Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

HEMOGLOBIN

Facility

$35.00

Service Code	CPT 85018
Hospital Charge Code	633741
Hospital Revenue Code	305
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: United Healthcare Commercial	$31.50

Hemoglobin A1c DMCL

Facility

$77.00

Service Code	CPT 83036
Hospital Charge Code	8037857
Hospital Revenue Code	301
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Aetna of IA Medicare	$43.89
Rate for Payer: Amerigroup Medicaid	$38.86
Rate for Payer: Amerigroup Medicare	$38.88
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.50
Rate for Payer: Iowa Total Care Managed Medicaid	$38.48
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Medical Associates Managed Medicare	$38.50
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: Molina Healthcare Managed Medicaid	$39.08
Rate for Payer: Molina Healthcare Managed Medicare	$39.05
Rate for Payer: Oscar Health of IA Commercial	$57.75
Rate for Payer: Partners Health Alliance Commercial	$57.75
Rate for Payer: United Healthcare Commercial	$69.30
Rate for Payer: United Healthcare Managed Medicare	$45.43
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Hemoglobin A1c DMCL

Facility

$77.00

Service Code	CPT 83036
Hospital Charge Code	8037857
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: United Healthcare Commercial	$69.30

Hemorrhoidectomy, internal, by rubber band ligation(s)

Facility

$1,451.30

Service Code	CPT 46221
Hospital Revenue Code	490
Min. Negotiated Rate	$1,319.36
Max. Negotiated Rate	$1,451.30
Rate for Payer: Wellmark IA HMO	$1,319.36
Rate for Payer: Wellmark IA PPO	$1,451.30

HEMORRHOIDECTOMY INTERNAL/EXTERNAL 2 OR MORE

Professional

Both

$1,663.00

Service Code	CPT 46260
Hospital Charge Code	8825543
Hospital Revenue Code	975
Min. Negotiated Rate	$434.59
Max. Negotiated Rate	$1,164.10
Rate for Payer: Aetna of IA Medicare	$434.59
Rate for Payer: Amerigroup Medicaid	$449.37
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$521.51
Rate for Payer: Iowa Total Care Managed Medicaid	$443.28
Rate for Payer: Medical Associates Commercial	$825.72
Rate for Payer: Medical Associates Managed Medicare	$434.59
Rate for Payer: Midlands Choice Commercial	$1,164.10
Rate for Payer: Oscar Health of IA Commercial	$751.84
Rate for Payer: Partners Health Alliance Commercial	$651.88

heparin 25,000 units-NaCl 0.45% Sol 250ml bag [VDMC]

Facility

$86.06

Service Code	HCPCS J1644
Hospital Charge Code	16879209
Hospital Revenue Code	259
Min. Negotiated Rate	$43.01
Max. Negotiated Rate	$77.45
Rate for Payer: Aetna of IA Commercial	$77.45
Rate for Payer: Aetna of IA Medical Rental Products	$77.45
Rate for Payer: Aetna of IA Medicare	$49.05
Rate for Payer: Amerigroup Medicaid	$43.43
Rate for Payer: Amerigroup Medicare	$43.46
Rate for Payer: Cash Price	$68.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$64.54
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$43.03
Rate for Payer: Iowa Total Care Managed Medicaid	$43.01
Rate for Payer: Medical Associates Commercial	$64.54
Rate for Payer: Medical Associates Managed Medicare	$43.03
Rate for Payer: Midlands Choice Commercial	$60.24
Rate for Payer: Molina Healthcare Managed Medicaid	$43.68
Rate for Payer: Molina Healthcare Managed Medicare	$43.65
Rate for Payer: Oscar Health of IA Commercial	$64.54
Rate for Payer: Partners Health Alliance Commercial	$64.54
Rate for Payer: United Healthcare Commercial	$77.45
Rate for Payer: United Healthcare Managed Medicare	$50.78

heparin 25,000 units-NaCl 0.45% Sol 250ml bag [VDMC]

Facility

$86.06

Service Code	HCPCS J1644
Hospital Charge Code	16879209
Hospital Revenue Code	259
Min. Negotiated Rate	$60.24
Max. Negotiated Rate	$77.45
Rate for Payer: Aetna of IA Commercial	$77.45
Rate for Payer: Aetna of IA Medical Rental Products	$77.45
Rate for Payer: Cash Price	$68.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$64.54
Rate for Payer: Medical Associates Commercial	$64.54
Rate for Payer: Midlands Choice Commercial	$60.24
Rate for Payer: United Healthcare Commercial	$77.45

heparin 5000 units/mL 1 ml SDS Inj [VDMC]

Facility

$23.42

Service Code	HCPCS J1644
Hospital Charge Code	10393209
Hospital Revenue Code	259
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$21.08
Rate for Payer: Aetna of IA Commercial	$21.08
Rate for Payer: Aetna of IA Medical Rental Products	$21.08
Rate for Payer: Cash Price	$18.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.56
Rate for Payer: Medical Associates Commercial	$17.56
Rate for Payer: Midlands Choice Commercial	$16.39
Rate for Payer: United Healthcare Commercial	$21.08

heparin 5000 units/mL 1 ml SDS Inj [VDMC]

Facility

$23.42

Service Code	HCPCS J1644
Hospital Charge Code	10393209
Hospital Revenue Code	259
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$21.08
Rate for Payer: Aetna of IA Commercial	$21.08
Rate for Payer: Aetna of IA Medical Rental Products	$21.08
Rate for Payer: Aetna of IA Medicare	$13.35
Rate for Payer: Amerigroup Medicaid	$11.82
Rate for Payer: Amerigroup Medicare	$11.83
Rate for Payer: Cash Price	$18.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.71
Rate for Payer: Iowa Total Care Managed Medicaid	$11.71
Rate for Payer: Medical Associates Commercial	$17.56
Rate for Payer: Medical Associates Managed Medicare	$11.71
Rate for Payer: Midlands Choice Commercial	$16.39
Rate for Payer: Molina Healthcare Managed Medicaid	$11.89
Rate for Payer: Molina Healthcare Managed Medicare	$11.88
Rate for Payer: Oscar Health of IA Commercial	$17.56
Rate for Payer: Partners Health Alliance Commercial	$17.56
Rate for Payer: United Healthcare Commercial	$21.08
Rate for Payer: United Healthcare Managed Medicare	$13.82

heparin flush ADULT 100 units/mL 5 ML SDS Sol [VDMC]

Facility

$21.29

Service Code	HCPCS J1642
Hospital Charge Code	10393349
Hospital Revenue Code	259
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$19.16
Rate for Payer: Aetna of IA Commercial	$19.16
Rate for Payer: Aetna of IA Medical Rental Products	$19.16
Rate for Payer: Aetna of IA Medicare	$12.14
Rate for Payer: Amerigroup Medicaid	$10.75
Rate for Payer: Amerigroup Medicare	$10.75
Rate for Payer: Cash Price	$17.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.97
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.64
Rate for Payer: Iowa Total Care Managed Medicaid	$10.64
Rate for Payer: Medical Associates Commercial	$15.97
Rate for Payer: Medical Associates Managed Medicare	$10.64
Rate for Payer: Midlands Choice Commercial	$14.90
Rate for Payer: Molina Healthcare Managed Medicaid	$10.80
Rate for Payer: Molina Healthcare Managed Medicare	$10.80
Rate for Payer: Oscar Health of IA Commercial	$15.97
Rate for Payer: Partners Health Alliance Commercial	$15.97
Rate for Payer: United Healthcare Commercial	$19.16
Rate for Payer: United Healthcare Managed Medicare	$12.56

heparin flush ADULT 100 units/mL 5 ML SDS Sol [VDMC]

Facility

$21.29

Service Code	HCPCS J1642
Hospital Charge Code	10393349
Hospital Revenue Code	259
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$19.16
Rate for Payer: Aetna of IA Commercial	$19.16
Rate for Payer: Aetna of IA Medical Rental Products	$19.16
Rate for Payer: Cash Price	$17.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.97
Rate for Payer: Medical Associates Commercial	$15.97
Rate for Payer: Midlands Choice Commercial	$14.90
Rate for Payer: United Healthcare Commercial	$19.16

heparin flush BABY 10 units/mL 3 MLSol [VDMC]

Facility

$21.27

Service Code	HCPCS J1642
Hospital Charge Code	10393278
Hospital Revenue Code	259
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$19.14
Rate for Payer: Aetna of IA Commercial	$19.14
Rate for Payer: Aetna of IA Medical Rental Products	$19.14
Rate for Payer: Cash Price	$17.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.95
Rate for Payer: Medical Associates Commercial	$15.95
Rate for Payer: Midlands Choice Commercial	$14.89
Rate for Payer: United Healthcare Commercial	$19.14

heparin flush BABY 10 units/mL 3 MLSol [VDMC]

Facility

$21.27

Service Code	HCPCS J1642
Hospital Charge Code	10393278
Hospital Revenue Code	259
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$19.14
Rate for Payer: Aetna of IA Commercial	$19.14
Rate for Payer: Aetna of IA Medical Rental Products	$19.14
Rate for Payer: Aetna of IA Medicare	$12.12
Rate for Payer: Amerigroup Medicaid	$10.73
Rate for Payer: Amerigroup Medicare	$10.74
Rate for Payer: Cash Price	$17.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.64
Rate for Payer: Iowa Total Care Managed Medicaid	$10.63
Rate for Payer: Medical Associates Commercial	$15.95
Rate for Payer: Medical Associates Managed Medicare	$10.64
Rate for Payer: Midlands Choice Commercial	$14.89
Rate for Payer: Molina Healthcare Managed Medicaid	$10.79
Rate for Payer: Molina Healthcare Managed Medicare	$10.79
Rate for Payer: Oscar Health of IA Commercial	$15.95
Rate for Payer: Partners Health Alliance Commercial	$15.95
Rate for Payer: United Healthcare Commercial	$19.14
Rate for Payer: United Healthcare Managed Medicare	$12.55

hepatitis A adult vaccine 1440 units/mL preservative free Sus[VDMC]

Facility

$147.42

Service Code	HCPCS 90632
Hospital Charge Code	12945366
Hospital Revenue Code	259
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$132.68
Rate for Payer: Aetna of IA Commercial	$132.68
Rate for Payer: Aetna of IA Medical Rental Products	$132.68
Rate for Payer: Aetna of IA Medicare	$84.03
Rate for Payer: Amerigroup Medicaid	$74.40
Rate for Payer: Amerigroup Medicare	$74.45
Rate for Payer: Cash Price	$117.94
Rate for Payer: Cash Price	$117.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$110.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$73.71
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$110.56
Rate for Payer: Medical Associates Managed Medicare	$73.71
Rate for Payer: Midlands Choice Commercial	$103.19
Rate for Payer: Molina Healthcare Managed Medicaid	$74.82
Rate for Payer: Molina Healthcare Managed Medicare	$74.77
Rate for Payer: Oscar Health of IA Commercial	$110.56
Rate for Payer: Partners Health Alliance Commercial	$110.56
Rate for Payer: United Healthcare Commercial	$132.68
Rate for Payer: United Healthcare Managed Medicare	$86.98
Rate for Payer: Wellmark IA HMO	$62.00
Rate for Payer: Wellmark IA PPO	$68.20

hepatitis A adult vaccine 1440 units/mL preservative free Sus[VDMC]

Facility

$147.42

Service Code	HCPCS 90632
Hospital Charge Code	12945366
Hospital Revenue Code	259
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$132.68
Rate for Payer: Aetna of IA Commercial	$132.68
Rate for Payer: Aetna of IA Medical Rental Products	$132.68
Rate for Payer: Cash Price	$117.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$110.56
Rate for Payer: Medical Associates Commercial	$110.56
Rate for Payer: Midlands Choice Commercial	$103.19
Rate for Payer: United Healthcare Commercial	$132.68

Hepatitis A Antibody IgM DMCL

Facility

$107.00

Service Code	CPT 86709
Hospital Charge Code	8037858
Hospital Revenue Code	302
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of IA Commercial	$96.30
Rate for Payer: Aetna of IA Medical Rental Products	$96.30
Rate for Payer: Cash Price	$85.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.25
Rate for Payer: Medical Associates Commercial	$80.25
Rate for Payer: Midlands Choice Commercial	$74.90
Rate for Payer: United Healthcare Commercial	$96.30

Hepatitis A Antibody IgM DMCL

Facility

$107.00

Service Code	CPT 86709
Hospital Charge Code	8037858
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of IA Commercial	$96.30
Rate for Payer: Aetna of IA Medical Rental Products	$96.30
Rate for Payer: Aetna of IA Medicare	$60.99
Rate for Payer: Amerigroup Medicaid	$54.00
Rate for Payer: Amerigroup Medicare	$54.04
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$53.50
Rate for Payer: Iowa Total Care Managed Medicaid	$53.48
Rate for Payer: Medical Associates Commercial	$80.25
Rate for Payer: Medical Associates Managed Medicare	$53.50
Rate for Payer: Midlands Choice Commercial	$74.90
Rate for Payer: Molina Healthcare Managed Medicaid	$54.30
Rate for Payer: Molina Healthcare Managed Medicare	$54.27
Rate for Payer: Oscar Health of IA Commercial	$80.25
Rate for Payer: Partners Health Alliance Commercial	$80.25
Rate for Payer: United Healthcare Commercial	$96.30
Rate for Payer: United Healthcare Managed Medicare	$63.13
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Hepatitis A Antibody Total DMCL

Facility

$118.00

Service Code	CPT 86708
Hospital Charge Code	8037859
Hospital Revenue Code	302
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of IA Commercial	$106.20
Rate for Payer: Aetna of IA Medical Rental Products	$106.20
Rate for Payer: Cash Price	$94.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$88.50
Rate for Payer: Medical Associates Commercial	$88.50
Rate for Payer: Midlands Choice Commercial	$82.60
Rate for Payer: United Healthcare Commercial	$106.20

Hepatitis A Antibody Total DMCL

Facility

$118.00

Service Code	CPT 86708
Hospital Charge Code	8037859
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of IA Commercial	$106.20
Rate for Payer: Aetna of IA Medical Rental Products	$106.20
Rate for Payer: Aetna of IA Medicare	$67.26
Rate for Payer: Amerigroup Medicaid	$59.55
Rate for Payer: Amerigroup Medicare	$59.59
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$88.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.00
Rate for Payer: Iowa Total Care Managed Medicaid	$58.98
Rate for Payer: Medical Associates Commercial	$88.50
Rate for Payer: Medical Associates Managed Medicare	$59.00
Rate for Payer: Midlands Choice Commercial	$82.60
Rate for Payer: Molina Healthcare Managed Medicaid	$59.88
Rate for Payer: Molina Healthcare Managed Medicare	$59.85
Rate for Payer: Oscar Health of IA Commercial	$88.50
Rate for Payer: Partners Health Alliance Commercial	$88.50
Rate for Payer: United Healthcare Commercial	$106.20
Rate for Payer: United Healthcare Managed Medicare	$69.62
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

hepatitis A pediatric vaccine 25 units/0.5 mL SDV [VDMC]

Facility

$73.58

Service Code	HCPCS 90633
Hospital Charge Code	18590050
Hospital Revenue Code	259
Min. Negotiated Rate	$51.51
Max. Negotiated Rate	$66.22
Rate for Payer: Aetna of IA Commercial	$66.22
Rate for Payer: Aetna of IA Medical Rental Products	$66.22
Rate for Payer: Cash Price	$58.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.18
Rate for Payer: Medical Associates Commercial	$55.18
Rate for Payer: Midlands Choice Commercial	$51.51
Rate for Payer: United Healthcare Commercial	$66.22

hepatitis A pediatric vaccine 25 units/0.5 mL SDV [VDMC]

Facility

$73.58

Service Code	HCPCS 90633
Hospital Charge Code	18590050
Hospital Revenue Code	259
Min. Negotiated Rate	$36.78
Max. Negotiated Rate	$68.20
Rate for Payer: Aetna of IA Commercial	$66.22
Rate for Payer: Aetna of IA Medical Rental Products	$66.22
Rate for Payer: Aetna of IA Medicare	$41.94
Rate for Payer: Amerigroup Medicaid	$37.14
Rate for Payer: Amerigroup Medicare	$37.16
Rate for Payer: Cash Price	$58.86
Rate for Payer: Cash Price	$58.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.18
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.79
Rate for Payer: Iowa Total Care Managed Medicaid	$36.78
Rate for Payer: Medical Associates Commercial	$55.18
Rate for Payer: Medical Associates Managed Medicare	$36.79
Rate for Payer: Midlands Choice Commercial	$51.51
Rate for Payer: Molina Healthcare Managed Medicaid	$37.34
Rate for Payer: Molina Healthcare Managed Medicare	$37.32
Rate for Payer: Oscar Health of IA Commercial	$55.18
Rate for Payer: Partners Health Alliance Commercial	$55.18
Rate for Payer: United Healthcare Commercial	$66.22
Rate for Payer: United Healthcare Managed Medicare	$43.41
Rate for Payer: Wellmark IA HMO	$62.00
Rate for Payer: Wellmark IA PPO	$68.20

hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus[VDMC]

Facility

$72.38

Service Code	HCPCS 90633
Hospital Charge Code	15904355
Hospital Revenue Code	259
Min. Negotiated Rate	$50.67
Max. Negotiated Rate	$65.14
Rate for Payer: Aetna of IA Commercial	$65.14
Rate for Payer: Aetna of IA Medical Rental Products	$65.14
Rate for Payer: Cash Price	$57.91
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.28
Rate for Payer: Medical Associates Commercial	$54.28
Rate for Payer: Midlands Choice Commercial	$50.67
Rate for Payer: United Healthcare Commercial	$65.14

hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus[VDMC]

Facility

$72.38

Service Code	HCPCS 90633
Hospital Charge Code	15904355
Hospital Revenue Code	259
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$68.20
Rate for Payer: Aetna of IA Commercial	$65.14
Rate for Payer: Aetna of IA Medical Rental Products	$65.14
Rate for Payer: Aetna of IA Medicare	$41.26
Rate for Payer: Amerigroup Medicaid	$36.53
Rate for Payer: Amerigroup Medicare	$36.55
Rate for Payer: Cash Price	$57.91
Rate for Payer: Cash Price	$57.91
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.19
Rate for Payer: Iowa Total Care Managed Medicaid	$36.18
Rate for Payer: Medical Associates Commercial	$54.28
Rate for Payer: Medical Associates Managed Medicare	$36.19
Rate for Payer: Midlands Choice Commercial	$50.67
Rate for Payer: Molina Healthcare Managed Medicaid	$36.73
Rate for Payer: Molina Healthcare Managed Medicare	$36.71
Rate for Payer: Oscar Health of IA Commercial	$54.28
Rate for Payer: Partners Health Alliance Commercial	$54.28
Rate for Payer: United Healthcare Commercial	$65.14
Rate for Payer: United Healthcare Managed Medicare	$42.70
Rate for Payer: Wellmark IA HMO	$62.00
Rate for Payer: Wellmark IA PPO	$68.20

hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]

Facility

$102.38

Service Code	HCPCS 90746
Hospital Charge Code	11815338
Hospital Revenue Code	259
Min. Negotiated Rate	$51.17
Max. Negotiated Rate	$92.14
Rate for Payer: Aetna of IA Commercial	$92.14
Rate for Payer: Aetna of IA Medical Rental Products	$92.14
Rate for Payer: Aetna of IA Medicare	$58.36
Rate for Payer: Amerigroup Medicaid	$51.67
Rate for Payer: Amerigroup Medicare	$51.70
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.19
Rate for Payer: Iowa Total Care Managed Medicaid	$51.17
Rate for Payer: Medical Associates Commercial	$76.78
Rate for Payer: Medical Associates Managed Medicare	$51.19
Rate for Payer: Midlands Choice Commercial	$71.67
Rate for Payer: Molina Healthcare Managed Medicaid	$51.96
Rate for Payer: Molina Healthcare Managed Medicare	$51.93
Rate for Payer: Oscar Health of IA Commercial	$76.78
Rate for Payer: Partners Health Alliance Commercial	$76.78
Rate for Payer: United Healthcare Commercial	$92.14
Rate for Payer: United Healthcare Managed Medicare	$60.40
Rate for Payer: Wellmark IA HMO	$62.00
Rate for Payer: Wellmark IA PPO	$68.20

hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]

Facility

$102.38

Service Code	HCPCS 90746
Hospital Charge Code	11815338
Hospital Revenue Code	259
Min. Negotiated Rate	$71.67
Max. Negotiated Rate	$92.14
Rate for Payer: Aetna of IA Commercial	$92.14
Rate for Payer: Aetna of IA Medical Rental Products	$92.14
Rate for Payer: Cash Price	$81.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.78
Rate for Payer: Medical Associates Commercial	$76.78
Rate for Payer: Midlands Choice Commercial	$71.67
Rate for Payer: United Healthcare Commercial	$92.14

Know your out-of-pocket cost for care.

All Charges