Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

prednisoLONE 45 mg/15 mL Syr [VDMC]

Facility

$69.24

Service Code	HCPCS J7510
Hospital Charge Code	11221578
Hospital Revenue Code	259
Min. Negotiated Rate	$48.47
Max. Negotiated Rate	$62.32
Rate for Payer: Aetna of IA Commercial	$62.32
Rate for Payer: Aetna of IA Medical Rental Products	$62.32
Rate for Payer: Cash Price	$55.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.93
Rate for Payer: Medical Associates Commercial	$51.93
Rate for Payer: Midlands Choice Commercial	$48.47
Rate for Payer: United Healthcare Commercial	$62.32

prednisoLONE Ophth acetate 1% Susp 5 ml [VDMC]

Facility

$106.80

Service Code	HCPCS A9270
Hospital Charge Code	10437361
Hospital Revenue Code	259
Min. Negotiated Rate	$53.38
Max. Negotiated Rate	$96.12
Rate for Payer: Aetna of IA Commercial	$96.12
Rate for Payer: Aetna of IA Medical Rental Products	$96.12
Rate for Payer: Aetna of IA Medicare	$60.88
Rate for Payer: Amerigroup Medicaid	$53.90
Rate for Payer: Amerigroup Medicare	$53.93
Rate for Payer: Cash Price	$85.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$53.40
Rate for Payer: Iowa Total Care Managed Medicaid	$53.38
Rate for Payer: Medical Associates Commercial	$80.10
Rate for Payer: Medical Associates Managed Medicare	$53.40
Rate for Payer: Midlands Choice Commercial	$74.76
Rate for Payer: Molina Healthcare Managed Medicaid	$54.20
Rate for Payer: Molina Healthcare Managed Medicare	$54.17
Rate for Payer: Oscar Health of IA Commercial	$80.10
Rate for Payer: Partners Health Alliance Commercial	$80.10
Rate for Payer: United Healthcare Commercial	$96.12
Rate for Payer: United Healthcare Managed Medicare	$63.01

prednisoLONE Ophth acetate 1% Susp 5 ml [VDMC]

Facility

$106.80

Service Code	HCPCS A9270
Hospital Charge Code	10437361
Hospital Revenue Code	259
Min. Negotiated Rate	$74.76
Max. Negotiated Rate	$96.12
Rate for Payer: Aetna of IA Commercial	$96.12
Rate for Payer: Aetna of IA Medical Rental Products	$96.12
Rate for Payer: Cash Price	$85.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.10
Rate for Payer: Medical Associates Commercial	$80.10
Rate for Payer: Midlands Choice Commercial	$74.76
Rate for Payer: United Healthcare Commercial	$96.12

prednisoLONE sodium phosphate 5 mg/5 mL Oral Liq [VDMC]

Facility

$13.27

Service Code	HCPCS J7510
Hospital Charge Code	10415499
Hospital Revenue Code	259
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$11.94
Rate for Payer: Aetna of IA Commercial	$11.94
Rate for Payer: Aetna of IA Medical Rental Products	$11.94
Rate for Payer: Aetna of IA Medicare	$7.56
Rate for Payer: Amerigroup Medicaid	$6.70
Rate for Payer: Amerigroup Medicare	$6.70
Rate for Payer: Cash Price	$10.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.64
Rate for Payer: Iowa Total Care Managed Medicaid	$6.63
Rate for Payer: Medical Associates Commercial	$9.95
Rate for Payer: Medical Associates Managed Medicare	$6.64
Rate for Payer: Midlands Choice Commercial	$9.29
Rate for Payer: Molina Healthcare Managed Medicaid	$6.73
Rate for Payer: Molina Healthcare Managed Medicare	$6.73
Rate for Payer: Oscar Health of IA Commercial	$9.95
Rate for Payer: Partners Health Alliance Commercial	$9.95
Rate for Payer: United Healthcare Commercial	$11.94
Rate for Payer: United Healthcare Managed Medicare	$7.83

prednisoLONE sodium phosphate 5 mg/5 mL Oral Liq [VDMC]

Facility

$13.27

Service Code	HCPCS J7510
Hospital Charge Code	10415499
Hospital Revenue Code	259
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$11.94
Rate for Payer: Aetna of IA Commercial	$11.94
Rate for Payer: Aetna of IA Medical Rental Products	$11.94
Rate for Payer: Cash Price	$10.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.95
Rate for Payer: Medical Associates Commercial	$9.95
Rate for Payer: Midlands Choice Commercial	$9.29
Rate for Payer: United Healthcare Commercial	$11.94

predniSONE 10 mg Tab [VDMC]

Facility

$1.41

Service Code	HCPCS A9270
Hospital Charge Code	10415637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna of IA Commercial	$1.27
Rate for Payer: Aetna of IA Medical Rental Products	$1.27
Rate for Payer: Aetna of IA Medicare	$0.80
Rate for Payer: Amerigroup Medicaid	$0.71
Rate for Payer: Amerigroup Medicare	$0.71
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.71
Rate for Payer: Iowa Total Care Managed Medicaid	$0.70
Rate for Payer: Medical Associates Commercial	$1.06
Rate for Payer: Medical Associates Managed Medicare	$0.71
Rate for Payer: Midlands Choice Commercial	$0.99
Rate for Payer: Molina Healthcare Managed Medicaid	$0.72
Rate for Payer: Molina Healthcare Managed Medicare	$0.72
Rate for Payer: Oscar Health of IA Commercial	$1.06
Rate for Payer: Partners Health Alliance Commercial	$1.06
Rate for Payer: United Healthcare Commercial	$1.27
Rate for Payer: United Healthcare Managed Medicare	$0.83

predniSONE 10 mg Tab [VDMC]

Facility

$1.41

Service Code	HCPCS A9270
Hospital Charge Code	10415637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna of IA Commercial	$1.27
Rate for Payer: Aetna of IA Medical Rental Products	$1.27
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.06
Rate for Payer: Medical Associates Commercial	$1.06
Rate for Payer: Midlands Choice Commercial	$0.99
Rate for Payer: United Healthcare Commercial	$1.27

predniSONE 1 mg Tab [VDMC]

Facility

$1.64

Service Code	HCPCS A9270
Hospital Charge Code	10415568
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of IA Commercial	$1.48
Rate for Payer: Aetna of IA Medical Rental Products	$1.48
Rate for Payer: Aetna of IA Medicare	$0.93
Rate for Payer: Amerigroup Medicaid	$0.83
Rate for Payer: Amerigroup Medicare	$0.83
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.23
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.82
Rate for Payer: Iowa Total Care Managed Medicaid	$0.82
Rate for Payer: Medical Associates Commercial	$1.23
Rate for Payer: Medical Associates Managed Medicare	$0.82
Rate for Payer: Midlands Choice Commercial	$1.15
Rate for Payer: Molina Healthcare Managed Medicaid	$0.83
Rate for Payer: Molina Healthcare Managed Medicare	$0.83
Rate for Payer: Oscar Health of IA Commercial	$1.23
Rate for Payer: Partners Health Alliance Commercial	$1.23
Rate for Payer: United Healthcare Commercial	$1.48
Rate for Payer: United Healthcare Managed Medicare	$0.97

predniSONE 1 mg Tab [VDMC]

Facility

$1.64

Service Code	HCPCS A9270
Hospital Charge Code	10415568
Hospital Revenue Code	259
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of IA Commercial	$1.48
Rate for Payer: Aetna of IA Medical Rental Products	$1.48
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.23
Rate for Payer: Medical Associates Commercial	$1.23
Rate for Payer: Midlands Choice Commercial	$1.15
Rate for Payer: United Healthcare Commercial	$1.48

predniSONE 20 mg Tab [VDMC]

Facility

$1.50

Service Code	HCPCS A9270
Hospital Charge Code	10415706
Hospital Revenue Code	259
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of IA Commercial	$1.35
Rate for Payer: Aetna of IA Medical Rental Products	$1.35
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.12
Rate for Payer: Medical Associates Commercial	$1.12
Rate for Payer: Midlands Choice Commercial	$1.05
Rate for Payer: United Healthcare Commercial	$1.35

predniSONE 20 mg Tab [VDMC]

Facility

$1.50

Service Code	HCPCS A9270
Hospital Charge Code	10415706
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of IA Commercial	$1.35
Rate for Payer: Aetna of IA Medical Rental Products	$1.35
Rate for Payer: Aetna of IA Medicare	$0.86
Rate for Payer: Amerigroup Medicaid	$0.76
Rate for Payer: Amerigroup Medicare	$0.76
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.12
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	$0.75
Rate for Payer: Medical Associates Commercial	$1.12
Rate for Payer: Medical Associates Managed Medicare	$0.75
Rate for Payer: Midlands Choice Commercial	$1.05
Rate for Payer: Molina Healthcare Managed Medicaid	$0.76
Rate for Payer: Molina Healthcare Managed Medicare	$0.76
Rate for Payer: Oscar Health of IA Commercial	$1.12
Rate for Payer: Partners Health Alliance Commercial	$1.12
Rate for Payer: United Healthcare Commercial	$1.35
Rate for Payer: United Healthcare Managed Medicare	$0.89

predniSONE 5 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	10415775
Hospital Revenue Code	259
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: United Healthcare Commercial	$1.37

predniSONE 5 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	10415775
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Aetna of IA Medicare	$0.87
Rate for Payer: Amerigroup Medicaid	$0.77
Rate for Payer: Amerigroup Medicare	$0.77
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
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	$0.76
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Medical Associates Managed Medicare	$0.76
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: Molina Healthcare Managed Medicaid	$0.77
Rate for Payer: Molina Healthcare Managed Medicare	$0.77
Rate for Payer: Oscar Health of IA Commercial	$1.14
Rate for Payer: Partners Health Alliance Commercial	$1.14
Rate for Payer: United Healthcare Commercial	$1.37
Rate for Payer: United Healthcare Managed Medicare	$0.90

pregabalin 25 mg oral capsule [VDMC]

Facility

$3.24

Service Code	HCPCS A9270
Hospital Charge Code	10415844
Hospital Revenue Code	259
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of IA Commercial	$2.92
Rate for Payer: Aetna of IA Medical Rental Products	$2.92
Rate for Payer: Aetna of IA Medicare	$1.85
Rate for Payer: Amerigroup Medicaid	$1.64
Rate for Payer: Amerigroup Medicare	$1.64
Rate for Payer: Cash Price	$2.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.43
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.62
Rate for Payer: Iowa Total Care Managed Medicaid	$1.62
Rate for Payer: Medical Associates Commercial	$2.43
Rate for Payer: Medical Associates Managed Medicare	$1.62
Rate for Payer: Midlands Choice Commercial	$2.27
Rate for Payer: Molina Healthcare Managed Medicaid	$1.64
Rate for Payer: Molina Healthcare Managed Medicare	$1.64
Rate for Payer: Oscar Health of IA Commercial	$2.43
Rate for Payer: Partners Health Alliance Commercial	$2.43
Rate for Payer: United Healthcare Commercial	$2.92
Rate for Payer: United Healthcare Managed Medicare	$1.91

pregabalin 25 mg oral capsule [VDMC]

Facility

$3.24

Service Code	HCPCS A9270
Hospital Charge Code	10415844
Hospital Revenue Code	259
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of IA Commercial	$2.92
Rate for Payer: Aetna of IA Medical Rental Products	$2.92
Rate for Payer: Cash Price	$2.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.43
Rate for Payer: Medical Associates Commercial	$2.43
Rate for Payer: Midlands Choice Commercial	$2.27
Rate for Payer: United Healthcare Commercial	$2.92

pregabalin 75 mg oral capsule [VDMC]

Facility

$3.12

Service Code	HCPCS A9270
Hospital Charge Code	10415913
Hospital Revenue Code	259
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna of IA Commercial	$2.81
Rate for Payer: Aetna of IA Medical Rental Products	$2.81
Rate for Payer: Aetna of IA Medicare	$1.78
Rate for Payer: Amerigroup Medicaid	$1.57
Rate for Payer: Amerigroup Medicare	$1.58
Rate for Payer: Cash Price	$2.49
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.34
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.56
Rate for Payer: Iowa Total Care Managed Medicaid	$1.56
Rate for Payer: Medical Associates Commercial	$2.34
Rate for Payer: Medical Associates Managed Medicare	$1.56
Rate for Payer: Midlands Choice Commercial	$2.18
Rate for Payer: Molina Healthcare Managed Medicaid	$1.58
Rate for Payer: Molina Healthcare Managed Medicare	$1.58
Rate for Payer: Oscar Health of IA Commercial	$2.34
Rate for Payer: Partners Health Alliance Commercial	$2.34
Rate for Payer: United Healthcare Commercial	$2.81
Rate for Payer: United Healthcare Managed Medicare	$1.84

pregabalin 75 mg oral capsule [VDMC]

Facility

$3.12

Service Code	HCPCS A9270
Hospital Charge Code	10415913
Hospital Revenue Code	259
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna of IA Commercial	$2.81
Rate for Payer: Aetna of IA Medical Rental Products	$2.81
Rate for Payer: Cash Price	$2.49
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.34
Rate for Payer: Medical Associates Commercial	$2.34
Rate for Payer: Midlands Choice Commercial	$2.18
Rate for Payer: United Healthcare Commercial	$2.81

PREGNANCY-SERUM

Facility

$92.00

Service Code	CPT 84703
Hospital Charge Code	4022808
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of IA Commercial	$82.80
Rate for Payer: Aetna of IA Medical Rental Products	$82.80
Rate for Payer: Aetna of IA Medicare	$52.44
Rate for Payer: Amerigroup Medicaid	$46.43
Rate for Payer: Amerigroup Medicare	$46.46
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.00
Rate for Payer: Iowa Total Care Managed Medicaid	$45.98
Rate for Payer: Medical Associates Commercial	$69.00
Rate for Payer: Medical Associates Managed Medicare	$46.00
Rate for Payer: Midlands Choice Commercial	$64.40
Rate for Payer: Molina Healthcare Managed Medicaid	$46.69
Rate for Payer: Molina Healthcare Managed Medicare	$46.66
Rate for Payer: Oscar Health of IA Commercial	$69.00
Rate for Payer: Partners Health Alliance Commercial	$69.00
Rate for Payer: United Healthcare Commercial	$82.80
Rate for Payer: United Healthcare Managed Medicare	$54.28
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

PREGNANCY-SERUM

Facility

$92.00

Service Code	CPT 84703
Hospital Charge Code	4022808
Hospital Revenue Code	301
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of IA Commercial	$82.80
Rate for Payer: Aetna of IA Medical Rental Products	$82.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.00
Rate for Payer: Medical Associates Commercial	$69.00
Rate for Payer: Midlands Choice Commercial	$64.40
Rate for Payer: United Healthcare Commercial	$82.80

PREGNANCY TEST-URINE

Facility

$60.00

Service Code	CPT 81025
Hospital Charge Code	4022807
Hospital Revenue Code	301
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of IA Commercial	$54.00
Rate for Payer: Aetna of IA Medical Rental Products	$54.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.00
Rate for Payer: Medical Associates Commercial	$45.00
Rate for Payer: Midlands Choice Commercial	$42.00
Rate for Payer: United Healthcare Commercial	$54.00

PREGNANCY TEST-URINE

Facility

$60.00

Service Code	CPT 81025
Hospital Charge Code	4022807
Hospital Revenue Code	301
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of IA Commercial	$54.00
Rate for Payer: Aetna of IA Medical Rental Products	$54.00
Rate for Payer: Aetna of IA Medicare	$34.20
Rate for Payer: Amerigroup Medicaid	$30.28
Rate for Payer: Amerigroup Medicare	$30.30
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.00
Rate for Payer: Iowa Total Care Managed Medicaid	$29.99
Rate for Payer: Medical Associates Commercial	$45.00
Rate for Payer: Medical Associates Managed Medicare	$30.00
Rate for Payer: Midlands Choice Commercial	$42.00
Rate for Payer: Molina Healthcare Managed Medicaid	$30.45
Rate for Payer: Molina Healthcare Managed Medicare	$30.43
Rate for Payer: Oscar Health of IA Commercial	$45.00
Rate for Payer: Partners Health Alliance Commercial	$45.00
Rate for Payer: United Healthcare Commercial	$54.00
Rate for Payer: United Healthcare Managed Medicare	$35.40
Rate for Payer: Wellmark IA HMO	$22.32
Rate for Payer: Wellmark IA PPO	$24.55

Prematurity With Major Problems

Facility

$9,354.23

Service Code	MS-DRG 791
Hospital Charge Code	533
Min. Negotiated Rate	$9,218.66
Max. Negotiated Rate	$9,354.23
Rate for Payer: Amerigroup Medicaid	$9,309.04
Rate for Payer: Iowa Total Care Managed Medicaid	$9,218.66
Rate for Payer: Molina Healthcare Managed Medicaid	$9,354.23

Prematurity Without Major Problems

Facility

$4,328.69

Service Code	MS-DRG 792
Hospital Charge Code	534
Min. Negotiated Rate	$4,265.96
Max. Negotiated Rate	$4,328.69
Rate for Payer: Amerigroup Medicaid	$4,307.78
Rate for Payer: Iowa Total Care Managed Medicaid	$4,265.96
Rate for Payer: Molina Healthcare Managed Medicaid	$4,328.69

Prenatal Multivitamins [VDMC]

Facility

$1.30

Service Code	HCPCS S0197
Hospital Charge Code	13362152
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
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	$0.66
Rate for Payer: Amerigroup Medicare	$0.66
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	$0.65
Rate for Payer: Iowa Total Care Managed Medicaid	$0.65
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$0.91
Rate for Payer: Molina Healthcare Managed Medicaid	$0.66
Rate for Payer: Molina Healthcare Managed Medicare	$0.66
Rate for Payer: Oscar Health of IA Commercial	$0.98
Rate for Payer: Partners Health Alliance Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.17
Rate for Payer: United Healthcare Managed Medicare	$0.77

Prenatal Multivitamins [VDMC]

Facility

$1.30

Service Code	HCPCS S0197
Hospital Charge Code	13362152
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