Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

TREAT SHOULDER DISLOCATION

Facility

$686.00

Service Code	CPT 23650
Hospital Charge Code	4864819
Hospital Revenue Code	450
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$617.40
Rate for Payer: Aetna of IA Commercial	$617.40
Rate for Payer: Aetna of IA Medical Rental Products	$617.40
Rate for Payer: Aetna of IA Medicare	$391.02
Rate for Payer: Amerigroup Medicaid	$395.68
Rate for Payer: Amerigroup Medicare	$311.79
Rate for Payer: Cash Price	$548.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$514.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$308.70
Rate for Payer: Iowa Total Care Managed Medicaid	$391.84
Rate for Payer: Medical Associates Commercial	$514.50
Rate for Payer: Medical Associates Managed Medicare	$308.70
Rate for Payer: Midlands Choice Commercial	$480.20
Rate for Payer: Molina Healthcare Managed Medicaid	$397.61
Rate for Payer: Partners Health Alliance Commercial	$355.00
Rate for Payer: United Healthcare Commercial	$617.40
Rate for Payer: United Healthcare Managed Medicare	$404.74

TREAT THUMB DISLOCATION

Facility

$628.00

Service Code	CPT 26641
Hospital Charge Code	4860782
Hospital Revenue Code	450
Min. Negotiated Rate	$439.60
Max. Negotiated Rate	$565.20
Rate for Payer: Aetna of IA Commercial	$565.20
Rate for Payer: Aetna of IA Medical Rental Products	$565.20
Rate for Payer: Cash Price	$502.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.00
Rate for Payer: Medical Associates Commercial	$471.00
Rate for Payer: Midlands Choice Commercial	$439.60
Rate for Payer: United Healthcare Commercial	$565.20

TREAT THUMB DISLOCATION

Facility

$628.00

Service Code	CPT 26641
Hospital Charge Code	4860782
Hospital Revenue Code	450
Min. Negotiated Rate	$282.60
Max. Negotiated Rate	$565.20
Rate for Payer: Aetna of IA Commercial	$565.20
Rate for Payer: Aetna of IA Medical Rental Products	$565.20
Rate for Payer: Aetna of IA Medicare	$357.96
Rate for Payer: Amerigroup Medicaid	$362.23
Rate for Payer: Amerigroup Medicare	$285.43
Rate for Payer: Cash Price	$502.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$282.60
Rate for Payer: Iowa Total Care Managed Medicaid	$358.71
Rate for Payer: Medical Associates Commercial	$471.00
Rate for Payer: Medical Associates Managed Medicare	$282.60
Rate for Payer: Midlands Choice Commercial	$439.60
Rate for Payer: Molina Healthcare Managed Medicaid	$363.99
Rate for Payer: Partners Health Alliance Commercial	$324.99
Rate for Payer: United Healthcare Commercial	$565.20
Rate for Payer: United Healthcare Managed Medicare	$370.52

TREAT THUMB DISLOCATION

Professional

Both

$1,243.00

Service Code	CPT 26641
Hospital Charge Code	7982802
Hospital Revenue Code	981
Min. Negotiated Rate	$576.26
Max. Negotiated Rate	$932.25
Rate for Payer: Cash Price	$994.40
Rate for Payer: Cash Price	$994.40
Rate for Payer: Medical Associates Commercial	$932.25
Rate for Payer: Midlands Choice Commercial	$870.10
Rate for Payer: Partners Health Alliance Commercial	$932.25
Rate for Payer: United Healthcare Commercial	$576.26

TREAT TOE DISLOCATION

Facility

$499.00

Service Code	CPT 28660
Hospital Charge Code	4864873
Hospital Revenue Code	450
Min. Negotiated Rate	$224.55
Max. Negotiated Rate	$449.10
Rate for Payer: Aetna of IA Commercial	$449.10
Rate for Payer: Aetna of IA Medical Rental Products	$449.10
Rate for Payer: Aetna of IA Medicare	$284.43
Rate for Payer: Amerigroup Medicaid	$287.82
Rate for Payer: Amerigroup Medicare	$226.80
Rate for Payer: Cash Price	$399.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$374.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$224.55
Rate for Payer: Iowa Total Care Managed Medicaid	$285.03
Rate for Payer: Medical Associates Commercial	$374.25
Rate for Payer: Medical Associates Managed Medicare	$224.55
Rate for Payer: Midlands Choice Commercial	$349.30
Rate for Payer: Molina Healthcare Managed Medicaid	$289.22
Rate for Payer: Partners Health Alliance Commercial	$258.23
Rate for Payer: United Healthcare Commercial	$449.10
Rate for Payer: United Healthcare Managed Medicare	$294.41

TREAT TOE DISLOCATION

Professional

Both

$277.00

Service Code	CPT 28660
Hospital Charge Code	7982791
Hospital Revenue Code	981
Min. Negotiated Rate	$179.57
Max. Negotiated Rate	$207.75
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Medical Associates Commercial	$207.75
Rate for Payer: Midlands Choice Commercial	$193.90
Rate for Payer: Partners Health Alliance Commercial	$207.75
Rate for Payer: United Healthcare Commercial	$179.57

TREAT TOE DISLOCATION

Facility

$499.00

Service Code	CPT 28660
Hospital Charge Code	4864873
Hospital Revenue Code	450
Min. Negotiated Rate	$349.30
Max. Negotiated Rate	$449.10
Rate for Payer: Aetna of IA Commercial	$449.10
Rate for Payer: Aetna of IA Medical Rental Products	$449.10
Rate for Payer: Cash Price	$399.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$374.25
Rate for Payer: Medical Associates Commercial	$374.25
Rate for Payer: Midlands Choice Commercial	$349.30
Rate for Payer: United Healthcare Commercial	$449.10

TREAT WRIST BONE FRACTURE

Facility

$628.00

Service Code	CPT 25630
Hospital Charge Code	7983035
Hospital Revenue Code	450
Min. Negotiated Rate	$439.60
Max. Negotiated Rate	$565.20
Rate for Payer: Aetna of IA Commercial	$565.20
Rate for Payer: Aetna of IA Medical Rental Products	$565.20
Rate for Payer: Cash Price	$502.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.00
Rate for Payer: Medical Associates Commercial	$471.00
Rate for Payer: Midlands Choice Commercial	$439.60
Rate for Payer: United Healthcare Commercial	$565.20

TREAT WRIST BONE FRACTURE

Facility

$628.00

Service Code	CPT 25630
Hospital Charge Code	7983035
Hospital Revenue Code	450
Min. Negotiated Rate	$282.60
Max. Negotiated Rate	$565.20
Rate for Payer: Aetna of IA Commercial	$565.20
Rate for Payer: Aetna of IA Medical Rental Products	$565.20
Rate for Payer: Aetna of IA Medicare	$357.96
Rate for Payer: Amerigroup Medicaid	$362.23
Rate for Payer: Amerigroup Medicare	$285.43
Rate for Payer: Cash Price	$502.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$282.60
Rate for Payer: Iowa Total Care Managed Medicaid	$358.71
Rate for Payer: Medical Associates Commercial	$471.00
Rate for Payer: Medical Associates Managed Medicare	$282.60
Rate for Payer: Midlands Choice Commercial	$439.60
Rate for Payer: Molina Healthcare Managed Medicaid	$363.99
Rate for Payer: Partners Health Alliance Commercial	$324.99
Rate for Payer: United Healthcare Commercial	$565.20
Rate for Payer: United Healthcare Managed Medicare	$370.52

TREAT WRIST DISLOCATION

Facility

$1,256.00

Service Code	CPT 25675
Hospital Charge Code	4864857
Hospital Revenue Code	450
Min. Negotiated Rate	$565.20
Max. Negotiated Rate	$1,130.40
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Aetna of IA Medicare	$715.92
Rate for Payer: Amerigroup Medicaid	$724.46
Rate for Payer: Amerigroup Medicare	$570.85
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$565.20
Rate for Payer: Iowa Total Care Managed Medicaid	$717.43
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Medical Associates Managed Medicare	$565.20
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: Molina Healthcare Managed Medicaid	$727.98
Rate for Payer: Partners Health Alliance Commercial	$649.98
Rate for Payer: United Healthcare Commercial	$1,130.40
Rate for Payer: United Healthcare Managed Medicare	$741.04

TREAT WRIST DISLOCATION

Facility

$1,256.00

Service Code	CPT 25675
Hospital Charge Code	4864857
Hospital Revenue Code	450
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,130.40
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: United Healthcare Commercial	$1,130.40

Treponemal Antibodies IgG/IgM DMCL

Facility

$114.00

Service Code	CPT 86780
Hospital Charge Code	8481982
Hospital Revenue Code	302
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

Treponemal Antibodies IgG/IgM DMCL

Facility

$114.00

Service Code	CPT 86780
Hospital Charge Code	8481982
Hospital Revenue Code	302
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$58.99
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26

triamcinolone 10 mg/1mL 5ml MDV Inj Susp [VDMC]

Facility

$64.52

Service Code	HCPCS J3301
Hospital Charge Code	10426185
Hospital Revenue Code	259
Min. Negotiated Rate	$29.03
Max. Negotiated Rate	$58.07
Rate for Payer: Aetna of IA Commercial	$58.07
Rate for Payer: Aetna of IA Medical Rental Products	$58.07
Rate for Payer: Aetna of IA Medicare	$36.78
Rate for Payer: Amerigroup Medicaid	$37.22
Rate for Payer: Amerigroup Medicare	$29.32
Rate for Payer: Cash Price	$51.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.03
Rate for Payer: Iowa Total Care Managed Medicaid	$36.85
Rate for Payer: Medical Associates Commercial	$48.39
Rate for Payer: Medical Associates Managed Medicare	$29.03
Rate for Payer: Midlands Choice Commercial	$45.16
Rate for Payer: Molina Healthcare Managed Medicaid	$37.40
Rate for Payer: Partners Health Alliance Commercial	$33.39
Rate for Payer: United Healthcare Commercial	$58.07
Rate for Payer: United Healthcare Managed Medicare	$38.07

triamcinolone 10 mg/1mL 5ml MDV Inj Susp [VDMC]

Facility

$64.52

Service Code	HCPCS J3301
Hospital Charge Code	10426185
Hospital Revenue Code	259
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$58.07
Rate for Payer: Aetna of IA Commercial	$58.07
Rate for Payer: Aetna of IA Medical Rental Products	$58.07
Rate for Payer: Cash Price	$51.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.39
Rate for Payer: Medical Associates Commercial	$48.39
Rate for Payer: Midlands Choice Commercial	$45.16
Rate for Payer: United Healthcare Commercial	$58.07

triamcinolone acetonide 0.025% 80gm cream [VDMC]

Facility

$27.08

Service Code	HCPCS A9270
Hospital Charge Code	10426254
Hospital Revenue Code	259
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$24.37
Rate for Payer: Aetna of IA Commercial	$24.37
Rate for Payer: Aetna of IA Medical Rental Products	$24.37
Rate for Payer: Aetna of IA Medicare	$15.44
Rate for Payer: Amerigroup Medicaid	$15.62
Rate for Payer: Amerigroup Medicare	$12.31
Rate for Payer: Cash Price	$21.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.19
Rate for Payer: Iowa Total Care Managed Medicaid	$15.47
Rate for Payer: Medical Associates Commercial	$20.31
Rate for Payer: Medical Associates Managed Medicare	$12.19
Rate for Payer: Midlands Choice Commercial	$18.96
Rate for Payer: Molina Healthcare Managed Medicaid	$15.70
Rate for Payer: Partners Health Alliance Commercial	$14.01
Rate for Payer: United Healthcare Commercial	$24.37
Rate for Payer: United Healthcare Managed Medicare	$15.98

triamcinolone acetonide 0.025% 80gm cream [VDMC]

Facility

$27.08

Service Code	HCPCS A9270
Hospital Charge Code	10426254
Hospital Revenue Code	259
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$24.37
Rate for Payer: Aetna of IA Commercial	$24.37
Rate for Payer: Aetna of IA Medical Rental Products	$24.37
Rate for Payer: Cash Price	$21.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.31
Rate for Payer: Medical Associates Commercial	$20.31
Rate for Payer: Midlands Choice Commercial	$18.96
Rate for Payer: United Healthcare Commercial	$24.37

triamcinolone acetonide 40 mg/mL 1ml SDV Sus [VDMC]

Facility

$33.10

Service Code	HCPCS J3301
Hospital Charge Code	11224388
Hospital Revenue Code	259
Min. Negotiated Rate	$23.17
Max. Negotiated Rate	$29.79
Rate for Payer: Aetna of IA Commercial	$29.79
Rate for Payer: Aetna of IA Medical Rental Products	$29.79
Rate for Payer: Cash Price	$26.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.82
Rate for Payer: Medical Associates Commercial	$24.82
Rate for Payer: Midlands Choice Commercial	$23.17
Rate for Payer: United Healthcare Commercial	$29.79

triamcinolone acetonide 40 mg/mL 1ml SDV Sus [VDMC]

Facility

$33.10

Service Code	HCPCS J3301
Hospital Charge Code	11224388
Hospital Revenue Code	259
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$29.79
Rate for Payer: Aetna of IA Commercial	$29.79
Rate for Payer: Aetna of IA Medical Rental Products	$29.79
Rate for Payer: Aetna of IA Medicare	$18.87
Rate for Payer: Amerigroup Medicaid	$19.09
Rate for Payer: Amerigroup Medicare	$15.04
Rate for Payer: Cash Price	$26.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.89
Rate for Payer: Iowa Total Care Managed Medicaid	$18.91
Rate for Payer: Medical Associates Commercial	$24.82
Rate for Payer: Medical Associates Managed Medicare	$14.89
Rate for Payer: Midlands Choice Commercial	$23.17
Rate for Payer: Molina Healthcare Managed Medicaid	$19.18
Rate for Payer: Partners Health Alliance Commercial	$17.13
Rate for Payer: United Healthcare Commercial	$29.79
Rate for Payer: United Healthcare Managed Medicare	$19.53

triamcinolone Top 0.025% 15 gm Crm [VDMC]

Facility

$15.08

Service Code	HCPCS A9270
Hospital Charge Code	10426315
Hospital Revenue Code	259
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna of IA Commercial	$13.57
Rate for Payer: Aetna of IA Medical Rental Products	$13.57
Rate for Payer: Cash Price	$12.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.31
Rate for Payer: Medical Associates Commercial	$11.31
Rate for Payer: Midlands Choice Commercial	$10.56
Rate for Payer: United Healthcare Commercial	$13.57

triamcinolone Top 0.025% 15 gm Crm [VDMC]

Facility

$15.08

Service Code	HCPCS A9270
Hospital Charge Code	10426315
Hospital Revenue Code	259
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna of IA Commercial	$13.57
Rate for Payer: Aetna of IA Medical Rental Products	$13.57
Rate for Payer: Aetna of IA Medicare	$8.60
Rate for Payer: Amerigroup Medicaid	$8.70
Rate for Payer: Amerigroup Medicare	$6.85
Rate for Payer: Cash Price	$12.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.79
Rate for Payer: Iowa Total Care Managed Medicaid	$8.61
Rate for Payer: Medical Associates Commercial	$11.31
Rate for Payer: Medical Associates Managed Medicare	$6.79
Rate for Payer: Midlands Choice Commercial	$10.56
Rate for Payer: Molina Healthcare Managed Medicaid	$8.74
Rate for Payer: Partners Health Alliance Commercial	$7.80
Rate for Payer: United Healthcare Commercial	$13.57
Rate for Payer: United Healthcare Managed Medicare	$8.90

triamcinolone Top 0.025% 15 gm Oint [VDMC]

Facility

$24.56

Service Code	HCPCS A9270
Hospital Charge Code	10426380
Hospital Revenue Code	259
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$22.10
Rate for Payer: Aetna of IA Commercial	$22.10
Rate for Payer: Aetna of IA Medical Rental Products	$22.10
Rate for Payer: Aetna of IA Medicare	$14.00
Rate for Payer: Amerigroup Medicaid	$14.17
Rate for Payer: Amerigroup Medicare	$11.16
Rate for Payer: Cash Price	$19.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.05
Rate for Payer: Iowa Total Care Managed Medicaid	$14.03
Rate for Payer: Medical Associates Commercial	$18.42
Rate for Payer: Medical Associates Managed Medicare	$11.05
Rate for Payer: Midlands Choice Commercial	$17.19
Rate for Payer: Molina Healthcare Managed Medicaid	$14.23
Rate for Payer: Partners Health Alliance Commercial	$12.71
Rate for Payer: United Healthcare Commercial	$22.10
Rate for Payer: United Healthcare Managed Medicare	$14.49

triamcinolone Top 0.025% 15 gm Oint [VDMC]

Facility

$24.56

Service Code	HCPCS A9270
Hospital Charge Code	10426380
Hospital Revenue Code	259
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$22.10
Rate for Payer: Aetna of IA Commercial	$22.10
Rate for Payer: Aetna of IA Medical Rental Products	$22.10
Rate for Payer: Cash Price	$19.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.42
Rate for Payer: Medical Associates Commercial	$18.42
Rate for Payer: Midlands Choice Commercial	$17.19
Rate for Payer: United Healthcare Commercial	$22.10

triamcinolone Top 0.1% 15 gm Crm [VDMC]

Facility

$14.24

Service Code	HCPCS A9270
Hospital Charge Code	10426510
Hospital Revenue Code	259
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$12.82
Rate for Payer: Aetna of IA Commercial	$12.82
Rate for Payer: Aetna of IA Medical Rental Products	$12.82
Rate for Payer: Aetna of IA Medicare	$8.12
Rate for Payer: Amerigroup Medicaid	$8.21
Rate for Payer: Amerigroup Medicare	$6.47
Rate for Payer: Cash Price	$11.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.68
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.41
Rate for Payer: Iowa Total Care Managed Medicaid	$8.13
Rate for Payer: Medical Associates Commercial	$10.68
Rate for Payer: Medical Associates Managed Medicare	$6.41
Rate for Payer: Midlands Choice Commercial	$9.97
Rate for Payer: Molina Healthcare Managed Medicaid	$8.25
Rate for Payer: Partners Health Alliance Commercial	$7.37
Rate for Payer: United Healthcare Commercial	$12.82
Rate for Payer: United Healthcare Managed Medicare	$8.40

triamcinolone Top 0.1% 15 gm Crm [VDMC]

Facility

$14.24

Service Code	HCPCS A9270
Hospital Charge Code	10426510
Hospital Revenue Code	259
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$12.82
Rate for Payer: Aetna of IA Commercial	$12.82
Rate for Payer: Aetna of IA Medical Rental Products	$12.82
Rate for Payer: Cash Price	$11.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.68
Rate for Payer: Medical Associates Commercial	$10.68
Rate for Payer: Midlands Choice Commercial	$9.97
Rate for Payer: United Healthcare Commercial	$12.82

Know your out-of-pocket cost for care.

All Charges