Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

REMOVE IMPACTED EAR WAX UNI

Facility

$69.00

Service Code	CPT 69210
Hospital Charge Code	4866851
Hospital Revenue Code	450
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of IA Commercial	$62.10
Rate for Payer: Aetna of IA Medical Rental Products	$62.10
Rate for Payer: Aetna of IA Medicare	$39.33
Rate for Payer: Amerigroup Medicaid	$39.80
Rate for Payer: Amerigroup Medicare	$31.36
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.05
Rate for Payer: Iowa Total Care Managed Medicaid	$39.41
Rate for Payer: Medical Associates Commercial	$51.75
Rate for Payer: Medical Associates Managed Medicare	$31.05
Rate for Payer: Midlands Choice Commercial	$48.30
Rate for Payer: Molina Healthcare Managed Medicaid	$39.99
Rate for Payer: Partners Health Alliance Commercial	$35.71
Rate for Payer: United Healthcare Commercial	$62.10
Rate for Payer: United Healthcare Managed Medicare	$40.71

REMOVE IMPACTED EAR WAX UNI

Facility

$69.00

Service Code	CPT 69210
Hospital Charge Code	4866851
Hospital Revenue Code	450
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of IA Commercial	$62.10
Rate for Payer: Aetna of IA Medical Rental Products	$62.10
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.75
Rate for Payer: Medical Associates Commercial	$51.75
Rate for Payer: Midlands Choice Commercial	$48.30
Rate for Payer: United Healthcare Commercial	$62.10

REMOVE INT/EXT HEM 1 GROUP

Facility

$2,793.00

Service Code	CPT 46255
Hospital Charge Code	7982944
Hospital Revenue Code	450
Min. Negotiated Rate	$1,256.85
Max. Negotiated Rate	$5,078.84
Rate for Payer: Aetna of IA Commercial	$2,513.70
Rate for Payer: Aetna of IA Medical Rental Products	$2,513.70
Rate for Payer: Aetna of IA Medicare	$1,592.01
Rate for Payer: Amerigroup Medicaid	$1,611.00
Rate for Payer: Amerigroup Medicare	$1,269.42
Rate for Payer: Cash Price	$2,234.40
Rate for Payer: Cash Price	$2,234.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,094.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,256.85
Rate for Payer: Iowa Total Care Managed Medicaid	$1,595.36
Rate for Payer: Medical Associates Commercial	$2,094.75
Rate for Payer: Medical Associates Managed Medicare	$1,256.85
Rate for Payer: Midlands Choice Commercial	$1,955.10
Rate for Payer: Molina Healthcare Managed Medicaid	$1,618.82
Rate for Payer: Partners Health Alliance Commercial	$1,445.38
Rate for Payer: United Healthcare Commercial	$2,513.70
Rate for Payer: United Healthcare Managed Medicare	$1,647.87
Rate for Payer: Wellmark IA HMO WHPI	$4,610.63
Rate for Payer: Wellmark IA PPO	$5,078.84

REMOVE INT/EXT HEM 1 GROUP

Facility

$2,793.00

Service Code	CPT 46255
Hospital Charge Code	7982944
Hospital Revenue Code	450
Min. Negotiated Rate	$1,955.10
Max. Negotiated Rate	$2,513.70
Rate for Payer: Aetna of IA Commercial	$2,513.70
Rate for Payer: Aetna of IA Medical Rental Products	$2,513.70
Rate for Payer: Cash Price	$2,234.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,094.75
Rate for Payer: Medical Associates Commercial	$2,094.75
Rate for Payer: Midlands Choice Commercial	$1,955.10
Rate for Payer: United Healthcare Commercial	$2,513.70

REMOVE IUD

Facility

$401.00

Service Code	CPT 58301
Hospital Charge Code	4863438
Hospital Revenue Code	450
Min. Negotiated Rate	$280.70
Max. Negotiated Rate	$360.90
Rate for Payer: Aetna of IA Commercial	$360.90
Rate for Payer: Aetna of IA Medical Rental Products	$360.90
Rate for Payer: Cash Price	$320.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$300.75
Rate for Payer: Medical Associates Commercial	$300.75
Rate for Payer: Midlands Choice Commercial	$280.70
Rate for Payer: United Healthcare Commercial	$360.90

REMOVE IUD

Facility

$401.00

Service Code	CPT 58301
Hospital Charge Code	4863438
Hospital Revenue Code	450
Min. Negotiated Rate	$180.45
Max. Negotiated Rate	$360.90
Rate for Payer: Aetna of IA Commercial	$360.90
Rate for Payer: Aetna of IA Medical Rental Products	$360.90
Rate for Payer: Aetna of IA Medicare	$228.57
Rate for Payer: Amerigroup Medicaid	$231.30
Rate for Payer: Amerigroup Medicare	$182.25
Rate for Payer: Cash Price	$320.80
Rate for Payer: Cash Price	$320.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$300.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$180.45
Rate for Payer: Iowa Total Care Managed Medicaid	$229.05
Rate for Payer: Medical Associates Commercial	$300.75
Rate for Payer: Medical Associates Managed Medicare	$180.45
Rate for Payer: Midlands Choice Commercial	$280.70
Rate for Payer: Molina Healthcare Managed Medicaid	$232.42
Rate for Payer: Partners Health Alliance Commercial	$207.52
Rate for Payer: United Healthcare Commercial	$360.90
Rate for Payer: United Healthcare Managed Medicare	$236.59
Rate for Payer: Wellmark IA HMO WHPI	$273.67
Rate for Payer: Wellmark IA PPO	$301.47

REMOVE NASAL FOREIGN BODY

Facility

$64.00

Service Code	CPT 30300
Hospital Charge Code	4864902
Hospital Revenue Code	450
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$370.98
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$336.78
Rate for Payer: Wellmark IA PPO	$370.98

REMOVE NASAL FOREIGN BODY

Facility

$64.00

Service Code	CPT 30300
Hospital Charge Code	4864902
Hospital Revenue Code	450
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

REMOVE PILONIDAL CYST EXTEN

Facility

$1,696.00

Service Code	CPT 11771
Hospital Charge Code	7982953
Hospital Revenue Code	450
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$1,526.40
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: United Healthcare Commercial	$1,526.40

REMOVE PILONIDAL CYST EXTEN

Facility

$1,696.00

Service Code	CPT 11771
Hospital Charge Code	7982953
Hospital Revenue Code	450
Min. Negotiated Rate	$763.20
Max. Negotiated Rate	$5,511.52
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Aetna of IA Medicare	$966.72
Rate for Payer: Amerigroup Medicaid	$978.25
Rate for Payer: Amerigroup Medicare	$770.83
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$763.20
Rate for Payer: Iowa Total Care Managed Medicaid	$968.76
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Medical Associates Managed Medicare	$763.20
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: Molina Healthcare Managed Medicaid	$983.00
Rate for Payer: Partners Health Alliance Commercial	$877.68
Rate for Payer: United Healthcare Commercial	$1,526.40
Rate for Payer: United Healthcare Managed Medicare	$1,000.64
Rate for Payer: Wellmark IA HMO WHPI	$5,003.41
Rate for Payer: Wellmark IA PPO	$5,511.52

REMOVE PILONIDAL CYST SIMPLE

Facility

$1,696.00

Service Code	CPT 11770
Hospital Charge Code	7982952
Hospital Revenue Code	450
Min. Negotiated Rate	$763.20
Max. Negotiated Rate	$2,975.61
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Aetna of IA Medicare	$966.72
Rate for Payer: Amerigroup Medicaid	$978.25
Rate for Payer: Amerigroup Medicare	$770.83
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$763.20
Rate for Payer: Iowa Total Care Managed Medicaid	$968.76
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Medical Associates Managed Medicare	$763.20
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: Molina Healthcare Managed Medicaid	$983.00
Rate for Payer: Partners Health Alliance Commercial	$877.68
Rate for Payer: United Healthcare Commercial	$1,526.40
Rate for Payer: United Healthcare Managed Medicare	$1,000.64
Rate for Payer: Wellmark IA HMO WHPI	$2,701.29
Rate for Payer: Wellmark IA PPO	$2,975.61

REMOVE PILONIDAL CYST SIMPLE

Facility

$1,696.00

Service Code	CPT 11770
Hospital Charge Code	7982952
Hospital Revenue Code	450
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$1,526.40
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: United Healthcare Commercial	$1,526.40

REMOVE RECTAL OBSTRUCTION

Facility

$1,984.00

Service Code	CPT 45915
Hospital Charge Code	7982921
Hospital Revenue Code	450
Min. Negotiated Rate	$1,388.80
Max. Negotiated Rate	$1,785.60
Rate for Payer: Aetna of IA Commercial	$1,785.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,785.60
Rate for Payer: Cash Price	$1,587.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,488.00
Rate for Payer: Medical Associates Commercial	$1,488.00
Rate for Payer: Midlands Choice Commercial	$1,388.80
Rate for Payer: United Healthcare Commercial	$1,785.60

REMOVE RECTAL OBSTRUCTION

Facility

$1,984.00

Service Code	CPT 45915
Hospital Charge Code	7982921
Hospital Revenue Code	450
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$4,161.95
Rate for Payer: Aetna of IA Commercial	$1,785.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,785.60
Rate for Payer: Aetna of IA Medicare	$1,130.88
Rate for Payer: Amerigroup Medicaid	$1,144.37
Rate for Payer: Amerigroup Medicare	$901.73
Rate for Payer: Cash Price	$1,587.20
Rate for Payer: Cash Price	$1,587.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,488.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$892.80
Rate for Payer: Iowa Total Care Managed Medicaid	$1,133.26
Rate for Payer: Medical Associates Commercial	$1,488.00
Rate for Payer: Medical Associates Managed Medicare	$892.80
Rate for Payer: Midlands Choice Commercial	$1,388.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,149.93
Rate for Payer: Partners Health Alliance Commercial	$1,026.72
Rate for Payer: United Healthcare Commercial	$1,785.60
Rate for Payer: United Healthcare Managed Medicare	$1,170.56
Rate for Payer: Wellmark IA HMO WHPI	$3,778.26
Rate for Payer: Wellmark IA PPO	$4,161.95

REMOVE SPINE ELTRD PERQ ARAY

Professional

Both

$1,929.00

Service Code	CPT 63661
Hospital Charge Code	8015896
Hospital Revenue Code	975
Min. Negotiated Rate	$472.22
Max. Negotiated Rate	$1,519.70
Rate for Payer: Amerigroup Medicaid	$476.85
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Iowa Total Care Managed Medicaid	$472.22
Rate for Payer: Medical Associates Commercial	$1,446.75
Rate for Payer: Midlands Choice Commercial	$1,350.30
Rate for Payer: Molina Healthcare Managed Medicaid	$474.53
Rate for Payer: Partners Health Alliance Commercial	$1,446.75
Rate for Payer: United Healthcare Commercial	$963.06
Rate for Payer: Wellmark IA HMO WHPI	$1,291.70
Rate for Payer: Wellmark IA PPO	$1,519.70

REMOVE SPINE ELTRD PLATE

Professional

Both

$2,838.00

Service Code	CPT 63662
Hospital Charge Code	8015894
Hospital Revenue Code	975
Min. Negotiated Rate	$604.81
Max. Negotiated Rate	$2,128.50
Rate for Payer: Amerigroup Medicaid	$610.74
Rate for Payer: Cash Price	$2,270.40
Rate for Payer: Cash Price	$2,270.40
Rate for Payer: Iowa Total Care Managed Medicaid	$604.81
Rate for Payer: Medical Associates Commercial	$2,128.50
Rate for Payer: Midlands Choice Commercial	$1,986.60
Rate for Payer: Molina Healthcare Managed Medicaid	$607.77
Rate for Payer: Partners Health Alliance Commercial	$2,128.50
Rate for Payer: United Healthcare Commercial	$1,233.84
Rate for Payer: Wellmark IA HMO WHPI	$1,628.10
Rate for Payer: Wellmark IA PPO	$1,915.50

RENAL FAILURE WITH CC

Facility

$7,984.30

Service Code	MSDRG 683
Min. Negotiated Rate	$7,868.58
Max. Negotiated Rate	$7,984.30
Rate for Payer: Amerigroup Medicaid	$7,945.73
Rate for Payer: Iowa Total Care Managed Medicaid	$7,868.58
Rate for Payer: Molina Healthcare Managed Medicaid	$7,984.30

RENAL FAILURE WITH MCC

Facility

$13,136.77

Service Code	MSDRG 682
Min. Negotiated Rate	$12,946.38
Max. Negotiated Rate	$13,136.77
Rate for Payer: Amerigroup Medicaid	$13,073.31
Rate for Payer: Iowa Total Care Managed Medicaid	$12,946.38
Rate for Payer: Molina Healthcare Managed Medicaid	$13,136.77

RENAL FAILURE WITHOUT CC/MCC

Facility

$5,399.06

Service Code	MSDRG 684
Min. Negotiated Rate	$5,320.81
Max. Negotiated Rate	$5,399.06
Rate for Payer: Amerigroup Medicaid	$5,372.97
Rate for Payer: Iowa Total Care Managed Medicaid	$5,320.81
Rate for Payer: Molina Healthcare Managed Medicaid	$5,399.06

RENAL PROFILE

Facility

$162.00

Service Code	CPT 80069
Hospital Charge Code	1634883
Hospital Revenue Code	301
Min. Negotiated Rate	$60.97
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Aetna of IA Medicare	$92.34
Rate for Payer: Amerigroup Medicaid	$93.44
Rate for Payer: Amerigroup Medicare	$73.63
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.90
Rate for Payer: Iowa Total Care Managed Medicaid	$92.53
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Medical Associates Managed Medicare	$72.90
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: Molina Healthcare Managed Medicaid	$93.90
Rate for Payer: Partners Health Alliance Commercial	$83.84
Rate for Payer: United Healthcare Commercial	$145.80
Rate for Payer: United Healthcare Managed Medicare	$95.58
Rate for Payer: Wellmark IA HMO WHPI	$60.97
Rate for Payer: Wellmark IA PPO	$67.17

RENAL PROFILE

Facility

$162.00

Service Code	CPT 80069
Hospital Charge Code	1634883
Hospital Revenue Code	301
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: United Healthcare Commercial	$145.80

Renin Direct DMCL

Facility

$180.00

Service Code	CPT 84244
Hospital Charge Code	8037795
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Renin Direct DMCL

Facility

$180.00

Service Code	CPT 84244
Hospital Charge Code	8037795
Hospital Revenue Code	301
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

repaglinide 1 mg Tab [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	17838257
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of IA Commercial	$1.13
Rate for Payer: Aetna of IA Medical Rental Products	$1.13
Rate for Payer: Aetna of IA Medicare	$0.72
Rate for Payer: Amerigroup Medicaid	$0.73
Rate for Payer: Amerigroup Medicare	$0.57
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
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	$0.72
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Medical Associates Managed Medicare	$0.57
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: Molina Healthcare Managed Medicaid	$0.73
Rate for Payer: Partners Health Alliance Commercial	$0.65
Rate for Payer: United Healthcare Commercial	$1.13
Rate for Payer: United Healthcare Managed Medicare	$0.74

repaglinide 1 mg Tab [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	17838257
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of IA Commercial	$1.13
Rate for Payer: Aetna of IA Medical Rental Products	$1.13
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: United Healthcare Commercial	$1.13

Know your out-of-pocket cost for care.

All Charges