Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

flumazenil 0.1 mg/mL 10ml MDV [VDMC]

Facility

$54.76

Service Code	HCPCS J3490
Hospital Charge Code	22847357
Hospital Revenue Code	259
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$49.28
Rate for Payer: Aetna of IA Commercial	$49.28
Rate for Payer: Aetna of IA Medical Rental Products	$49.28
Rate for Payer: Aetna of IA Medicare	$31.21
Rate for Payer: Amerigroup Medicaid	$31.59
Rate for Payer: Amerigroup Medicare	$24.89
Rate for Payer: Cash Price	$43.81
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.07
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.64
Rate for Payer: Iowa Total Care Managed Medicaid	$31.28
Rate for Payer: Medical Associates Commercial	$41.07
Rate for Payer: Medical Associates Managed Medicare	$24.64
Rate for Payer: Midlands Choice Commercial	$38.33
Rate for Payer: Molina Healthcare Managed Medicaid	$31.74
Rate for Payer: Partners Health Alliance Commercial	$28.34
Rate for Payer: United Healthcare Commercial	$49.28
Rate for Payer: United Healthcare Managed Medicare	$32.31

flumazenil 0.1 mg/mL 5ml MDV [VDMC]

Facility

$30.31

Service Code	HCPCS J3490
Hospital Charge Code	10389728
Hospital Revenue Code	259
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$27.28
Rate for Payer: Aetna of IA Commercial	$27.28
Rate for Payer: Aetna of IA Medical Rental Products	$27.28
Rate for Payer: Aetna of IA Medicare	$17.28
Rate for Payer: Amerigroup Medicaid	$17.48
Rate for Payer: Amerigroup Medicare	$13.78
Rate for Payer: Cash Price	$24.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.64
Rate for Payer: Iowa Total Care Managed Medicaid	$17.31
Rate for Payer: Medical Associates Commercial	$22.73
Rate for Payer: Medical Associates Managed Medicare	$13.64
Rate for Payer: Midlands Choice Commercial	$21.22
Rate for Payer: Molina Healthcare Managed Medicaid	$17.57
Rate for Payer: Partners Health Alliance Commercial	$15.69
Rate for Payer: United Healthcare Commercial	$27.28
Rate for Payer: United Healthcare Managed Medicare	$17.88

flumazenil 0.1 mg/mL 5ml MDV [VDMC]

Facility

$30.31

Service Code	HCPCS J3490
Hospital Charge Code	10389728
Hospital Revenue Code	259
Min. Negotiated Rate	$21.22
Max. Negotiated Rate	$27.28
Rate for Payer: Aetna of IA Commercial	$27.28
Rate for Payer: Aetna of IA Medical Rental Products	$27.28
Rate for Payer: Cash Price	$24.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.73
Rate for Payer: Medical Associates Commercial	$22.73
Rate for Payer: Midlands Choice Commercial	$21.22
Rate for Payer: United Healthcare Commercial	$27.28

fluocinonide Top 0.05% Crm 30grams [VDMC]

Facility

$58.60

Service Code	HCPCS A9270
Hospital Charge Code	10389799
Hospital Revenue Code	259
Min. Negotiated Rate	$41.02
Max. Negotiated Rate	$52.74
Rate for Payer: Aetna of IA Commercial	$52.74
Rate for Payer: Aetna of IA Medical Rental Products	$52.74
Rate for Payer: Cash Price	$46.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.95
Rate for Payer: Medical Associates Commercial	$43.95
Rate for Payer: Midlands Choice Commercial	$41.02
Rate for Payer: United Healthcare Commercial	$52.74

fluocinonide Top 0.05% Crm 30grams [VDMC]

Facility

$58.60

Service Code	HCPCS A9270
Hospital Charge Code	10389799
Hospital Revenue Code	259
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$52.74
Rate for Payer: Aetna of IA Commercial	$52.74
Rate for Payer: Aetna of IA Medical Rental Products	$52.74
Rate for Payer: Aetna of IA Medicare	$33.40
Rate for Payer: Amerigroup Medicaid	$33.80
Rate for Payer: Amerigroup Medicare	$26.63
Rate for Payer: Cash Price	$46.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.37
Rate for Payer: Iowa Total Care Managed Medicaid	$33.47
Rate for Payer: Medical Associates Commercial	$43.95
Rate for Payer: Medical Associates Managed Medicare	$26.37
Rate for Payer: Midlands Choice Commercial	$41.02
Rate for Payer: Molina Healthcare Managed Medicaid	$33.96
Rate for Payer: Partners Health Alliance Commercial	$30.33
Rate for Payer: United Healthcare Commercial	$52.74
Rate for Payer: United Healthcare Managed Medicare	$34.57

fluocinonide Top 0.05% Oint 30gm [VDMC]

Facility

$107.36

Service Code	HCPCS A9270
Hospital Charge Code	10389864
Hospital Revenue Code	259
Min. Negotiated Rate	$48.31
Max. Negotiated Rate	$96.62
Rate for Payer: Aetna of IA Commercial	$96.62
Rate for Payer: Aetna of IA Medical Rental Products	$96.62
Rate for Payer: Aetna of IA Medicare	$61.20
Rate for Payer: Amerigroup Medicaid	$61.93
Rate for Payer: Amerigroup Medicare	$48.80
Rate for Payer: Cash Price	$85.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.52
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$48.31
Rate for Payer: Iowa Total Care Managed Medicaid	$61.32
Rate for Payer: Medical Associates Commercial	$80.52
Rate for Payer: Medical Associates Managed Medicare	$48.31
Rate for Payer: Midlands Choice Commercial	$75.15
Rate for Payer: Molina Healthcare Managed Medicaid	$62.23
Rate for Payer: Partners Health Alliance Commercial	$55.56
Rate for Payer: United Healthcare Commercial	$96.62
Rate for Payer: United Healthcare Managed Medicare	$63.34

fluocinonide Top 0.05% Oint 30gm [VDMC]

Facility

$107.36

Service Code	HCPCS A9270
Hospital Charge Code	10389864
Hospital Revenue Code	259
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$96.62
Rate for Payer: Aetna of IA Commercial	$96.62
Rate for Payer: Aetna of IA Medical Rental Products	$96.62
Rate for Payer: Cash Price	$85.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.52
Rate for Payer: Medical Associates Commercial	$80.52
Rate for Payer: Midlands Choice Commercial	$75.15
Rate for Payer: United Healthcare Commercial	$96.62

FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT, REPLACEMENT (CATHETER ONLY OR COMPLETE), OR REMOVAL (INCLUDES FLUOROSCOPIC GUIDANCE FOR VASCULAR ACCESS AND CATHETER MANIPULATION, ANY NECESSARY CONTRAST INJECTIONS THROUGH ACCESS SITE OR CATHETER WITH RELATED VENOGRAPHY RADIOLOGIC SUPERVISION AND INTERPRETATION, AND RADIOGRAPHIC DOCUMENTATION OF FINAL CATHETER POSITION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$510.77

Service Code	CPT 77001
Hospital Revenue Code	360
Min. Negotiated Rate	$463.69
Max. Negotiated Rate	$510.77
Rate for Payer: Wellmark IA HMO WHPI	$463.69
Rate for Payer: Wellmark IA PPO	$510.77

FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$510.77

Service Code	CPT 77002
Hospital Revenue Code	490
Min. Negotiated Rate	$463.69
Max. Negotiated Rate	$510.77
Rate for Payer: Wellmark IA HMO WHPI	$463.69
Rate for Payer: Wellmark IA PPO	$510.77

FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$510.77

Service Code	CPT 77002
Hospital Revenue Code	360
Min. Negotiated Rate	$463.69
Max. Negotiated Rate	$510.77
Rate for Payer: Wellmark IA HMO WHPI	$463.69
Rate for Payer: Wellmark IA PPO	$510.77

FLUoxetine 10 mg Cap(VDMC)

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10389929
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.14
Rate for Payer: Aetna of IA Commercial	$1.14
Rate for Payer: Aetna of IA Medical Rental Products	$1.14
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: United Healthcare Commercial	$1.14

FLUoxetine 10 mg Cap(VDMC)

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10389929
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.14
Rate for Payer: Aetna of IA Commercial	$1.14
Rate for Payer: Aetna of IA Medical Rental Products	$1.14
Rate for Payer: Aetna of IA Medicare	$0.72
Rate for Payer: Amerigroup Medicaid	$0.73
Rate for Payer: Amerigroup Medicare	$0.57
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.57
Rate for Payer: Iowa Total Care Managed Medicaid	$0.72
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Medical Associates Managed Medicare	$0.57
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: Molina Healthcare Managed Medicaid	$0.73
Rate for Payer: Partners Health Alliance Commercial	$0.65
Rate for Payer: United Healthcare Commercial	$1.14
Rate for Payer: United Healthcare Managed Medicare	$0.75

FLUoxetine 20 mg Cap [VDMC]

Facility

$1.10

Service Code	HCPCS A9270
Hospital Charge Code	10389998
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.99
Rate for Payer: Aetna of IA Commercial	$0.99
Rate for Payer: Aetna of IA Medical Rental Products	$0.99
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.82
Rate for Payer: Medical Associates Commercial	$0.82
Rate for Payer: Midlands Choice Commercial	$0.77
Rate for Payer: United Healthcare Commercial	$0.99

FLUoxetine 20 mg Cap [VDMC]

Facility

$1.10

Service Code	HCPCS A9270
Hospital Charge Code	10389998
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.99
Rate for Payer: Aetna of IA Commercial	$0.99
Rate for Payer: Aetna of IA Medical Rental Products	$0.99
Rate for Payer: Aetna of IA Medicare	$0.63
Rate for Payer: Amerigroup Medicaid	$0.63
Rate for Payer: Amerigroup Medicare	$0.50
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.49
Rate for Payer: Iowa Total Care Managed Medicaid	$0.63
Rate for Payer: Medical Associates Commercial	$0.82
Rate for Payer: Medical Associates Managed Medicare	$0.49
Rate for Payer: Midlands Choice Commercial	$0.77
Rate for Payer: Molina Healthcare Managed Medicaid	$0.64
Rate for Payer: Partners Health Alliance Commercial	$0.57
Rate for Payer: United Healthcare Commercial	$0.99
Rate for Payer: United Healthcare Managed Medicare	$0.65

fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol [VDMC]

Facility

$307.00

Service Code	HCPCS J2680
Hospital Charge Code	11219929
Hospital Revenue Code	259
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$276.30
Rate for Payer: Aetna of IA Commercial	$276.30
Rate for Payer: Aetna of IA Medical Rental Products	$276.30
Rate for Payer: Cash Price	$245.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$230.25
Rate for Payer: Medical Associates Commercial	$230.25
Rate for Payer: Midlands Choice Commercial	$214.90
Rate for Payer: United Healthcare Commercial	$276.30

fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol [VDMC]

Facility

$307.00

Service Code	HCPCS J2680
Hospital Charge Code	11219929
Hospital Revenue Code	259
Min. Negotiated Rate	$138.15
Max. Negotiated Rate	$276.30
Rate for Payer: Aetna of IA Commercial	$276.30
Rate for Payer: Aetna of IA Medical Rental Products	$276.30
Rate for Payer: Aetna of IA Medicare	$174.99
Rate for Payer: Amerigroup Medicaid	$177.08
Rate for Payer: Amerigroup Medicare	$139.53
Rate for Payer: Cash Price	$245.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$230.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$138.15
Rate for Payer: Iowa Total Care Managed Medicaid	$175.36
Rate for Payer: Medical Associates Commercial	$230.25
Rate for Payer: Medical Associates Managed Medicare	$138.15
Rate for Payer: Midlands Choice Commercial	$214.90
Rate for Payer: Molina Healthcare Managed Medicaid	$177.94
Rate for Payer: Partners Health Alliance Commercial	$158.87
Rate for Payer: United Healthcare Commercial	$276.30
Rate for Payer: United Healthcare Managed Medicare	$181.13

fluticasone CFC free 110 mcg/inh Inh Aer w/adapter [VDMC]

Facility

$919.44

Service Code	HCPCS A9270
Hospital Charge Code	10390205
Hospital Revenue Code	259
Min. Negotiated Rate	$643.61
Max. Negotiated Rate	$827.49
Rate for Payer: Aetna of IA Commercial	$827.49
Rate for Payer: Aetna of IA Medical Rental Products	$827.49
Rate for Payer: Cash Price	$735.55
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$689.58
Rate for Payer: Medical Associates Commercial	$689.58
Rate for Payer: Midlands Choice Commercial	$643.61
Rate for Payer: United Healthcare Commercial	$827.49

fluticasone CFC free 110 mcg/inh Inh Aer w/adapter [VDMC]

Facility

$919.44

Service Code	HCPCS A9270
Hospital Charge Code	10390205
Hospital Revenue Code	259
Min. Negotiated Rate	$413.75
Max. Negotiated Rate	$827.49
Rate for Payer: Aetna of IA Commercial	$827.49
Rate for Payer: Aetna of IA Medical Rental Products	$827.49
Rate for Payer: Aetna of IA Medicare	$524.08
Rate for Payer: Amerigroup Medicaid	$530.33
Rate for Payer: Amerigroup Medicare	$417.88
Rate for Payer: Cash Price	$735.55
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$689.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$413.75
Rate for Payer: Iowa Total Care Managed Medicaid	$525.18
Rate for Payer: Medical Associates Commercial	$689.58
Rate for Payer: Medical Associates Managed Medicare	$413.75
Rate for Payer: Midlands Choice Commercial	$643.61
Rate for Payer: Molina Healthcare Managed Medicaid	$532.91
Rate for Payer: Partners Health Alliance Commercial	$475.81
Rate for Payer: United Healthcare Commercial	$827.49
Rate for Payer: United Healthcare Managed Medicare	$542.47

fluticasone CFC free 44 mcg/inh Inh Aer w/adapter [VDMC]

Facility

$447.40

Service Code	HCPCS A9270
Hospital Charge Code	10390270
Hospital Revenue Code	259
Min. Negotiated Rate	$313.18
Max. Negotiated Rate	$402.66
Rate for Payer: Aetna of IA Commercial	$402.66
Rate for Payer: Aetna of IA Medical Rental Products	$402.66
Rate for Payer: Cash Price	$357.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$335.55
Rate for Payer: Medical Associates Commercial	$335.55
Rate for Payer: Midlands Choice Commercial	$313.18
Rate for Payer: United Healthcare Commercial	$402.66

fluticasone CFC free 44 mcg/inh Inh Aer w/adapter [VDMC]

Facility

$447.40

Service Code	HCPCS A9270
Hospital Charge Code	10390270
Hospital Revenue Code	259
Min. Negotiated Rate	$201.33
Max. Negotiated Rate	$402.66
Rate for Payer: Aetna of IA Commercial	$402.66
Rate for Payer: Aetna of IA Medical Rental Products	$402.66
Rate for Payer: Aetna of IA Medicare	$255.02
Rate for Payer: Amerigroup Medicaid	$258.06
Rate for Payer: Amerigroup Medicare	$203.34
Rate for Payer: Cash Price	$357.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$335.55
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$201.33
Rate for Payer: Iowa Total Care Managed Medicaid	$255.55
Rate for Payer: Medical Associates Commercial	$335.55
Rate for Payer: Medical Associates Managed Medicare	$201.33
Rate for Payer: Midlands Choice Commercial	$313.18
Rate for Payer: Molina Healthcare Managed Medicaid	$259.31
Rate for Payer: Partners Health Alliance Commercial	$231.53
Rate for Payer: United Healthcare Commercial	$402.66
Rate for Payer: United Healthcare Managed Medicare	$263.97

fluticasone Nasal 0.05 mg/inh Spry [VDMC]

Facility

$42.64

Service Code	HCPCS A9270
Hospital Charge Code	10390335
Hospital Revenue Code	259
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$38.38
Rate for Payer: Aetna of IA Commercial	$38.38
Rate for Payer: Aetna of IA Medical Rental Products	$38.38
Rate for Payer: Cash Price	$34.11
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.98
Rate for Payer: Medical Associates Commercial	$31.98
Rate for Payer: Midlands Choice Commercial	$29.85
Rate for Payer: United Healthcare Commercial	$38.38

fluticasone Nasal 0.05 mg/inh Spry [VDMC]

Facility

$42.64

Service Code	HCPCS A9270
Hospital Charge Code	10390335
Hospital Revenue Code	259
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$38.38
Rate for Payer: Aetna of IA Commercial	$38.38
Rate for Payer: Aetna of IA Medical Rental Products	$38.38
Rate for Payer: Aetna of IA Medicare	$24.30
Rate for Payer: Amerigroup Medicaid	$24.59
Rate for Payer: Amerigroup Medicare	$19.38
Rate for Payer: Cash Price	$34.11
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.98
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$19.19
Rate for Payer: Iowa Total Care Managed Medicaid	$24.36
Rate for Payer: Medical Associates Commercial	$31.98
Rate for Payer: Medical Associates Managed Medicare	$19.19
Rate for Payer: Midlands Choice Commercial	$29.85
Rate for Payer: Molina Healthcare Managed Medicaid	$24.71
Rate for Payer: Partners Health Alliance Commercial	$22.07
Rate for Payer: United Healthcare Commercial	$38.38
Rate for Payer: United Healthcare Managed Medicare	$25.16

fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr [VDMC]

Facility

$76.86

Service Code	HCPCS A9270
Hospital Charge Code	10390400
Hospital Revenue Code	259
Min. Negotiated Rate	$34.59
Max. Negotiated Rate	$69.18
Rate for Payer: Aetna of IA Commercial	$69.18
Rate for Payer: Aetna of IA Medical Rental Products	$69.18
Rate for Payer: Aetna of IA Medicare	$43.81
Rate for Payer: Amerigroup Medicaid	$44.34
Rate for Payer: Amerigroup Medicare	$34.93
Rate for Payer: Cash Price	$61.49
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.65
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.59
Rate for Payer: Iowa Total Care Managed Medicaid	$43.90
Rate for Payer: Medical Associates Commercial	$57.65
Rate for Payer: Medical Associates Managed Medicare	$34.59
Rate for Payer: Midlands Choice Commercial	$53.80
Rate for Payer: Molina Healthcare Managed Medicaid	$44.55
Rate for Payer: Partners Health Alliance Commercial	$39.78
Rate for Payer: United Healthcare Commercial	$69.18
Rate for Payer: United Healthcare Managed Medicare	$45.35

fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr [VDMC]

Facility

$76.86

Service Code	HCPCS A9270
Hospital Charge Code	10390400
Hospital Revenue Code	259
Min. Negotiated Rate	$53.80
Max. Negotiated Rate	$69.18
Rate for Payer: Aetna of IA Commercial	$69.18
Rate for Payer: Aetna of IA Medical Rental Products	$69.18
Rate for Payer: Cash Price	$61.49
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.65
Rate for Payer: Medical Associates Commercial	$57.65
Rate for Payer: Midlands Choice Commercial	$53.80
Rate for Payer: United Healthcare Commercial	$69.18

fluticasone-salmeterol 250 mcg-50 mcg Inh Pwdr [VDMC]

Facility

$177.48

Service Code	HCPCS A9270
Hospital Charge Code	10390465
Hospital Revenue Code	259
Min. Negotiated Rate	$79.87
Max. Negotiated Rate	$159.73
Rate for Payer: Aetna of IA Commercial	$159.73
Rate for Payer: Aetna of IA Medical Rental Products	$159.73
Rate for Payer: Aetna of IA Medicare	$101.16
Rate for Payer: Amerigroup Medicaid	$102.37
Rate for Payer: Amerigroup Medicare	$80.66
Rate for Payer: Cash Price	$141.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$133.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.87
Rate for Payer: Iowa Total Care Managed Medicaid	$101.38
Rate for Payer: Medical Associates Commercial	$133.11
Rate for Payer: Medical Associates Managed Medicare	$79.87
Rate for Payer: Midlands Choice Commercial	$124.24
Rate for Payer: Molina Healthcare Managed Medicaid	$102.87
Rate for Payer: Partners Health Alliance Commercial	$91.85
Rate for Payer: United Healthcare Commercial	$159.73
Rate for Payer: United Healthcare Managed Medicare	$104.71

Know your out-of-pocket cost for care.

All Charges