Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

metaxalone 800 mg Tab [VDMC]

Facility

$3.21

Service Code	HCPCS A9270
Hospital Charge Code	10403721
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna of IA Commercial	$2.89
Rate for Payer: Aetna of IA Medical Rental Products	$2.89
Rate for Payer: Aetna of IA Medicare	$1.83
Rate for Payer: Amerigroup Medicaid	$1.85
Rate for Payer: Amerigroup Medicare	$1.46
Rate for Payer: Cash Price	$2.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.41
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.44
Rate for Payer: Iowa Total Care Managed Medicaid	$1.83
Rate for Payer: Medical Associates Commercial	$2.41
Rate for Payer: Medical Associates Managed Medicare	$1.44
Rate for Payer: Midlands Choice Commercial	$2.25
Rate for Payer: Molina Healthcare Managed Medicaid	$1.86
Rate for Payer: Partners Health Alliance Commercial	$1.66
Rate for Payer: United Healthcare Commercial	$2.89
Rate for Payer: United Healthcare Managed Medicare	$1.89

metaxalone 800 mg Tab [VDMC]

Facility

$3.21

Service Code	HCPCS A9270
Hospital Charge Code	10403721
Hospital Revenue Code	259
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna of IA Commercial	$2.89
Rate for Payer: Aetna of IA Medical Rental Products	$2.89
Rate for Payer: Cash Price	$2.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.41
Rate for Payer: Medical Associates Commercial	$2.41
Rate for Payer: Midlands Choice Commercial	$2.25
Rate for Payer: United Healthcare Commercial	$2.89

metFORMIN 500 mg 24 HR ER Tab [VDMC]

Facility

$2.38

Service Code	HCPCS A9270
Hospital Charge Code	10403792
Hospital Revenue Code	259
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.14
Rate for Payer: Aetna of IA Commercial	$2.14
Rate for Payer: Aetna of IA Medical Rental Products	$2.14
Rate for Payer: Cash Price	$1.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.78
Rate for Payer: Medical Associates Commercial	$1.78
Rate for Payer: Midlands Choice Commercial	$1.66
Rate for Payer: United Healthcare Commercial	$2.14

metFORMIN 500 mg 24 HR ER Tab [VDMC]

Facility

$2.38

Service Code	HCPCS A9270
Hospital Charge Code	10403792
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.14
Rate for Payer: Aetna of IA Commercial	$2.14
Rate for Payer: Aetna of IA Medical Rental Products	$2.14
Rate for Payer: Aetna of IA Medicare	$1.35
Rate for Payer: Amerigroup Medicaid	$1.37
Rate for Payer: Amerigroup Medicare	$1.08
Rate for Payer: Cash Price	$1.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.07
Rate for Payer: Iowa Total Care Managed Medicaid	$1.36
Rate for Payer: Medical Associates Commercial	$1.78
Rate for Payer: Medical Associates Managed Medicare	$1.07
Rate for Payer: Midlands Choice Commercial	$1.66
Rate for Payer: Molina Healthcare Managed Medicaid	$1.38
Rate for Payer: Partners Health Alliance Commercial	$1.23
Rate for Payer: United Healthcare Commercial	$2.14
Rate for Payer: United Healthcare Managed Medicare	$1.40

metFORMIN 500 mg Tab [VDMC]

Facility

$1.19

Service Code	HCPCS A9270
Hospital Charge Code	10403861
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna of IA Commercial	$1.07
Rate for Payer: Aetna of IA Medical Rental Products	$1.07
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.89
Rate for Payer: Medical Associates Commercial	$0.89
Rate for Payer: Midlands Choice Commercial	$0.83
Rate for Payer: United Healthcare Commercial	$1.07

metFORMIN 500 mg Tab [VDMC]

Facility

$1.19

Service Code	HCPCS A9270
Hospital Charge Code	10403861
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna of IA Commercial	$1.07
Rate for Payer: Aetna of IA Medical Rental Products	$1.07
Rate for Payer: Aetna of IA Medicare	$0.68
Rate for Payer: Amerigroup Medicaid	$0.69
Rate for Payer: Amerigroup Medicare	$0.54
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.89
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.54
Rate for Payer: Iowa Total Care Managed Medicaid	$0.68
Rate for Payer: Medical Associates Commercial	$0.89
Rate for Payer: Medical Associates Managed Medicare	$0.54
Rate for Payer: Midlands Choice Commercial	$0.83
Rate for Payer: Molina Healthcare Managed Medicaid	$0.69
Rate for Payer: Partners Health Alliance Commercial	$0.62
Rate for Payer: United Healthcare Commercial	$1.07
Rate for Payer: United Healthcare Managed Medicare	$0.70

methadone 5 mg Tab[VDMC]

Facility

$4.17

Service Code	HCPCS A9270
Hospital Charge Code	11512126
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna of IA Commercial	$3.75
Rate for Payer: Aetna of IA Medical Rental Products	$3.75
Rate for Payer: Aetna of IA Medicare	$2.38
Rate for Payer: Amerigroup Medicaid	$2.40
Rate for Payer: Amerigroup Medicare	$1.89
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.13
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.88
Rate for Payer: Iowa Total Care Managed Medicaid	$2.38
Rate for Payer: Medical Associates Commercial	$3.13
Rate for Payer: Medical Associates Managed Medicare	$1.88
Rate for Payer: Midlands Choice Commercial	$2.92
Rate for Payer: Molina Healthcare Managed Medicaid	$2.42
Rate for Payer: Partners Health Alliance Commercial	$2.16
Rate for Payer: United Healthcare Commercial	$3.75
Rate for Payer: United Healthcare Managed Medicare	$2.46

methadone 5 mg Tab[VDMC]

Facility

$4.17

Service Code	HCPCS A9270
Hospital Charge Code	11512126
Hospital Revenue Code	259
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna of IA Commercial	$3.75
Rate for Payer: Aetna of IA Medical Rental Products	$3.75
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.13
Rate for Payer: Medical Associates Commercial	$3.13
Rate for Payer: Midlands Choice Commercial	$2.92
Rate for Payer: United Healthcare Commercial	$3.75

methimazole 5 mg Tab [VDMC]

Facility

$1.92

Service Code	HCPCS A9270
Hospital Charge Code	10404074
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.72
Rate for Payer: Aetna of IA Commercial	$1.72
Rate for Payer: Aetna of IA Medical Rental Products	$1.72
Rate for Payer: Cash Price	$1.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.44
Rate for Payer: Medical Associates Commercial	$1.44
Rate for Payer: Midlands Choice Commercial	$1.34
Rate for Payer: United Healthcare Commercial	$1.72

methimazole 5 mg Tab [VDMC]

Facility

$1.92

Service Code	HCPCS A9270
Hospital Charge Code	10404074
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.72
Rate for Payer: Aetna of IA Commercial	$1.72
Rate for Payer: Aetna of IA Medical Rental Products	$1.72
Rate for Payer: Aetna of IA Medicare	$1.09
Rate for Payer: Amerigroup Medicaid	$1.11
Rate for Payer: Amerigroup Medicare	$0.87
Rate for Payer: Cash Price	$1.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.44
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.86
Rate for Payer: Iowa Total Care Managed Medicaid	$1.09
Rate for Payer: Medical Associates Commercial	$1.44
Rate for Payer: Medical Associates Managed Medicare	$0.86
Rate for Payer: Midlands Choice Commercial	$1.34
Rate for Payer: Molina Healthcare Managed Medicaid	$1.11
Rate for Payer: Partners Health Alliance Commercial	$0.99
Rate for Payer: United Healthcare Commercial	$1.72
Rate for Payer: United Healthcare Managed Medicare	$1.13

methocarbamol 500 mg Tab [VDMC]

Facility

$1.66

Service Code	HCPCS A9270
Hospital Charge Code	10404145
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of IA Commercial	$1.49
Rate for Payer: Aetna of IA Medical Rental Products	$1.49
Rate for Payer: Aetna of IA Medicare	$0.95
Rate for Payer: Amerigroup Medicaid	$0.96
Rate for Payer: Amerigroup Medicare	$0.75
Rate for Payer: Cash Price	$1.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.24
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.75
Rate for Payer: Iowa Total Care Managed Medicaid	$0.95
Rate for Payer: Medical Associates Commercial	$1.24
Rate for Payer: Medical Associates Managed Medicare	$0.75
Rate for Payer: Midlands Choice Commercial	$1.16
Rate for Payer: Molina Healthcare Managed Medicaid	$0.96
Rate for Payer: Partners Health Alliance Commercial	$0.86
Rate for Payer: United Healthcare Commercial	$1.49
Rate for Payer: United Healthcare Managed Medicare	$0.98

methocarbamol 500 mg Tab [VDMC]

Facility

$1.66

Service Code	HCPCS A9270
Hospital Charge Code	10404145
Hospital Revenue Code	259
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of IA Commercial	$1.49
Rate for Payer: Aetna of IA Medical Rental Products	$1.49
Rate for Payer: Cash Price	$1.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.24
Rate for Payer: Medical Associates Commercial	$1.24
Rate for Payer: Midlands Choice Commercial	$1.16
Rate for Payer: United Healthcare Commercial	$1.49

methotrexate 25 mg/mL 2 ML PF SDV [VDMC]

Facility

$58.08

Service Code	HCPCS J9260
Hospital Charge Code	12477553
Hospital Revenue Code	259
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$52.27
Rate for Payer: Aetna of IA Commercial	$52.27
Rate for Payer: Aetna of IA Medical Rental Products	$52.27
Rate for Payer: Cash Price	$46.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.56
Rate for Payer: Medical Associates Commercial	$43.56
Rate for Payer: Midlands Choice Commercial	$40.66
Rate for Payer: United Healthcare Commercial	$52.27

methotrexate 25 mg/mL 2 ML PF SDV [VDMC]

Facility

$58.08

Service Code	HCPCS J9260
Hospital Charge Code	12477553
Hospital Revenue Code	259
Min. Negotiated Rate	$26.14
Max. Negotiated Rate	$658.38
Rate for Payer: Aetna of IA Commercial	$52.27
Rate for Payer: Aetna of IA Medical Rental Products	$52.27
Rate for Payer: Aetna of IA Medicare	$33.11
Rate for Payer: Amerigroup Medicaid	$33.50
Rate for Payer: Amerigroup Medicare	$26.40
Rate for Payer: Cash Price	$46.46
Rate for Payer: Cash Price	$46.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.14
Rate for Payer: Iowa Total Care Managed Medicaid	$33.18
Rate for Payer: Medical Associates Commercial	$43.56
Rate for Payer: Medical Associates Managed Medicare	$26.14
Rate for Payer: Midlands Choice Commercial	$40.66
Rate for Payer: Molina Healthcare Managed Medicaid	$33.66
Rate for Payer: Partners Health Alliance Commercial	$30.06
Rate for Payer: United Healthcare Commercial	$52.27
Rate for Payer: United Healthcare Managed Medicare	$34.27
Rate for Payer: Wellmark IA HMO WHPI	$597.69
Rate for Payer: Wellmark IA PPO	$658.38

methotrexate 2.5 mg Tab [VDMC]

Facility

$3.20

Service Code	HCPCS A9270
Hospital Charge Code	10404216
Hospital Revenue Code	259
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna of IA Commercial	$2.88
Rate for Payer: Aetna of IA Medical Rental Products	$2.88
Rate for Payer: Cash Price	$2.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.40
Rate for Payer: Medical Associates Commercial	$2.40
Rate for Payer: Midlands Choice Commercial	$2.24
Rate for Payer: United Healthcare Commercial	$2.88

methotrexate 2.5 mg Tab [VDMC]

Facility

$3.20

Service Code	HCPCS A9270
Hospital Charge Code	10404216
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna of IA Commercial	$2.88
Rate for Payer: Aetna of IA Medical Rental Products	$2.88
Rate for Payer: Aetna of IA Medicare	$1.83
Rate for Payer: Amerigroup Medicaid	$1.85
Rate for Payer: Amerigroup Medicare	$1.46
Rate for Payer: Cash Price	$2.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.44
Rate for Payer: Iowa Total Care Managed Medicaid	$1.83
Rate for Payer: Medical Associates Commercial	$2.40
Rate for Payer: Medical Associates Managed Medicare	$1.44
Rate for Payer: Midlands Choice Commercial	$2.24
Rate for Payer: Molina Healthcare Managed Medicaid	$1.86
Rate for Payer: Partners Health Alliance Commercial	$1.66
Rate for Payer: United Healthcare Commercial	$2.88
Rate for Payer: United Healthcare Managed Medicare	$1.89

methylene blue 5 mg/mL 10ml SDV inj [VDMC]

Facility

$789.71

Service Code	HCPCS J3490
Hospital Charge Code	18569211
Hospital Revenue Code	259
Min. Negotiated Rate	$552.80
Max. Negotiated Rate	$710.74
Rate for Payer: Aetna of IA Commercial	$710.74
Rate for Payer: Aetna of IA Medical Rental Products	$710.74
Rate for Payer: Cash Price	$631.77
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$592.28
Rate for Payer: Medical Associates Commercial	$592.28
Rate for Payer: Midlands Choice Commercial	$552.80
Rate for Payer: United Healthcare Commercial	$710.74

methylene blue 5 mg/mL 10ml SDV inj [VDMC]

Facility

$789.71

Service Code	HCPCS J3490
Hospital Charge Code	18569211
Hospital Revenue Code	259
Min. Negotiated Rate	$355.37
Max. Negotiated Rate	$710.74
Rate for Payer: Aetna of IA Commercial	$710.74
Rate for Payer: Aetna of IA Medical Rental Products	$710.74
Rate for Payer: Aetna of IA Medicare	$450.14
Rate for Payer: Amerigroup Medicaid	$455.51
Rate for Payer: Amerigroup Medicare	$358.92
Rate for Payer: Cash Price	$631.77
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$592.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$355.37
Rate for Payer: Iowa Total Care Managed Medicaid	$451.08
Rate for Payer: Medical Associates Commercial	$592.28
Rate for Payer: Medical Associates Managed Medicare	$355.37
Rate for Payer: Midlands Choice Commercial	$552.80
Rate for Payer: Molina Healthcare Managed Medicaid	$457.72
Rate for Payer: Partners Health Alliance Commercial	$408.68
Rate for Payer: United Healthcare Commercial	$710.74
Rate for Payer: United Healthcare Managed Medicare	$465.93

methylergonovine 0.2 mg/mL Inj Sol [VDMC]

Facility

$81.80

Service Code	HCPCS J2210
Hospital Charge Code	10404634
Hospital Revenue Code	259
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna of IA Commercial	$73.62
Rate for Payer: Aetna of IA Medical Rental Products	$73.62
Rate for Payer: Aetna of IA Medicare	$46.62
Rate for Payer: Amerigroup Medicaid	$47.18
Rate for Payer: Amerigroup Medicare	$37.18
Rate for Payer: Cash Price	$65.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.35
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.81
Rate for Payer: Iowa Total Care Managed Medicaid	$46.72
Rate for Payer: Medical Associates Commercial	$61.35
Rate for Payer: Medical Associates Managed Medicare	$36.81
Rate for Payer: Midlands Choice Commercial	$57.26
Rate for Payer: Molina Healthcare Managed Medicaid	$47.41
Rate for Payer: Partners Health Alliance Commercial	$42.33
Rate for Payer: United Healthcare Commercial	$73.62
Rate for Payer: United Healthcare Managed Medicare	$48.26

methylergonovine 0.2 mg/mL Inj Sol [VDMC]

Facility

$81.80

Service Code	HCPCS J2210
Hospital Charge Code	10404634
Hospital Revenue Code	259
Min. Negotiated Rate	$57.26
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna of IA Commercial	$73.62
Rate for Payer: Aetna of IA Medical Rental Products	$73.62
Rate for Payer: Cash Price	$65.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.35
Rate for Payer: Medical Associates Commercial	$61.35
Rate for Payer: Midlands Choice Commercial	$57.26
Rate for Payer: United Healthcare Commercial	$73.62

Methylmalonic Acid DMCL

Facility

$157.00

Service Code	CPT 83921
Hospital Charge Code	8037742
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Aetna of IA Medicare	$89.49
Rate for Payer: Amerigroup Medicaid	$90.56
Rate for Payer: Amerigroup Medicare	$71.36
Rate for Payer: Cash Price	$125.60
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$70.65
Rate for Payer: Iowa Total Care Managed Medicaid	$89.68
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Medical Associates Managed Medicare	$70.65
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: Molina Healthcare Managed Medicaid	$91.00
Rate for Payer: Partners Health Alliance Commercial	$81.25
Rate for Payer: United Healthcare Commercial	$141.30
Rate for Payer: United Healthcare Managed Medicare	$92.63
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Methylmalonic Acid DMCL

Facility

$157.00

Service Code	CPT 83921
Hospital Charge Code	8037742
Hospital Revenue Code	301
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: United Healthcare Commercial	$141.30

methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]

Facility

$645.20

Service Code	HCPCS J2212
Hospital Charge Code	11224341
Hospital Revenue Code	259
Min. Negotiated Rate	$451.64
Max. Negotiated Rate	$580.68
Rate for Payer: Aetna of IA Commercial	$580.68
Rate for Payer: Aetna of IA Medical Rental Products	$580.68
Rate for Payer: Cash Price	$516.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$483.90
Rate for Payer: Medical Associates Commercial	$483.90
Rate for Payer: Midlands Choice Commercial	$451.64
Rate for Payer: United Healthcare Commercial	$580.68

methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]

Facility

$645.20

Service Code	HCPCS J2212
Hospital Charge Code	11224341
Hospital Revenue Code	259
Min. Negotiated Rate	$290.34
Max. Negotiated Rate	$580.68
Rate for Payer: Aetna of IA Commercial	$580.68
Rate for Payer: Aetna of IA Medical Rental Products	$580.68
Rate for Payer: Aetna of IA Medicare	$367.76
Rate for Payer: Amerigroup Medicaid	$372.15
Rate for Payer: Amerigroup Medicare	$293.24
Rate for Payer: Cash Price	$516.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$483.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$290.34
Rate for Payer: Iowa Total Care Managed Medicaid	$368.54
Rate for Payer: Medical Associates Commercial	$483.90
Rate for Payer: Medical Associates Managed Medicare	$290.34
Rate for Payer: Midlands Choice Commercial	$451.64
Rate for Payer: Molina Healthcare Managed Medicaid	$373.96
Rate for Payer: Partners Health Alliance Commercial	$333.89
Rate for Payer: United Healthcare Commercial	$580.68
Rate for Payer: United Healthcare Managed Medicare	$380.67

methylphenidate 5 mg Tab [VDMC]

Facility

$3.37

Service Code	HCPCS A9270
Hospital Charge Code	10404703
Hospital Revenue Code	259
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna of IA Commercial	$3.03
Rate for Payer: Aetna of IA Medical Rental Products	$3.03
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.53
Rate for Payer: Medical Associates Commercial	$2.53
Rate for Payer: Midlands Choice Commercial	$2.36
Rate for Payer: United Healthcare Commercial	$3.03

Know your out-of-pocket cost for care.

All Charges