Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Giardia Antigen

Facility

$114.00

Service Code	CPT 87329
Hospital Charge Code	4022858
Hospital Revenue Code	306
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

Giardia Antigen

Facility

$114.00

Service Code	CPT 87329
Hospital Charge Code	4022858
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
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: 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	$59.00
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

Giardia Antigen

Facility

$114.00

Service Code	CPT 87329
Hospital Charge Code	8059691
Hospital Revenue Code	306
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

GL ANKLE SCREW 3.5MM X 14MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773165
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

GL ANKLE SCREW 3.5MM X 14MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773165
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

GL ANKLE SCREW 3.5MM X 16MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773167
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

GL ANKLE SCREW 3.5MM X 16MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773167
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

GL ANKLE SCREW 3.5MM X 18MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773169
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

GL ANKLE SCREW 3.5MM X 18MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8773169
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

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.00MMX52MM

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8823376
Hospital Revenue Code	278
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: United Healthcare Commercial	$429.30

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.00MMX52MM

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8823376
Hospital Revenue Code	278
Min. Negotiated Rate	$214.65
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Aetna of IA Medicare	$271.89
Rate for Payer: Amerigroup Medicaid	$275.13
Rate for Payer: Amerigroup Medicare	$216.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$214.65
Rate for Payer: Iowa Total Care Managed Medicaid	$272.46
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Medical Associates Managed Medicare	$214.65
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: Molina Healthcare Managed Medicaid	$276.47
Rate for Payer: Partners Health Alliance Commercial	$246.85
Rate for Payer: United Healthcare Commercial	$429.30
Rate for Payer: United Healthcare Managed Medicare	$281.43

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MMX40MM

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8831369
Hospital Revenue Code	278
Min. Negotiated Rate	$214.65
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Aetna of IA Medicare	$271.89
Rate for Payer: Amerigroup Medicaid	$275.13
Rate for Payer: Amerigroup Medicare	$216.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$214.65
Rate for Payer: Iowa Total Care Managed Medicaid	$272.46
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Medical Associates Managed Medicare	$214.65
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: Molina Healthcare Managed Medicaid	$276.47
Rate for Payer: Partners Health Alliance Commercial	$246.85
Rate for Payer: United Healthcare Commercial	$429.30
Rate for Payer: United Healthcare Managed Medicare	$281.43

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MMX40MM

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8831369
Hospital Revenue Code	278
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: United Healthcare Commercial	$429.30

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MM X 44MM

Facility

$504.00

Service Code	HCPCS C1713
Hospital Charge Code	8773171
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of IA Commercial	$453.60
Rate for Payer: Aetna of IA Medical Rental Products	$453.60
Rate for Payer: Aetna of IA Medicare	$287.28
Rate for Payer: Amerigroup Medicaid	$290.71
Rate for Payer: Amerigroup Medicare	$229.07
Rate for Payer: Cash Price	$403.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$378.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$226.80
Rate for Payer: Iowa Total Care Managed Medicaid	$287.88
Rate for Payer: Medical Associates Commercial	$378.00
Rate for Payer: Medical Associates Managed Medicare	$226.80
Rate for Payer: Midlands Choice Commercial	$352.80
Rate for Payer: Molina Healthcare Managed Medicaid	$292.12
Rate for Payer: Partners Health Alliance Commercial	$260.82
Rate for Payer: United Healthcare Commercial	$453.60
Rate for Payer: United Healthcare Managed Medicare	$297.36

GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MM X 44MM

Facility

$504.00

Service Code	HCPCS C1713
Hospital Charge Code	8773171
Hospital Revenue Code	278
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of IA Commercial	$453.60
Rate for Payer: Aetna of IA Medical Rental Products	$453.60
Rate for Payer: Cash Price	$403.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$378.00
Rate for Payer: Medical Associates Commercial	$378.00
Rate for Payer: Midlands Choice Commercial	$352.80
Rate for Payer: United Healthcare Commercial	$453.60

GLENOID W/KEEL LARGE

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.75
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Aetna of IA Medicare	$1,615.95
Rate for Payer: Amerigroup Medicaid	$1,635.23
Rate for Payer: Amerigroup Medicare	$1,288.51
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,275.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,619.35
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Medical Associates Managed Medicare	$1,275.75
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,643.17
Rate for Payer: Partners Health Alliance Commercial	$1,467.11
Rate for Payer: United Healthcare Commercial	$2,551.50
Rate for Payer: United Healthcare Managed Medicare	$1,672.65

GLENOID W/KEEL LARGE

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: United Healthcare Commercial	$2,551.50

GLENOID W/KEEL MEDIUM

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: United Healthcare Commercial	$2,551.50

GLENOID W/KEEL MEDIUM

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.75
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Aetna of IA Medicare	$1,615.95
Rate for Payer: Amerigroup Medicaid	$1,635.23
Rate for Payer: Amerigroup Medicare	$1,288.51
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,275.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,619.35
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Medical Associates Managed Medicare	$1,275.75
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,643.17
Rate for Payer: Partners Health Alliance Commercial	$1,467.11
Rate for Payer: United Healthcare Commercial	$2,551.50
Rate for Payer: United Healthcare Managed Medicare	$1,672.65

GLENOID W/KEEL SMALL

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.75
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Aetna of IA Medicare	$1,615.95
Rate for Payer: Amerigroup Medicaid	$1,635.23
Rate for Payer: Amerigroup Medicare	$1,288.51
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,275.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,619.35
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Medical Associates Managed Medicare	$1,275.75
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,643.17
Rate for Payer: Partners Health Alliance Commercial	$1,467.11
Rate for Payer: United Healthcare Commercial	$2,551.50
Rate for Payer: United Healthcare Managed Medicare	$1,672.65

GLENOID W/KEEL SMALL

Facility

$2,835.00

Service Code	HCPCS C1776
Hospital Charge Code	8047272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$2,551.50
Rate for Payer: Aetna of IA Commercial	$2,551.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,551.50
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,126.25
Rate for Payer: Medical Associates Commercial	$2,126.25
Rate for Payer: Midlands Choice Commercial	$1,984.50
Rate for Payer: United Healthcare Commercial	$2,551.50

glimepiride 2 mg Tab [VDMC]

Facility

$2.10

Service Code	HCPCS A9270
Hospital Charge Code	10391902
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of IA Commercial	$1.89
Rate for Payer: Aetna of IA Medical Rental Products	$1.89
Rate for Payer: Cash Price	$1.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.58
Rate for Payer: Medical Associates Commercial	$1.58
Rate for Payer: Midlands Choice Commercial	$1.47
Rate for Payer: United Healthcare Commercial	$1.89

glimepiride 2 mg Tab [VDMC]

Facility

$2.10

Service Code	HCPCS A9270
Hospital Charge Code	10391902
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of IA Commercial	$1.89
Rate for Payer: Aetna of IA Medical Rental Products	$1.89
Rate for Payer: Aetna of IA Medicare	$1.20
Rate for Payer: Amerigroup Medicaid	$1.21
Rate for Payer: Amerigroup Medicare	$0.95
Rate for Payer: Cash Price	$1.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.95
Rate for Payer: Iowa Total Care Managed Medicaid	$1.20
Rate for Payer: Medical Associates Commercial	$1.58
Rate for Payer: Medical Associates Managed Medicare	$0.95
Rate for Payer: Midlands Choice Commercial	$1.47
Rate for Payer: Molina Healthcare Managed Medicaid	$1.22
Rate for Payer: Partners Health Alliance Commercial	$1.09
Rate for Payer: United Healthcare Commercial	$1.89
Rate for Payer: United Healthcare Managed Medicare	$1.24

glimepiride 4 mg Tab [VDMC]

Facility

$2.89

Service Code	HCPCS A9270
Hospital Charge Code	10391971
Hospital Revenue Code	259
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna of IA Commercial	$2.60
Rate for Payer: Aetna of IA Medical Rental Products	$2.60
Rate for Payer: Aetna of IA Medicare	$1.65
Rate for Payer: Amerigroup Medicaid	$1.67
Rate for Payer: Amerigroup Medicare	$1.31
Rate for Payer: Cash Price	$2.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.17
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.30
Rate for Payer: Iowa Total Care Managed Medicaid	$1.65
Rate for Payer: Medical Associates Commercial	$2.17
Rate for Payer: Medical Associates Managed Medicare	$1.30
Rate for Payer: Midlands Choice Commercial	$2.02
Rate for Payer: Molina Healthcare Managed Medicaid	$1.68
Rate for Payer: Partners Health Alliance Commercial	$1.50
Rate for Payer: United Healthcare Commercial	$2.60
Rate for Payer: United Healthcare Managed Medicare	$1.71

glimepiride 4 mg Tab [VDMC]

Facility

$2.89

Service Code	HCPCS A9270
Hospital Charge Code	10391971
Hospital Revenue Code	259
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna of IA Commercial	$2.60
Rate for Payer: Aetna of IA Medical Rental Products	$2.60
Rate for Payer: Cash Price	$2.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.17
Rate for Payer: Medical Associates Commercial	$2.17
Rate for Payer: Midlands Choice Commercial	$2.02
Rate for Payer: United Healthcare Commercial	$2.60

Know your out-of-pocket cost for care.

All Charges