Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ALK PHOSPHATASE

Facility

$53.00

Service Code	CPT 84075
Hospital Charge Code	1620878
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of IA Commercial	$47.70
Rate for Payer: Aetna of IA Medical Rental Products	$47.70
Rate for Payer: Aetna of IA Medicare	$30.21
Rate for Payer: Amerigroup Medicaid	$26.75
Rate for Payer: Amerigroup Medicare	$26.76
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.50
Rate for Payer: Iowa Total Care Managed Medicaid	$26.49
Rate for Payer: Medical Associates Commercial	$39.75
Rate for Payer: Medical Associates Managed Medicare	$26.50
Rate for Payer: Midlands Choice Commercial	$37.10
Rate for Payer: Molina Healthcare Managed Medicaid	$26.90
Rate for Payer: Molina Healthcare Managed Medicare	$26.88
Rate for Payer: Oscar Health of IA Commercial	$39.75
Rate for Payer: Partners Health Alliance Commercial	$39.75
Rate for Payer: United Healthcare Commercial	$47.70
Rate for Payer: United Healthcare Managed Medicare	$31.27
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

ALK PHOSPHATASE

Facility

$53.00

Service Code	CPT 84075
Hospital Charge Code	1620878
Hospital Revenue Code	301
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of IA Commercial	$47.70
Rate for Payer: Aetna of IA Medical Rental Products	$47.70
Rate for Payer: Cash Price	$42.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.75
Rate for Payer: Medical Associates Commercial	$39.75
Rate for Payer: Midlands Choice Commercial	$37.10
Rate for Payer: United Healthcare Commercial	$47.70

Allergic Reactions With MCC

Facility

$11,120.94

Service Code	MS-DRG 915
Hospital Charge Code	633
Min. Negotiated Rate	$10,959.77
Max. Negotiated Rate	$11,120.94
Rate for Payer: Amerigroup Medicaid	$11,067.22
Rate for Payer: Iowa Total Care Managed Medicaid	$10,959.77
Rate for Payer: Molina Healthcare Managed Medicaid	$11,120.94

Allergic Reactions Without MCC

Facility

$5,287.35

Service Code	MS-DRG 916
Hospital Charge Code	634
Min. Negotiated Rate	$5,210.72
Max. Negotiated Rate	$5,287.35
Rate for Payer: Amerigroup Medicaid	$5,261.81
Rate for Payer: Iowa Total Care Managed Medicaid	$5,210.72
Rate for Payer: Molina Healthcare Managed Medicaid	$5,287.35

Allogeneic Bone Marrow Transplant

Facility

$137,857.79

Service Code	MS-DRG 014
Hospital Charge Code	704
Min. Negotiated Rate	$135,859.85
Max. Negotiated Rate	$137,857.79
Rate for Payer: Amerigroup Medicaid	$137,191.81
Rate for Payer: Iowa Total Care Managed Medicaid	$135,859.85
Rate for Payer: Molina Healthcare Managed Medicaid	$137,857.79

ALLOGRAFT 30X40MM 722-TS

Facility

$3,960.00

Service Code	CPT L8699
Hospital Charge Code	8942325
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.00
Max. Negotiated Rate	$3,564.00
Rate for Payer: Aetna of IA Commercial	$3,564.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,564.00
Rate for Payer: Cash Price	$3,168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,970.00
Rate for Payer: Medical Associates Commercial	$2,970.00
Rate for Payer: Midlands Choice Commercial	$2,772.00
Rate for Payer: United Healthcare Commercial	$3,564.00

ALLOGRAFT 30X40MM 722-TS

Facility

$3,960.00

Service Code	CPT L8699
Hospital Charge Code	8942325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,979.21
Max. Negotiated Rate	$3,564.00
Rate for Payer: Aetna of IA Commercial	$3,564.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,564.00
Rate for Payer: Aetna of IA Medicare	$2,257.20
Rate for Payer: Amerigroup Medicaid	$1,998.61
Rate for Payer: Amerigroup Medicare	$1,999.80
Rate for Payer: Cash Price	$3,168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,970.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,980.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,979.21
Rate for Payer: Medical Associates Commercial	$2,970.00
Rate for Payer: Medical Associates Managed Medicare	$1,980.00
Rate for Payer: Midlands Choice Commercial	$2,772.00
Rate for Payer: Molina Healthcare Managed Medicaid	$2,009.70
Rate for Payer: Molina Healthcare Managed Medicare	$2,008.51
Rate for Payer: Oscar Health of IA Commercial	$2,970.00
Rate for Payer: Partners Health Alliance Commercial	$2,970.00
Rate for Payer: United Healthcare Commercial	$3,564.00
Rate for Payer: United Healthcare Managed Medicare	$2,336.40

allopurinol 100 mg Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10364795
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of IA Commercial	$1.02
Rate for Payer: Aetna of IA Medical Rental Products	$1.02
Rate for Payer: Aetna of IA Medicare	$0.64
Rate for Payer: Amerigroup Medicaid	$0.57
Rate for Payer: Amerigroup Medicare	$0.57
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.85
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.57
Rate for Payer: Iowa Total Care Managed Medicaid	$0.56
Rate for Payer: Medical Associates Commercial	$0.85
Rate for Payer: Medical Associates Managed Medicare	$0.57
Rate for Payer: Midlands Choice Commercial	$0.79
Rate for Payer: Molina Healthcare Managed Medicaid	$0.57
Rate for Payer: Molina Healthcare Managed Medicare	$0.57
Rate for Payer: Oscar Health of IA Commercial	$0.85
Rate for Payer: Partners Health Alliance Commercial	$0.85
Rate for Payer: United Healthcare Commercial	$1.02
Rate for Payer: United Healthcare Managed Medicare	$0.67

allopurinol 100 mg Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10364795
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of IA Commercial	$1.02
Rate for Payer: Aetna of IA Medical Rental Products	$1.02
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.85
Rate for Payer: Medical Associates Commercial	$0.85
Rate for Payer: Midlands Choice Commercial	$0.79
Rate for Payer: United Healthcare Commercial	$1.02

allopurinol 300 mg Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	11263409
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Cash Price	$1.05
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	$0.92
Rate for Payer: United Healthcare Commercial	$1.18

allopurinol 300 mg Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	11263409
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Aetna of IA Medicare	$0.75
Rate for Payer: Amerigroup Medicaid	$0.66
Rate for Payer: Amerigroup Medicare	$0.66
Rate for Payer: Cash Price	$1.05
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	$0.66
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	$0.66
Rate for Payer: Midlands Choice Commercial	$0.92
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	$1.18
Rate for Payer: United Healthcare Managed Medicare	$0.77

ALPHA 1-ANTITRYPSIN

Facility

$139.00

Service Code	CPT 82103
Hospital Charge Code	8037489
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Molina Healthcare Managed Medicare	$70.50
Rate for Payer: Oscar Health of IA Commercial	$104.25
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

ALPHA 1-ANTITRYPSIN

Facility

$139.00

Service Code	CPT 82103
Hospital Charge Code	8037489
Hospital Revenue Code	301
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]

Facility

$1,267.36

Service Code	HCPCS J0256
Hospital Charge Code	22367300
Hospital Revenue Code	259
Min. Negotiated Rate	$633.43
Max. Negotiated Rate	$1,140.62
Rate for Payer: Aetna of IA Commercial	$1,140.62
Rate for Payer: Aetna of IA Medical Rental Products	$1,140.62
Rate for Payer: Aetna of IA Medicare	$722.40
Rate for Payer: Amerigroup Medicaid	$639.64
Rate for Payer: Amerigroup Medicare	$640.02
Rate for Payer: Cash Price	$1,013.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$950.52
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$633.68
Rate for Payer: Iowa Total Care Managed Medicaid	$633.43
Rate for Payer: Medical Associates Commercial	$950.52
Rate for Payer: Medical Associates Managed Medicare	$633.68
Rate for Payer: Midlands Choice Commercial	$887.15
Rate for Payer: Molina Healthcare Managed Medicaid	$643.19
Rate for Payer: Molina Healthcare Managed Medicare	$642.80
Rate for Payer: Oscar Health of IA Commercial	$950.52
Rate for Payer: Partners Health Alliance Commercial	$950.52
Rate for Payer: United Healthcare Commercial	$1,140.62
Rate for Payer: United Healthcare Managed Medicare	$747.74

alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]

Facility

$1,267.36

Service Code	HCPCS J0256
Hospital Charge Code	22367300
Hospital Revenue Code	259
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,140.62
Rate for Payer: Aetna of IA Commercial	$1,140.62
Rate for Payer: Aetna of IA Medical Rental Products	$1,140.62
Rate for Payer: Cash Price	$1,013.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$950.52
Rate for Payer: Medical Associates Commercial	$950.52
Rate for Payer: Midlands Choice Commercial	$887.15
Rate for Payer: United Healthcare Commercial	$1,140.62

ALPHA FETOPROTEIN

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8086832
Hospital Revenue Code	301
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

ALPHA FETOPROTEIN

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8086832
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Molina Healthcare Managed Medicare	$70.50
Rate for Payer: Oscar Health of IA Commercial	$104.25
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Alpha Fetoprotein Tumor Marker DMCL

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8037491
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Molina Healthcare Managed Medicare	$70.50
Rate for Payer: Oscar Health of IA Commercial	$104.25
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Alpha Fetoprotein Tumor Marker DMCL

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8037491
Hospital Revenue Code	301
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

ALPRAZolam 0.25 mg Tab [VDMC]

Facility

$3.08

Service Code	HCPCS A9270
Hospital Charge Code	10364933
Hospital Revenue Code	259
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.77
Rate for Payer: Aetna of IA Commercial	$2.77
Rate for Payer: Aetna of IA Medical Rental Products	$2.77
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.31
Rate for Payer: Medical Associates Commercial	$2.31
Rate for Payer: Midlands Choice Commercial	$2.16
Rate for Payer: United Healthcare Commercial	$2.77

ALPRAZolam 0.25 mg Tab [VDMC]

Facility

$3.08

Service Code	HCPCS A9270
Hospital Charge Code	10364933
Hospital Revenue Code	259
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.46
Rate for Payer: Aetna of IA Commercial	$2.77
Rate for Payer: Aetna of IA Medical Rental Products	$2.77
Rate for Payer: Aetna of IA Medicare	$1.76
Rate for Payer: Amerigroup Medicaid	$1.55
Rate for Payer: Amerigroup Medicare	$1.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.54
Rate for Payer: Iowa Total Care Managed Medicaid	$1.54
Rate for Payer: Medical Associates Commercial	$2.31
Rate for Payer: Medical Associates Managed Medicare	$1.54
Rate for Payer: Midlands Choice Commercial	$2.16
Rate for Payer: Molina Healthcare Managed Medicaid	$1.56
Rate for Payer: Molina Healthcare Managed Medicare	$1.56
Rate for Payer: Oscar Health of IA Commercial	$2.31
Rate for Payer: Partners Health Alliance Commercial	$2.31
Rate for Payer: United Healthcare Commercial	$2.77
Rate for Payer: United Healthcare Managed Medicare	$1.82

ALPRAZolam 0.5 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365002
Hospital Revenue Code	259
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.32
Rate for Payer: Medical Associates Commercial	$2.32
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: United Healthcare Commercial	$2.79

ALPRAZolam 0.5 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365002
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Aetna of IA Medicare	$1.77
Rate for Payer: Amerigroup Medicaid	$1.56
Rate for Payer: Amerigroup Medicare	$1.57
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.32
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.55
Rate for Payer: Iowa Total Care Managed Medicaid	$1.55
Rate for Payer: Medical Associates Commercial	$2.32
Rate for Payer: Medical Associates Managed Medicare	$1.55
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: Molina Healthcare Managed Medicaid	$1.57
Rate for Payer: Molina Healthcare Managed Medicare	$1.57
Rate for Payer: Oscar Health of IA Commercial	$2.32
Rate for Payer: Partners Health Alliance Commercial	$2.32
Rate for Payer: United Healthcare Commercial	$2.79
Rate for Payer: United Healthcare Managed Medicare	$1.83

ALPRAZolam 1 mg oral Dis Tab [VDMC]

Facility

$9.82

Service Code	HCPCS A9270
Hospital Charge Code	10365073
Hospital Revenue Code	259
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$8.84
Rate for Payer: Aetna of IA Commercial	$8.84
Rate for Payer: Aetna of IA Medical Rental Products	$8.84
Rate for Payer: Cash Price	$7.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.36
Rate for Payer: Medical Associates Commercial	$7.36
Rate for Payer: Midlands Choice Commercial	$6.87
Rate for Payer: United Healthcare Commercial	$8.84

ALPRAZolam 1 mg oral Dis Tab [VDMC]

Facility

$9.82

Service Code	HCPCS A9270
Hospital Charge Code	10365073
Hospital Revenue Code	259
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$8.84
Rate for Payer: Aetna of IA Commercial	$8.84
Rate for Payer: Aetna of IA Medical Rental Products	$8.84
Rate for Payer: Aetna of IA Medicare	$5.60
Rate for Payer: Amerigroup Medicaid	$4.96
Rate for Payer: Amerigroup Medicare	$4.96
Rate for Payer: Cash Price	$7.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.36
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.91
Rate for Payer: Iowa Total Care Managed Medicaid	$4.91
Rate for Payer: Medical Associates Commercial	$7.36
Rate for Payer: Medical Associates Managed Medicare	$4.91
Rate for Payer: Midlands Choice Commercial	$6.87
Rate for Payer: Molina Healthcare Managed Medicaid	$4.98
Rate for Payer: Molina Healthcare Managed Medicare	$4.98
Rate for Payer: Oscar Health of IA Commercial	$7.36
Rate for Payer: Partners Health Alliance Commercial	$7.36
Rate for Payer: United Healthcare Commercial	$8.84
Rate for Payer: United Healthcare Managed Medicare	$5.79

Know your out-of-pocket cost for care.

All Charges