Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

pyridoxine 50 mg Tab [VDMC]

Facility

$1.05

Service Code	HCPCS A9270
Hospital Charge Code	10417910
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of IA Commercial	$0.94
Rate for Payer: Aetna of IA Medical Rental Products	$0.94
Rate for Payer: Aetna of IA Medicare	$0.60
Rate for Payer: Amerigroup Medicaid	$0.60
Rate for Payer: Amerigroup Medicare	$0.48
Rate for Payer: Cash Price	$0.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.79
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.47
Rate for Payer: Iowa Total Care Managed Medicaid	$0.60
Rate for Payer: Medical Associates Commercial	$0.79
Rate for Payer: Medical Associates Managed Medicare	$0.47
Rate for Payer: Midlands Choice Commercial	$0.73
Rate for Payer: Molina Healthcare Managed Medicaid	$0.61
Rate for Payer: Partners Health Alliance Commercial	$0.54
Rate for Payer: United Healthcare Commercial	$0.94
Rate for Payer: United Healthcare Managed Medicare	$0.62

pyridoxine 50 mg Tab [VDMC]

Facility

$1.05

Service Code	HCPCS A9270
Hospital Charge Code	10417910
Hospital Revenue Code	259
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of IA Commercial	$0.94
Rate for Payer: Aetna of IA Medical Rental Products	$0.94
Rate for Payer: Cash Price	$0.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.79
Rate for Payer: Medical Associates Commercial	$0.79
Rate for Payer: Midlands Choice Commercial	$0.73
Rate for Payer: United Healthcare Commercial	$0.94

Quantiferon TB Gold Plus DMCL

Facility

$140.00

Service Code	CPT 86480
Hospital Charge Code	8488909
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of IA Commercial	$126.00
Rate for Payer: Aetna of IA Medical Rental Products	$126.00
Rate for Payer: Aetna of IA Medicare	$79.80
Rate for Payer: Amerigroup Medicaid	$80.75
Rate for Payer: Amerigroup Medicare	$63.63
Rate for Payer: Cash Price	$112.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$63.00
Rate for Payer: Iowa Total Care Managed Medicaid	$79.97
Rate for Payer: Medical Associates Commercial	$105.00
Rate for Payer: Medical Associates Managed Medicare	$63.00
Rate for Payer: Midlands Choice Commercial	$98.00
Rate for Payer: Molina Healthcare Managed Medicaid	$81.14
Rate for Payer: Partners Health Alliance Commercial	$72.45
Rate for Payer: United Healthcare Commercial	$126.00
Rate for Payer: United Healthcare Managed Medicare	$82.60

Quantiferon TB Gold Plus DMCL

Facility

$140.00

Service Code	CPT 86480
Hospital Charge Code	8488909
Hospital Revenue Code	300
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of IA Commercial	$126.00
Rate for Payer: Aetna of IA Medical Rental Products	$126.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.00
Rate for Payer: Medical Associates Commercial	$105.00
Rate for Payer: Midlands Choice Commercial	$98.00
Rate for Payer: United Healthcare Commercial	$126.00

QUEtiapine 100 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10417979
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

QUEtiapine 100 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10417979
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

QUEtiapine 25 mg Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10418050
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of IA Commercial	$1.30
Rate for Payer: Aetna of IA Medical Rental Products	$1.30
Rate for Payer: Aetna of IA Medicare	$0.82
Rate for Payer: Amerigroup Medicaid	$0.83
Rate for Payer: Amerigroup Medicare	$0.66
Rate for Payer: Cash Price	$1.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.65
Rate for Payer: Iowa Total Care Managed Medicaid	$0.83
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: Molina Healthcare Managed Medicaid	$0.84
Rate for Payer: Partners Health Alliance Commercial	$0.75
Rate for Payer: United Healthcare Commercial	$1.30
Rate for Payer: United Healthcare Managed Medicare	$0.85

QUEtiapine 25 mg Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10418050
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of IA Commercial	$1.30
Rate for Payer: Aetna of IA Medical Rental Products	$1.30
Rate for Payer: Cash Price	$1.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: United Healthcare Commercial	$1.30

QUICKFIX SCREW 2X10MM

Facility

$432.00

Service Code	HCPCS C1713
Hospital Charge Code	8852325
Hospital Revenue Code	278
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: United Healthcare Commercial	$388.80

QUICKFIX SCREW 2X10MM

Facility

$432.00

Service Code	HCPCS C1713
Hospital Charge Code	8852325
Hospital Revenue Code	278
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Aetna of IA Medicare	$246.24
Rate for Payer: Amerigroup Medicaid	$249.18
Rate for Payer: Amerigroup Medicare	$196.34
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$194.40
Rate for Payer: Iowa Total Care Managed Medicaid	$246.76
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Medical Associates Managed Medicare	$194.40
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: Molina Healthcare Managed Medicaid	$250.39
Rate for Payer: Partners Health Alliance Commercial	$223.56
Rate for Payer: United Healthcare Commercial	$388.80
Rate for Payer: United Healthcare Managed Medicare	$254.88

QUICKFIX SCREW 2X11MM

Facility

$432.00

Service Code	HCPCS C1783
Hospital Charge Code	8463228
Hospital Revenue Code	278
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: United Healthcare Commercial	$388.80

QUICKFIX SCREW 2X11MM

Facility

$432.00

Service Code	HCPCS C1783
Hospital Charge Code	8463228
Hospital Revenue Code	278
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Aetna of IA Medicare	$246.24
Rate for Payer: Amerigroup Medicaid	$249.18
Rate for Payer: Amerigroup Medicare	$196.34
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$194.40
Rate for Payer: Iowa Total Care Managed Medicaid	$246.76
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Medical Associates Managed Medicare	$194.40
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: Molina Healthcare Managed Medicaid	$250.39
Rate for Payer: Partners Health Alliance Commercial	$223.56
Rate for Payer: United Healthcare Commercial	$388.80
Rate for Payer: United Healthcare Managed Medicare	$254.88

QUICKFIX SCREW 2X13MM

Facility

$432.00

Service Code	HCPCS C1713
Hospital Charge Code	8852327
Hospital Revenue Code	278
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: United Healthcare Commercial	$388.80

QUICKFIX SCREW 2X13MM

Facility

$432.00

Service Code	HCPCS C1713
Hospital Charge Code	8852327
Hospital Revenue Code	278
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Aetna of IA Medicare	$246.24
Rate for Payer: Amerigroup Medicaid	$249.18
Rate for Payer: Amerigroup Medicare	$196.34
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$194.40
Rate for Payer: Iowa Total Care Managed Medicaid	$246.76
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Medical Associates Managed Medicare	$194.40
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: Molina Healthcare Managed Medicaid	$250.39
Rate for Payer: Partners Health Alliance Commercial	$223.56
Rate for Payer: United Healthcare Commercial	$388.80
Rate for Payer: United Healthcare Managed Medicare	$254.88

Qutenza Administration Charge

Facility

$300.00

Service Code	CPT 17999
Hospital Charge Code	8964103
Hospital Revenue Code	761
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of IA Commercial	$270.00
Rate for Payer: Aetna of IA Medical Rental Products	$270.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$225.00
Rate for Payer: Medical Associates Commercial	$225.00
Rate for Payer: Midlands Choice Commercial	$210.00
Rate for Payer: United Healthcare Commercial	$270.00

Qutenza Administration Charge

Facility

$300.00

Service Code	CPT 17999
Hospital Charge Code	8964103
Hospital Revenue Code	761
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of IA Commercial	$270.00
Rate for Payer: Aetna of IA Medical Rental Products	$270.00
Rate for Payer: Aetna of IA Medicare	$171.00
Rate for Payer: Amerigroup Medicaid	$173.04
Rate for Payer: Amerigroup Medicare	$136.35
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$225.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$135.00
Rate for Payer: Iowa Total Care Managed Medicaid	$171.36
Rate for Payer: Medical Associates Commercial	$225.00
Rate for Payer: Medical Associates Managed Medicare	$135.00
Rate for Payer: Midlands Choice Commercial	$210.00
Rate for Payer: Molina Healthcare Managed Medicaid	$173.88
Rate for Payer: Partners Health Alliance Commercial	$155.25
Rate for Payer: United Healthcare Commercial	$270.00
Rate for Payer: United Healthcare Managed Medicare	$177.00

rabies immune globulin, human 150 intl units/mL 2ml IM SDV [VDMC]

Facility

$1,775.00

Service Code	HCPCS 90376
Hospital Charge Code	10432228
Hospital Revenue Code	259
Min. Negotiated Rate	$798.75
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of IA Commercial	$1,597.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,597.50
Rate for Payer: Aetna of IA Medicare	$1,011.75
Rate for Payer: Amerigroup Medicaid	$1,023.82
Rate for Payer: Amerigroup Medicare	$806.74
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,331.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$798.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,013.88
Rate for Payer: Medical Associates Commercial	$1,331.25
Rate for Payer: Medical Associates Managed Medicare	$798.75
Rate for Payer: Midlands Choice Commercial	$1,242.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,028.79
Rate for Payer: Partners Health Alliance Commercial	$918.56
Rate for Payer: United Healthcare Commercial	$1,597.50
Rate for Payer: United Healthcare Managed Medicare	$1,047.25

rabies immune globulin, human 150 intl units/mL 2ml IM SDV [VDMC]

Facility

$1,775.00

Service Code	HCPCS 90376
Hospital Charge Code	10432228
Hospital Revenue Code	259
Min. Negotiated Rate	$1,242.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of IA Commercial	$1,597.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,597.50
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,331.25
Rate for Payer: Medical Associates Commercial	$1,331.25
Rate for Payer: Midlands Choice Commercial	$1,242.50
Rate for Payer: United Healthcare Commercial	$1,597.50

rabies vaccine, purified chick embryo cell 2.5 intl units SDV Pow[VDMC]

Facility

$1,542.88

Service Code	HCPCS 90675
Hospital Charge Code	18398617
Hospital Revenue Code	259
Min. Negotiated Rate	$1,080.02
Max. Negotiated Rate	$1,388.59
Rate for Payer: Aetna of IA Commercial	$1,388.59
Rate for Payer: Aetna of IA Medical Rental Products	$1,388.59
Rate for Payer: Cash Price	$1,234.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,157.16
Rate for Payer: Medical Associates Commercial	$1,157.16
Rate for Payer: Midlands Choice Commercial	$1,080.02
Rate for Payer: United Healthcare Commercial	$1,388.59

rabies vaccine, purified chick embryo cell 2.5 intl units SDV Pow[VDMC]

Facility

$1,542.88

Service Code	HCPCS 90675
Hospital Charge Code	18398617
Hospital Revenue Code	259
Min. Negotiated Rate	$694.30
Max. Negotiated Rate	$1,388.59
Rate for Payer: Aetna of IA Commercial	$1,388.59
Rate for Payer: Aetna of IA Medical Rental Products	$1,388.59
Rate for Payer: Aetna of IA Medicare	$879.44
Rate for Payer: Amerigroup Medicaid	$889.93
Rate for Payer: Amerigroup Medicare	$701.24
Rate for Payer: Cash Price	$1,234.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,157.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$694.30
Rate for Payer: Iowa Total Care Managed Medicaid	$881.29
Rate for Payer: Medical Associates Commercial	$1,157.16
Rate for Payer: Medical Associates Managed Medicare	$694.30
Rate for Payer: Midlands Choice Commercial	$1,080.02
Rate for Payer: Molina Healthcare Managed Medicaid	$894.25
Rate for Payer: Partners Health Alliance Commercial	$798.44
Rate for Payer: United Healthcare Commercial	$1,388.59
Rate for Payer: United Healthcare Managed Medicare	$910.30

racepinephrine 2.25% Sol UD [VDMC]

Facility

$7.67

Service Code	HCPCS A9270
Hospital Charge Code	10437426
Hospital Revenue Code	259
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna of IA Commercial	$6.90
Rate for Payer: Aetna of IA Medical Rental Products	$6.90
Rate for Payer: Cash Price	$6.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.75
Rate for Payer: Medical Associates Commercial	$5.75
Rate for Payer: Midlands Choice Commercial	$5.37
Rate for Payer: United Healthcare Commercial	$6.90

racepinephrine 2.25% Sol UD [VDMC]

Facility

$7.67

Service Code	HCPCS A9270
Hospital Charge Code	10437426
Hospital Revenue Code	259
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna of IA Commercial	$6.90
Rate for Payer: Aetna of IA Medical Rental Products	$6.90
Rate for Payer: Aetna of IA Medicare	$4.37
Rate for Payer: Amerigroup Medicaid	$4.42
Rate for Payer: Amerigroup Medicare	$3.48
Rate for Payer: Cash Price	$6.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.45
Rate for Payer: Iowa Total Care Managed Medicaid	$4.38
Rate for Payer: Medical Associates Commercial	$5.75
Rate for Payer: Medical Associates Managed Medicare	$3.45
Rate for Payer: Midlands Choice Commercial	$5.37
Rate for Payer: Molina Healthcare Managed Medicaid	$4.44
Rate for Payer: Partners Health Alliance Commercial	$3.97
Rate for Payer: United Healthcare Commercial	$6.90
Rate for Payer: United Healthcare Managed Medicare	$4.52

raloxifene 60 mg Tab[VDMC]

Facility

$2.60

Service Code	HCPCS A9270
Hospital Charge Code	11522776
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of IA Commercial	$2.34
Rate for Payer: Aetna of IA Medical Rental Products	$2.34
Rate for Payer: Aetna of IA Medicare	$1.48
Rate for Payer: Amerigroup Medicaid	$1.50
Rate for Payer: Amerigroup Medicare	$1.18
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.17
Rate for Payer: Iowa Total Care Managed Medicaid	$1.49
Rate for Payer: Medical Associates Commercial	$1.95
Rate for Payer: Medical Associates Managed Medicare	$1.17
Rate for Payer: Midlands Choice Commercial	$1.82
Rate for Payer: Molina Healthcare Managed Medicaid	$1.51
Rate for Payer: Partners Health Alliance Commercial	$1.35
Rate for Payer: United Healthcare Commercial	$2.34
Rate for Payer: United Healthcare Managed Medicare	$1.53

raloxifene 60 mg Tab[VDMC]

Facility

$2.60

Service Code	HCPCS A9270
Hospital Charge Code	11522776
Hospital Revenue Code	259
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of IA Commercial	$2.34
Rate for Payer: Aetna of IA Medical Rental Products	$2.34
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.95
Rate for Payer: Medical Associates Commercial	$1.95
Rate for Payer: Midlands Choice Commercial	$1.82
Rate for Payer: United Healthcare Commercial	$2.34

ramipril 1.25 mg Cap [VDMC]

Facility

$1.30

Service Code	HCPCS A9270
Hospital Charge Code	10418397
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

Know your out-of-pocket cost for care.

All Charges