Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

gabapentin 250 mg/5 mL Solution[VDMC]

Facility

$3.71

Service Code	HCPCS A9270
Hospital Charge Code	23101177
Hospital Revenue Code	259
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.34
Rate for Payer: Aetna of IA Commercial	$3.34
Rate for Payer: Aetna of IA Medical Rental Products	$3.34
Rate for Payer: Cash Price	$2.97
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.78
Rate for Payer: Medical Associates Commercial	$2.78
Rate for Payer: Midlands Choice Commercial	$2.60
Rate for Payer: United Healthcare Commercial	$3.34

gabapentin 300 mg Cap [VDMC]

Facility

$1.36

Service Code	HCPCS A9270
Hospital Charge Code	10391549
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna of IA Commercial	$1.23
Rate for Payer: Aetna of IA Medical Rental Products	$1.23
Rate for Payer: Aetna of IA Medicare	$0.78
Rate for Payer: Amerigroup Medicaid	$0.79
Rate for Payer: Amerigroup Medicare	$0.62
Rate for Payer: Cash Price	$1.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.02
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.61
Rate for Payer: Iowa Total Care Managed Medicaid	$0.78
Rate for Payer: Medical Associates Commercial	$1.02
Rate for Payer: Medical Associates Managed Medicare	$0.61
Rate for Payer: Midlands Choice Commercial	$0.95
Rate for Payer: Molina Healthcare Managed Medicaid	$0.79
Rate for Payer: Partners Health Alliance Commercial	$0.71
Rate for Payer: United Healthcare Commercial	$1.23
Rate for Payer: United Healthcare Managed Medicare	$0.80

gabapentin 300 mg Cap [VDMC]

Facility

$1.36

Service Code	HCPCS A9270
Hospital Charge Code	10391549
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna of IA Commercial	$1.23
Rate for Payer: Aetna of IA Medical Rental Products	$1.23
Rate for Payer: Cash Price	$1.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.02
Rate for Payer: Medical Associates Commercial	$1.02
Rate for Payer: Midlands Choice Commercial	$0.95
Rate for Payer: United Healthcare Commercial	$1.23

GAIT THERAPEUTIC TRAINING PER 15 MIN

Facility

$114.00

Service Code	CPT 97116 GP
Hospital Charge Code	1374013
Hospital Revenue Code	420
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

GAIT THERAPEUTIC TRAINING PER 15 MIN

Facility

$114.00

Service Code	CPT 97116 GP
Hospital Charge Code	1374013
Hospital Revenue Code	420
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$58.99
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26

Gastrointestinal Basic Bacteria by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984516
Hospital Revenue Code	306
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

Gastrointestinal Basic Bacteria by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984516
Hospital Revenue Code	306
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.91
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42

Gastrointestinal Panel by PCR DMCL

Facility

$750.00

Service Code	CPT 87507
Hospital Charge Code	8505666
Hospital Revenue Code	300
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of IA Commercial	$675.00
Rate for Payer: Aetna of IA Medical Rental Products	$675.00
Rate for Payer: Aetna of IA Medicare	$427.50
Rate for Payer: Amerigroup Medicaid	$432.60
Rate for Payer: Amerigroup Medicare	$340.88
Rate for Payer: Cash Price	$600.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$562.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$337.50
Rate for Payer: Iowa Total Care Managed Medicaid	$428.40
Rate for Payer: Medical Associates Commercial	$562.50
Rate for Payer: Medical Associates Managed Medicare	$337.50
Rate for Payer: Midlands Choice Commercial	$525.00
Rate for Payer: Molina Healthcare Managed Medicaid	$434.70
Rate for Payer: Partners Health Alliance Commercial	$388.12
Rate for Payer: United Healthcare Commercial	$675.00
Rate for Payer: United Healthcare Managed Medicare	$442.50

Gastrointestinal Panel by PCR DMCL

Facility

$750.00

Service Code	CPT 87507
Hospital Charge Code	8505666
Hospital Revenue Code	300
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of IA Commercial	$675.00
Rate for Payer: Aetna of IA Medical Rental Products	$675.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$562.50
Rate for Payer: Medical Associates Commercial	$562.50
Rate for Payer: Midlands Choice Commercial	$525.00
Rate for Payer: United Healthcare Commercial	$675.00

Gastrointestinal Parasite Panel by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984515
Hospital Revenue Code	306
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.91
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42

Gastrointestinal Parasite Panel by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984515
Hospital Revenue Code	306
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

Gastrointestinal Virus Panel by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984518
Hospital Revenue Code	306
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

Gastrointestinal Virus Panel by PCR DMCL

Facility

$338.00

Service Code	CPT 87505
Hospital Charge Code	8984518
Hospital Revenue Code	306
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.91
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42

Gastroscope Biopsy Charge

Facility

$95.00

Hospital Charge Code	8051947
Hospital Revenue Code	750
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of IA Commercial	$85.50
Rate for Payer: Aetna of IA Medical Rental Products	$85.50
Rate for Payer: Aetna of IA Medicare	$54.15
Rate for Payer: Amerigroup Medicaid	$54.80
Rate for Payer: Amerigroup Medicare	$43.18
Rate for Payer: Cash Price	$76.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$71.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.75
Rate for Payer: Iowa Total Care Managed Medicaid	$54.26
Rate for Payer: Medical Associates Commercial	$71.25
Rate for Payer: Medical Associates Managed Medicare	$42.75
Rate for Payer: Midlands Choice Commercial	$66.50
Rate for Payer: Molina Healthcare Managed Medicaid	$55.06
Rate for Payer: Partners Health Alliance Commercial	$49.16
Rate for Payer: United Healthcare Commercial	$85.50
Rate for Payer: United Healthcare Managed Medicare	$56.05

Gastroscope Biopsy Charge

Facility

$95.00

Hospital Charge Code	8051947
Hospital Revenue Code	750
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of IA Commercial	$85.50
Rate for Payer: Aetna of IA Medical Rental Products	$85.50
Rate for Payer: Cash Price	$76.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$71.25
Rate for Payer: Medical Associates Commercial	$71.25
Rate for Payer: Midlands Choice Commercial	$66.50
Rate for Payer: United Healthcare Commercial	$85.50

Gastroscopy

Facility

$2,615.00

Hospital Charge Code	7745193
Hospital Revenue Code	750
Min. Negotiated Rate	$1,830.50
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: United Healthcare Commercial	$2,353.50

Gastroscopy

Facility

$2,615.00

Hospital Charge Code	7745193
Hospital Revenue Code	750
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Aetna of IA Medicare	$1,490.55
Rate for Payer: Amerigroup Medicaid	$1,508.33
Rate for Payer: Amerigroup Medicare	$1,188.52
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,176.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,493.69
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Medical Associates Managed Medicare	$1,176.75
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,515.65
Rate for Payer: Partners Health Alliance Commercial	$1,353.26
Rate for Payer: United Healthcare Commercial	$2,353.50
Rate for Payer: United Healthcare Managed Medicare	$1,542.85

Gastroscopy Dilat Esophag Dial

Facility

$2,615.00

Hospital Charge Code	7745192
Hospital Revenue Code	750
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Aetna of IA Medicare	$1,490.55
Rate for Payer: Amerigroup Medicaid	$1,508.33
Rate for Payer: Amerigroup Medicare	$1,188.52
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,176.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,493.69
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Medical Associates Managed Medicare	$1,176.75
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,515.65
Rate for Payer: Partners Health Alliance Commercial	$1,353.26
Rate for Payer: United Healthcare Commercial	$2,353.50
Rate for Payer: United Healthcare Managed Medicare	$1,542.85

Gastroscopy Dilat Esophag Dial

Facility

$2,615.00

Hospital Charge Code	7745192
Hospital Revenue Code	750
Min. Negotiated Rate	$1,830.50
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: United Healthcare Commercial	$2,353.50

Gastroscopy with Biopsy

Facility

$2,615.00

Hospital Charge Code	8055105
Hospital Revenue Code	750
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Aetna of IA Medicare	$1,490.55
Rate for Payer: Amerigroup Medicaid	$1,508.33
Rate for Payer: Amerigroup Medicare	$1,188.52
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,176.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,493.69
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Medical Associates Managed Medicare	$1,176.75
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,515.65
Rate for Payer: Partners Health Alliance Commercial	$1,353.26
Rate for Payer: United Healthcare Commercial	$2,353.50
Rate for Payer: United Healthcare Managed Medicare	$1,542.85

Gastroscopy with Biopsy

Facility

$2,615.00

Hospital Charge Code	8055105
Hospital Revenue Code	750
Min. Negotiated Rate	$1,830.50
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of IA Commercial	$2,353.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,353.50
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,961.25
Rate for Payer: Medical Associates Commercial	$1,961.25
Rate for Payer: Midlands Choice Commercial	$1,830.50
Rate for Payer: United Healthcare Commercial	$2,353.50

GC PROBE

Facility

$128.00

Service Code	CPT 87591
Hospital Charge Code	8093934
Hospital Revenue Code	306
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of IA Commercial	$115.20
Rate for Payer: Aetna of IA Medical Rental Products	$115.20
Rate for Payer: Aetna of IA Medicare	$72.96
Rate for Payer: Amerigroup Medicaid	$73.83
Rate for Payer: Amerigroup Medicare	$58.18
Rate for Payer: Cash Price	$102.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.60
Rate for Payer: Iowa Total Care Managed Medicaid	$73.11
Rate for Payer: Medical Associates Commercial	$96.00
Rate for Payer: Medical Associates Managed Medicare	$57.60
Rate for Payer: Midlands Choice Commercial	$89.60
Rate for Payer: Molina Healthcare Managed Medicaid	$74.19
Rate for Payer: Partners Health Alliance Commercial	$66.24
Rate for Payer: United Healthcare Commercial	$115.20
Rate for Payer: United Healthcare Managed Medicare	$75.52

GC PROBE

Facility

$128.00

Service Code	CPT 87591
Hospital Charge Code	8093934
Hospital Revenue Code	306
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of IA Commercial	$115.20
Rate for Payer: Aetna of IA Medical Rental Products	$115.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.00
Rate for Payer: Medical Associates Commercial	$96.00
Rate for Payer: Midlands Choice Commercial	$89.60
Rate for Payer: United Healthcare Commercial	$115.20

gemfibrozil 600 mg Tab [VDMC]

Facility

$1.88

Service Code	HCPCS A9270
Hospital Charge Code	10391618
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of IA Commercial	$1.69
Rate for Payer: Aetna of IA Medical Rental Products	$1.69
Rate for Payer: Aetna of IA Medicare	$1.07
Rate for Payer: Amerigroup Medicaid	$1.08
Rate for Payer: Amerigroup Medicare	$0.85
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.41
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.85
Rate for Payer: Iowa Total Care Managed Medicaid	$1.07
Rate for Payer: Medical Associates Commercial	$1.41
Rate for Payer: Medical Associates Managed Medicare	$0.85
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: Molina Healthcare Managed Medicaid	$1.09
Rate for Payer: Partners Health Alliance Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.69
Rate for Payer: United Healthcare Managed Medicare	$1.11

gemfibrozil 600 mg Tab [VDMC]

Facility

$1.88

Service Code	HCPCS A9270
Hospital Charge Code	10391618
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of IA Commercial	$1.69
Rate for Payer: Aetna of IA Medical Rental Products	$1.69
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.41
Rate for Payer: Medical Associates Commercial	$1.41
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: United Healthcare Commercial	$1.69

Know your out-of-pocket cost for care.

All Charges