3.09
Rate for Payer: Aetna of IA Medical Rental Products	$3.09
Rate for Payer: Aetna of IA Medicare	$1.96
Rate for Payer: Amerigroup Medicaid	$1.98
Rate for Payer: Amerigroup Medicare	$1.56
Rate for Payer: Cash Price	$2.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.55
Rate for Payer: Iowa Total Care Managed Medicaid	$1.96
Rate for Payer: Medical Associates Commercial	$2.58
Rate for Payer: Medical Associates Managed Medicare	$1.55
Rate for Payer: Midlands Choice Commercial	$2.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1.99
Rate for Payer: Partners Health Alliance Commercial	$1.78
Rate for Payer: United Healthcare Commercial	$3.09
Rate for Payer: United Healthcare Managed Medicare	$2.03

DULoxetine DR 60 mg Cap [VDMC]

Facility

$4.44

Service Code	HCPCS A9270
Hospital Charge Code	10385285
Hospital Revenue Code	259
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of IA Commercial	$4.00
Rate for Payer: Aetna of IA Medical Rental Products	$4.00
Rate for Payer: Aetna of IA Medicare	$2.53
Rate for Payer: Amerigroup Medicaid	$2.56
Rate for Payer: Amerigroup Medicare	$2.02
Rate for Payer: Cash Price	$3.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.00
Rate for Payer: Iowa Total Care Managed Medicaid	$2.54
Rate for Payer: Medical Associates Commercial	$3.33
Rate for Payer: Medical Associates Managed Medicare	$2.00
Rate for Payer: Midlands Choice Commercial	$3.11
Rate for Payer: Molina Healthcare Managed Medicaid	$2.58
Rate for Payer: Partners Health Alliance Commercial	$2.30
Rate for Payer: United Healthcare Commercial	$4.00
Rate for Payer: United Healthcare Managed Medicare	$2.62

DULoxetine DR 60 mg Cap [VDMC]

Facility

$4.44

Service Code	HCPCS A9270
Hospital Charge Code	10385285
Hospital Revenue Code	259
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of IA Commercial	$4.00
Rate for Payer: Aetna of IA Medical Rental Products	$4.00
Rate for Payer: Cash Price	$3.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.33
Rate for Payer: Medical Associates Commercial	$3.33
Rate for Payer: Midlands Choice Commercial	$3.11
Rate for Payer: United Healthcare Commercial	$4.00

Know your out-of-pocket cost for care.

All Charges