Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

HYDROmorphone 2 mg Tab [VDMC]

Facility

$3.48

Service Code	HCPCS A9270
Hospital Charge Code	10394725
Hospital Revenue Code	259
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna of IA Commercial	$3.13
Rate for Payer: Aetna of IA Medical Rental Products	$3.13
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.61
Rate for Payer: Medical Associates Commercial	$2.61
Rate for Payer: Midlands Choice Commercial	$2.44
Rate for Payer: United Healthcare Commercial	$3.13

HYDROmorphone 2 mg Tab [VDMC]

Facility

$3.48

Service Code	HCPCS A9270
Hospital Charge Code	10394725
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna of IA Commercial	$3.13
Rate for Payer: Aetna of IA Medical Rental Products	$3.13
Rate for Payer: Aetna of IA Medicare	$1.98
Rate for Payer: Amerigroup Medicaid	$2.01
Rate for Payer: Amerigroup Medicare	$1.58
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.61
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.57
Rate for Payer: Iowa Total Care Managed Medicaid	$1.99
Rate for Payer: Medical Associates Commercial	$2.61
Rate for Payer: Medical Associates Managed Medicare	$1.57
Rate for Payer: Midlands Choice Commercial	$2.44
Rate for Payer: Molina Healthcare Managed Medicaid	$2.02
Rate for Payer: Partners Health Alliance Commercial	$1.80
Rate for Payer: United Healthcare Commercial	$3.13
Rate for Payer: United Healthcare Managed Medicare	$2.05

HYDROmorphone 4 mg/mL Inj Sol [VDMC]

Facility

$47.19

Service Code	HCPCS J1171
Hospital Charge Code	10394932
Hospital Revenue Code	259
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$42.47
Rate for Payer: Aetna of IA Medical Rental Products	$42.47
Rate for Payer: Aetna of IA Medicare	$26.90
Rate for Payer: Amerigroup Medicaid	$27.22
Rate for Payer: Amerigroup Medicare	$21.45
Rate for Payer: Cash Price	$37.75
Rate for Payer: Cash Price	$37.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.24
Rate for Payer: Iowa Total Care Managed Medicaid	$26.96
Rate for Payer: Medical Associates Commercial	$35.39
Rate for Payer: Medical Associates Managed Medicare	$21.24
Rate for Payer: Midlands Choice Commercial	$33.03
Rate for Payer: Molina Healthcare Managed Medicaid	$27.35
Rate for Payer: Partners Health Alliance Commercial	$24.42
Rate for Payer: United Healthcare Commercial	$42.47
Rate for Payer: United Healthcare Managed Medicare	$27.84
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

HYDROmorphone 4 mg/mL Inj Sol [VDMC]

Facility

$47.19

Service Code	HCPCS J1171
Hospital Charge Code	10394932
Hospital Revenue Code	259
Min. Negotiated Rate	$33.03
Max. Negotiated Rate	$42.47
Rate for Payer: Aetna of IA Commercial	$42.47
Rate for Payer: Aetna of IA Medical Rental Products	$42.47
Rate for Payer: Cash Price	$37.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.39
Rate for Payer: Medical Associates Commercial	$35.39
Rate for Payer: Midlands Choice Commercial	$33.03
Rate for Payer: United Healthcare Commercial	$42.47

hydrophilic ointment 454 gm [VDMC]

Facility

$52.00

Service Code	HCPCS A9270
Hospital Charge Code	10432657
Hospital Revenue Code	259
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

hydrophilic ointment 454 gm [VDMC]

Facility

$52.00

Service Code	HCPCS A9270
Hospital Charge Code	10432657
Hospital Revenue Code	259
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

HYDROPHILIC WOUND DRESSING 85 GRAM

Facility

$64.00

Hospital Charge Code	8013714
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Aetna of IA Medicare	$36.48
Rate for Payer: Amerigroup Medicaid	$36.92
Rate for Payer: Amerigroup Medicare	$29.09
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.80
Rate for Payer: Iowa Total Care Managed Medicaid	$36.56
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Medical Associates Managed Medicare	$28.80
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: Molina Healthcare Managed Medicaid	$37.09
Rate for Payer: Partners Health Alliance Commercial	$33.12
Rate for Payer: United Healthcare Commercial	$57.60
Rate for Payer: United Healthcare Managed Medicare	$37.76

HYDROPHILIC WOUND DRESSING 85 GRAM

Facility

$64.00

Hospital Charge Code	8013714
Hospital Revenue Code	250
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: United Healthcare Commercial	$57.60

Hydrophilic Wound Dressing oint tube [VDMC]

Facility

$8.44

Service Code	HCPCS A9270
Hospital Charge Code	23071981
Hospital Revenue Code	259
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna of IA Commercial	$7.60
Rate for Payer: Aetna of IA Medical Rental Products	$7.60
Rate for Payer: Aetna of IA Medicare	$4.81
Rate for Payer: Amerigroup Medicaid	$4.87
Rate for Payer: Amerigroup Medicare	$3.84
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.80
Rate for Payer: Iowa Total Care Managed Medicaid	$4.82
Rate for Payer: Medical Associates Commercial	$6.33
Rate for Payer: Medical Associates Managed Medicare	$3.80
Rate for Payer: Midlands Choice Commercial	$5.91
Rate for Payer: Molina Healthcare Managed Medicaid	$4.89
Rate for Payer: Partners Health Alliance Commercial	$4.37
Rate for Payer: United Healthcare Commercial	$7.60
Rate for Payer: United Healthcare Managed Medicare	$4.98

Hydrophilic Wound Dressing oint tube [VDMC]

Facility

$8.44

Service Code	HCPCS A9270
Hospital Charge Code	23071981
Hospital Revenue Code	259
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna of IA Commercial	$7.60
Rate for Payer: Aetna of IA Medical Rental Products	$7.60
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.33
Rate for Payer: Medical Associates Commercial	$6.33
Rate for Payer: Midlands Choice Commercial	$5.91
Rate for Payer: United Healthcare Commercial	$7.60

hydroxychloroquine 200 mg Tab [VDMC]

Facility

$1.68

Service Code	HCPCS A9270
Hospital Charge Code	10395001
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna of IA Commercial	$1.51
Rate for Payer: Aetna of IA Medical Rental Products	$1.51
Rate for Payer: Aetna of IA Medicare	$0.96
Rate for Payer: Amerigroup Medicaid	$0.97
Rate for Payer: Amerigroup Medicare	$0.76
Rate for Payer: Cash Price	$1.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.26
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.76
Rate for Payer: Iowa Total Care Managed Medicaid	$0.96
Rate for Payer: Medical Associates Commercial	$1.26
Rate for Payer: Medical Associates Managed Medicare	$0.76
Rate for Payer: Midlands Choice Commercial	$1.18
Rate for Payer: Molina Healthcare Managed Medicaid	$0.97
Rate for Payer: Partners Health Alliance Commercial	$0.87
Rate for Payer: United Healthcare Commercial	$1.51
Rate for Payer: United Healthcare Managed Medicare	$0.99

hydroxychloroquine 200 mg Tab [VDMC]

Facility

$1.68

Service Code	HCPCS A9270
Hospital Charge Code	10395001
Hospital Revenue Code	259
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna of IA Commercial	$1.51
Rate for Payer: Aetna of IA Medical Rental Products	$1.51
Rate for Payer: Cash Price	$1.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.26
Rate for Payer: Medical Associates Commercial	$1.26
Rate for Payer: Midlands Choice Commercial	$1.18
Rate for Payer: United Healthcare Commercial	$1.51

hydroxyurEA 500 mg Cap [VDMC]

Facility

$2.30

Service Code	HCPCS A9270
Hospital Charge Code	10395072
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna of IA Commercial	$2.07
Rate for Payer: Aetna of IA Medical Rental Products	$2.07
Rate for Payer: Cash Price	$1.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Midlands Choice Commercial	$1.61
Rate for Payer: United Healthcare Commercial	$2.07

hydroxyurEA 500 mg Cap [VDMC]

Facility

$2.30

Service Code	HCPCS A9270
Hospital Charge Code	10395072
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna of IA Commercial	$2.07
Rate for Payer: Aetna of IA Medical Rental Products	$2.07
Rate for Payer: Aetna of IA Medicare	$1.31
Rate for Payer: Amerigroup Medicaid	$1.33
Rate for Payer: Amerigroup Medicare	$1.05
Rate for Payer: Cash Price	$1.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.04
Rate for Payer: Iowa Total Care Managed Medicaid	$1.32
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Medical Associates Managed Medicare	$1.04
Rate for Payer: Midlands Choice Commercial	$1.61
Rate for Payer: Molina Healthcare Managed Medicaid	$1.34
Rate for Payer: Partners Health Alliance Commercial	$1.19
Rate for Payer: United Healthcare Commercial	$2.07
Rate for Payer: United Healthcare Managed Medicare	$1.36

hydrOXYzine hydrochloride 10 mg Tab [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10395143
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.00

hydrOXYzine hydrochloride 10 mg Tab [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10395143
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Aetna of IA Medicare	$0.63
Rate for Payer: Amerigroup Medicaid	$0.64
Rate for Payer: Amerigroup Medicare	$0.51
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.50
Rate for Payer: Iowa Total Care Managed Medicaid	$0.64
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Medical Associates Managed Medicare	$0.50
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: Molina Healthcare Managed Medicaid	$0.64
Rate for Payer: Partners Health Alliance Commercial	$0.58
Rate for Payer: United Healthcare Commercial	$1.00
Rate for Payer: United Healthcare Managed Medicare	$0.66

hydrOXYzine hydrochloride 25 mg/mL Sol[VDMC]

Facility

$85.94

Service Code	HCPCS J3410
Hospital Charge Code	11754562
Hospital Revenue Code	259
Min. Negotiated Rate	$38.67
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$77.34
Rate for Payer: Aetna of IA Medical Rental Products	$77.34
Rate for Payer: Aetna of IA Medicare	$48.98
Rate for Payer: Amerigroup Medicaid	$49.57
Rate for Payer: Amerigroup Medicare	$39.06
Rate for Payer: Cash Price	$68.75
Rate for Payer: Cash Price	$68.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$64.45
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.67
Rate for Payer: Iowa Total Care Managed Medicaid	$49.09
Rate for Payer: Medical Associates Commercial	$64.45
Rate for Payer: Medical Associates Managed Medicare	$38.67
Rate for Payer: Midlands Choice Commercial	$60.16
Rate for Payer: Molina Healthcare Managed Medicaid	$49.81
Rate for Payer: Partners Health Alliance Commercial	$44.47
Rate for Payer: United Healthcare Commercial	$77.34
Rate for Payer: United Healthcare Managed Medicare	$50.70
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

hydrOXYzine hydrochloride 25 mg/mL Sol[VDMC]

Facility

$85.94

Service Code	HCPCS J3410
Hospital Charge Code	11754562
Hospital Revenue Code	259
Min. Negotiated Rate	$60.16
Max. Negotiated Rate	$77.34
Rate for Payer: Aetna of IA Commercial	$77.34
Rate for Payer: Aetna of IA Medical Rental Products	$77.34
Rate for Payer: Cash Price	$68.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$64.45
Rate for Payer: Medical Associates Commercial	$64.45
Rate for Payer: Midlands Choice Commercial	$60.16
Rate for Payer: United Healthcare Commercial	$77.34

hydrOXYzine hydrochloride 25 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10395212
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna of IA Commercial	$1.43
Rate for Payer: Aetna of IA Medical Rental Products	$1.43
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: United Healthcare Commercial	$1.43

hydrOXYzine hydrochloride 25 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10395212
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna of IA Commercial	$1.43
Rate for Payer: Aetna of IA Medical Rental Products	$1.43
Rate for Payer: Aetna of IA Medicare	$0.91
Rate for Payer: Amerigroup Medicaid	$0.92
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.72
Rate for Payer: Iowa Total Care Managed Medicaid	$0.91
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Medical Associates Managed Medicare	$0.72
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: Molina Healthcare Managed Medicaid	$0.92
Rate for Payer: Partners Health Alliance Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$1.43
Rate for Payer: United Healthcare Managed Medicare	$0.94

HYLAN G-F 20 1MG ( 48MG PER DOSE) CHARGE

Professional

Both

$24.00

Service Code	CPT J7325
Hospital Charge Code	8068951
Hospital Revenue Code	636
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$18.00
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: Partners Health Alliance Commercial	$18.00
Rate for Payer: United Healthcare Commercial	$9.16
Rate for Payer: Wellmark IA HMO WHPI	$8.88
Rate for Payer: Wellmark IA PPO	$8.88

hylan G-F 20 48 mg/6 mL SDV syringe [VDMC]

Facility

$1,824.20

Service Code	HCPCS J7325
Hospital Charge Code	10395352
Hospital Revenue Code	259
Min. Negotiated Rate	$820.89
Max. Negotiated Rate	$1,641.78
Rate for Payer: Aetna of IA Commercial	$1,641.78
Rate for Payer: Aetna of IA Medical Rental Products	$1,641.78
Rate for Payer: Aetna of IA Medicare	$1,039.79
Rate for Payer: Amerigroup Medicaid	$1,052.20
Rate for Payer: Amerigroup Medicare	$829.10
Rate for Payer: Cash Price	$1,459.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,368.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$820.89
Rate for Payer: Iowa Total Care Managed Medicaid	$1,041.98
Rate for Payer: Medical Associates Commercial	$1,368.15
Rate for Payer: Medical Associates Managed Medicare	$820.89
Rate for Payer: Midlands Choice Commercial	$1,276.94
Rate for Payer: Molina Healthcare Managed Medicaid	$1,057.31
Rate for Payer: Partners Health Alliance Commercial	$944.02
Rate for Payer: United Healthcare Commercial	$1,641.78
Rate for Payer: United Healthcare Managed Medicare	$1,076.28

hylan G-F 20 48 mg/6 mL SDV syringe [VDMC]

Facility

$1,824.20

Service Code	HCPCS J7325
Hospital Charge Code	10395352
Hospital Revenue Code	259
Min. Negotiated Rate	$1,276.94
Max. Negotiated Rate	$1,641.78
Rate for Payer: Aetna of IA Commercial	$1,641.78
Rate for Payer: Aetna of IA Medical Rental Products	$1,641.78
Rate for Payer: Cash Price	$1,459.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,368.15
Rate for Payer: Medical Associates Commercial	$1,368.15
Rate for Payer: Midlands Choice Commercial	$1,276.94
Rate for Payer: United Healthcare Commercial	$1,641.78

hyoscyamine 0.125 mg Dis Tab [VDMC]

Facility

$1.30

Service Code	HCPCS A9270
Hospital Charge Code	10395421
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of IA Commercial	$1.17
Rate for Payer: Aetna of IA Medical Rental Products	$1.17
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Midlands Choice Commercial	$0.91
Rate for Payer: United Healthcare Commercial	$1.17

hyoscyamine 0.125 mg Dis Tab [VDMC]

Facility

$1.30

Service Code	HCPCS A9270
Hospital Charge Code	10395421
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of IA Commercial	$1.17
Rate for Payer: Aetna of IA Medical Rental Products	$1.17
Rate for Payer: Aetna of IA Medicare	$0.74
Rate for Payer: Amerigroup Medicaid	$0.75
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.59
Rate for Payer: Iowa Total Care Managed Medicaid	$0.74
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Medical Associates Managed Medicare	$0.59
Rate for Payer: Midlands Choice Commercial	$0.91
Rate for Payer: Molina Healthcare Managed Medicaid	$0.76
Rate for Payer: Partners Health Alliance Commercial	$0.67
Rate for Payer: United Healthcare Commercial	$1.17
Rate for Payer: United Healthcare Managed Medicare	$0.77

Know your out-of-pocket cost for care.

All Charges