Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ASSESSMENT OF APHASIA HR

Facility

$357.00

Service Code	CPT 96105 GN
Hospital Charge Code	1373853
Hospital Revenue Code	440
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of IA Commercial	$321.30
Rate for Payer: Aetna of IA Medical Rental Products	$321.30
Rate for Payer: Cash Price	$285.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$267.75
Rate for Payer: Medical Associates Commercial	$267.75
Rate for Payer: Midlands Choice Commercial	$249.90
Rate for Payer: United Healthcare Commercial	$321.30

AST (SGOT)

Facility

$49.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of IA Commercial	$44.10
Rate for Payer: Aetna of IA Medical Rental Products	$44.10
Rate for Payer: Cash Price	$39.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.75
Rate for Payer: Medical Associates Commercial	$36.75
Rate for Payer: Midlands Choice Commercial	$34.30
Rate for Payer: United Healthcare Commercial	$44.10

AST (SGOT)

Facility

$49.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of IA Commercial	$44.10
Rate for Payer: Aetna of IA Medical Rental Products	$44.10
Rate for Payer: Aetna of IA Medicare	$27.93
Rate for Payer: Amerigroup Medicaid	$24.73
Rate for Payer: Amerigroup Medicare	$24.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.50
Rate for Payer: Iowa Total Care Managed Medicaid	$24.49
Rate for Payer: Medical Associates Commercial	$36.75
Rate for Payer: Medical Associates Managed Medicare	$24.50
Rate for Payer: Midlands Choice Commercial	$34.30
Rate for Payer: Molina Healthcare Managed Medicaid	$24.87
Rate for Payer: Molina Healthcare Managed Medicare	$24.85
Rate for Payer: Oscar Health of IA Commercial	$36.75
Rate for Payer: Partners Health Alliance Commercial	$36.75
Rate for Payer: United Healthcare Commercial	$44.10
Rate for Payer: United Healthcare Managed Medicare	$28.91
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

atenolol 50 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10368172
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Aetna of IA Medicare	$0.74
Rate for Payer: Amerigroup Medicaid	$0.65
Rate for Payer: Amerigroup Medicare	$0.65
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
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	$0.64
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: Molina Healthcare Managed Medicaid	$0.65
Rate for Payer: Molina Healthcare Managed Medicare	$0.65
Rate for Payer: Oscar Health of IA Commercial	$0.97
Rate for Payer: Partners Health Alliance Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.16
Rate for Payer: United Healthcare Managed Medicare	$0.76

atenolol 50 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10368172
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

atezolizumab 1200 mg/20 mL SDV inj [VDMC]

Facility

$19,039.70

Service Code	HCPCS J9022
Hospital Charge Code	21210955
Hospital Revenue Code	259
Min. Negotiated Rate	$13,327.79
Max. Negotiated Rate	$17,135.73
Rate for Payer: Aetna of IA Commercial	$17,135.73
Rate for Payer: Aetna of IA Medical Rental Products	$17,135.73
Rate for Payer: Cash Price	$15,231.76
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,279.78
Rate for Payer: Medical Associates Commercial	$14,279.78
Rate for Payer: Midlands Choice Commercial	$13,327.79
Rate for Payer: United Healthcare Commercial	$17,135.73

atezolizumab 1200 mg/20 mL SDV inj [VDMC]

Facility

$19,039.70

Service Code	HCPCS J9022
Hospital Charge Code	21210955
Hospital Revenue Code	259
Min. Negotiated Rate	$9,516.04
Max. Negotiated Rate	$17,135.73
Rate for Payer: Aetna of IA Commercial	$17,135.73
Rate for Payer: Aetna of IA Medical Rental Products	$17,135.73
Rate for Payer: Aetna of IA Medicare	$10,852.63
Rate for Payer: Amerigroup Medicaid	$9,609.34
Rate for Payer: Amerigroup Medicare	$9,615.05
Rate for Payer: Cash Price	$15,231.76
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,279.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9,519.85
Rate for Payer: Iowa Total Care Managed Medicaid	$9,516.04
Rate for Payer: Medical Associates Commercial	$14,279.78
Rate for Payer: Medical Associates Managed Medicare	$9,519.85
Rate for Payer: Midlands Choice Commercial	$13,327.79
Rate for Payer: Molina Healthcare Managed Medicaid	$9,662.65
Rate for Payer: Molina Healthcare Managed Medicare	$9,656.94
Rate for Payer: Oscar Health of IA Commercial	$14,279.78
Rate for Payer: Partners Health Alliance Commercial	$14,279.78
Rate for Payer: United Healthcare Commercial	$17,135.73
Rate for Payer: United Healthcare Managed Medicare	$11,233.42

Atherosclerosis With MCC

Facility

$7,001.90

Service Code	MS-DRG 302
Hospital Charge Code	159
Min. Negotiated Rate	$6,900.42
Max. Negotiated Rate	$7,001.90
Rate for Payer: Amerigroup Medicaid	$6,968.07
Rate for Payer: Iowa Total Care Managed Medicaid	$6,900.42
Rate for Payer: Molina Healthcare Managed Medicaid	$7,001.90

Atherosclerosis Without MCC

Facility

$6,058.01

Service Code	MS-DRG 303
Hospital Charge Code	160
Min. Negotiated Rate	$5,970.21
Max. Negotiated Rate	$6,058.01
Rate for Payer: Amerigroup Medicaid	$6,028.74
Rate for Payer: Iowa Total Care Managed Medicaid	$5,970.21
Rate for Payer: Molina Healthcare Managed Medicaid	$6,058.01

atorvastatin 10 mg Tab [VDMC]

Facility

$1.12

Service Code	HCPCS A9270
Hospital Charge Code	10368310
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of IA Commercial	$1.01
Rate for Payer: Aetna of IA Medical Rental Products	$1.01
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	$0.84
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.56
Rate for Payer: Iowa Total Care Managed Medicaid	$0.56
Rate for Payer: Medical Associates Commercial	$0.84
Rate for Payer: Medical Associates Managed Medicare	$0.56
Rate for Payer: Midlands Choice Commercial	$0.78
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	$0.84
Rate for Payer: Partners Health Alliance Commercial	$0.84
Rate for Payer: United Healthcare Commercial	$1.01
Rate for Payer: United Healthcare Managed Medicare	$0.66

atorvastatin 10 mg Tab [VDMC]

Facility

$1.12

Service Code	HCPCS A9270
Hospital Charge Code	10368310
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of IA Commercial	$1.01
Rate for Payer: Aetna of IA Medical Rental Products	$1.01
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.84
Rate for Payer: Medical Associates Commercial	$0.84
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.01

atorvastatin 20 mg Tab [VDMC]

Facility

$1.09

Service Code	HCPCS A9270
Hospital Charge Code	11514534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of IA Commercial	$0.98
Rate for Payer: Aetna of IA Medical Rental Products	$0.98
Rate for Payer: Cash Price	$0.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.82
Rate for Payer: Medical Associates Commercial	$0.82
Rate for Payer: Midlands Choice Commercial	$0.76
Rate for Payer: United Healthcare Commercial	$0.98

atorvastatin 20 mg Tab [VDMC]

Facility

$1.09

Service Code	HCPCS A9270
Hospital Charge Code	11514534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of IA Commercial	$0.98
Rate for Payer: Aetna of IA Medical Rental Products	$0.98
Rate for Payer: Aetna of IA Medicare	$0.62
Rate for Payer: Amerigroup Medicaid	$0.55
Rate for Payer: Amerigroup Medicare	$0.55
Rate for Payer: Cash Price	$0.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.55
Rate for Payer: Iowa Total Care Managed Medicaid	$0.54
Rate for Payer: Medical Associates Commercial	$0.82
Rate for Payer: Medical Associates Managed Medicare	$0.55
Rate for Payer: Midlands Choice Commercial	$0.76
Rate for Payer: Molina Healthcare Managed Medicaid	$0.55
Rate for Payer: Molina Healthcare Managed Medicare	$0.55
Rate for Payer: Oscar Health of IA Commercial	$0.82
Rate for Payer: Partners Health Alliance Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$0.98
Rate for Payer: United Healthcare Managed Medicare	$0.64

atorvastatin 40 mg Tab [VDMC]

Facility

$1.71

Service Code	HCPCS A9270
Hospital Charge Code	10368448
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of IA Commercial	$1.54
Rate for Payer: Aetna of IA Medical Rental Products	$1.54
Rate for Payer: Aetna of IA Medicare	$0.97
Rate for Payer: Amerigroup Medicaid	$0.86
Rate for Payer: Amerigroup Medicare	$0.86
Rate for Payer: Cash Price	$1.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.86
Rate for Payer: Iowa Total Care Managed Medicaid	$0.85
Rate for Payer: Medical Associates Commercial	$1.28
Rate for Payer: Medical Associates Managed Medicare	$0.86
Rate for Payer: Midlands Choice Commercial	$1.20
Rate for Payer: Molina Healthcare Managed Medicaid	$0.87
Rate for Payer: Molina Healthcare Managed Medicare	$0.87
Rate for Payer: Oscar Health of IA Commercial	$1.28
Rate for Payer: Partners Health Alliance Commercial	$1.28
Rate for Payer: United Healthcare Commercial	$1.54
Rate for Payer: United Healthcare Managed Medicare	$1.01

atorvastatin 40 mg Tab [VDMC]

Facility

$1.71

Service Code	HCPCS A9270
Hospital Charge Code	10368448
Hospital Revenue Code	259
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of IA Commercial	$1.54
Rate for Payer: Aetna of IA Medical Rental Products	$1.54
Rate for Payer: Cash Price	$1.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.28
Rate for Payer: Medical Associates Commercial	$1.28
Rate for Payer: Midlands Choice Commercial	$1.20
Rate for Payer: United Healthcare Commercial	$1.54

atropine 1 mg/mL 1 ml SDV Inj Sol [VDMC]

Facility

$41.67

Service Code	HCPCS J0461
Hospital Charge Code	10368588
Hospital Revenue Code	259
Min. Negotiated Rate	$29.17
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of IA Commercial	$37.50
Rate for Payer: Aetna of IA Medical Rental Products	$37.50
Rate for Payer: Cash Price	$33.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.25
Rate for Payer: Medical Associates Commercial	$31.25
Rate for Payer: Midlands Choice Commercial	$29.17
Rate for Payer: United Healthcare Commercial	$37.50

atropine 1 mg/mL 1 ml SDV Inj Sol [VDMC]

Facility

$41.67

Service Code	HCPCS J0461
Hospital Charge Code	10368588
Hospital Revenue Code	259
Min. Negotiated Rate	$20.83
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of IA Commercial	$37.50
Rate for Payer: Aetna of IA Medical Rental Products	$37.50
Rate for Payer: Aetna of IA Medicare	$23.75
Rate for Payer: Amerigroup Medicaid	$21.03
Rate for Payer: Amerigroup Medicare	$21.04
Rate for Payer: Cash Price	$33.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.84
Rate for Payer: Iowa Total Care Managed Medicaid	$20.83
Rate for Payer: Medical Associates Commercial	$31.25
Rate for Payer: Medical Associates Managed Medicare	$20.84
Rate for Payer: Midlands Choice Commercial	$29.17
Rate for Payer: Molina Healthcare Managed Medicaid	$21.15
Rate for Payer: Molina Healthcare Managed Medicare	$21.14
Rate for Payer: Oscar Health of IA Commercial	$31.25
Rate for Payer: Partners Health Alliance Commercial	$31.25
Rate for Payer: United Healthcare Commercial	$37.50
Rate for Payer: United Healthcare Managed Medicare	$24.59

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [VDMC]

Facility

$3.62

Service Code	HCPCS A9270
Hospital Charge Code	10368722
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$3.26
Rate for Payer: Aetna of IA Commercial	$3.26
Rate for Payer: Aetna of IA Medical Rental Products	$3.26
Rate for Payer: Aetna of IA Medicare	$2.06
Rate for Payer: Amerigroup Medicaid	$1.83
Rate for Payer: Amerigroup Medicare	$1.83
Rate for Payer: Cash Price	$2.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.72
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.81
Rate for Payer: Iowa Total Care Managed Medicaid	$1.81
Rate for Payer: Medical Associates Commercial	$2.72
Rate for Payer: Medical Associates Managed Medicare	$1.81
Rate for Payer: Midlands Choice Commercial	$2.53
Rate for Payer: Molina Healthcare Managed Medicaid	$1.84
Rate for Payer: Molina Healthcare Managed Medicare	$1.84
Rate for Payer: Oscar Health of IA Commercial	$2.72
Rate for Payer: Partners Health Alliance Commercial	$2.72
Rate for Payer: United Healthcare Commercial	$3.26
Rate for Payer: United Healthcare Managed Medicare	$2.14

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [VDMC]

Facility

$3.62

Service Code	HCPCS A9270
Hospital Charge Code	10368722
Hospital Revenue Code	259
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$3.26
Rate for Payer: Aetna of IA Commercial	$3.26
Rate for Payer: Aetna of IA Medical Rental Products	$3.26
Rate for Payer: Cash Price	$2.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.72
Rate for Payer: Medical Associates Commercial	$2.72
Rate for Payer: Midlands Choice Commercial	$2.53
Rate for Payer: United Healthcare Commercial	$3.26

atropine emergency syringe 0.1 mg/mL 10 ml SDV Inj Sol [VDMC]

Facility

$68.52

Service Code	HCPCS J0461
Hospital Charge Code	10368517
Hospital Revenue Code	259
Min. Negotiated Rate	$34.25
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna of IA Commercial	$61.67
Rate for Payer: Aetna of IA Medical Rental Products	$61.67
Rate for Payer: Aetna of IA Medicare	$39.06
Rate for Payer: Amerigroup Medicaid	$34.58
Rate for Payer: Amerigroup Medicare	$34.60
Rate for Payer: Cash Price	$54.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.26
Rate for Payer: Iowa Total Care Managed Medicaid	$34.25
Rate for Payer: Medical Associates Commercial	$51.39
Rate for Payer: Medical Associates Managed Medicare	$34.26
Rate for Payer: Midlands Choice Commercial	$47.96
Rate for Payer: Molina Healthcare Managed Medicaid	$34.77
Rate for Payer: Molina Healthcare Managed Medicare	$34.75
Rate for Payer: Oscar Health of IA Commercial	$51.39
Rate for Payer: Partners Health Alliance Commercial	$51.39
Rate for Payer: United Healthcare Commercial	$61.67
Rate for Payer: United Healthcare Managed Medicare	$40.43

atropine emergency syringe 0.1 mg/mL 10 ml SDV Inj Sol [VDMC]

Facility

$68.52

Service Code	HCPCS J0461
Hospital Charge Code	10368517
Hospital Revenue Code	259
Min. Negotiated Rate	$47.96
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna of IA Commercial	$61.67
Rate for Payer: Aetna of IA Medical Rental Products	$61.67
Rate for Payer: Cash Price	$54.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.39
Rate for Payer: Medical Associates Commercial	$51.39
Rate for Payer: Midlands Choice Commercial	$47.96
Rate for Payer: United Healthcare Commercial	$61.67

atropine/hyoscyamine/PB/scopolamine Oral Elix [VDMC]

Facility

$6.88

Service Code	HCPCS A9270
Hospital Charge Code	10368657
Hospital Revenue Code	259
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.19
Rate for Payer: Aetna of IA Commercial	$6.19
Rate for Payer: Aetna of IA Medical Rental Products	$6.19
Rate for Payer: Cash Price	$5.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.16
Rate for Payer: Medical Associates Commercial	$5.16
Rate for Payer: Midlands Choice Commercial	$4.82
Rate for Payer: United Healthcare Commercial	$6.19

atropine/hyoscyamine/PB/scopolamine Oral Elix [VDMC]

Facility

$6.88

Service Code	HCPCS A9270
Hospital Charge Code	10368657
Hospital Revenue Code	259
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$6.19
Rate for Payer: Aetna of IA Commercial	$6.19
Rate for Payer: Aetna of IA Medical Rental Products	$6.19
Rate for Payer: Aetna of IA Medicare	$3.92
Rate for Payer: Amerigroup Medicaid	$3.47
Rate for Payer: Amerigroup Medicare	$3.47
Rate for Payer: Cash Price	$5.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.44
Rate for Payer: Iowa Total Care Managed Medicaid	$3.44
Rate for Payer: Medical Associates Commercial	$5.16
Rate for Payer: Medical Associates Managed Medicare	$3.44
Rate for Payer: Midlands Choice Commercial	$4.82
Rate for Payer: Molina Healthcare Managed Medicaid	$3.49
Rate for Payer: Molina Healthcare Managed Medicare	$3.49
Rate for Payer: Oscar Health of IA Commercial	$5.16
Rate for Payer: Partners Health Alliance Commercial	$5.16
Rate for Payer: United Healthcare Commercial	$6.19
Rate for Payer: United Healthcare Managed Medicare	$4.06

atropine Ophth 1% Sol 5mL [VDMC]

Facility

$159.04

Service Code	HCPCS A9270
Hospital Charge Code	11555809
Hospital Revenue Code	259
Min. Negotiated Rate	$79.49
Max. Negotiated Rate	$143.14
Rate for Payer: Aetna of IA Commercial	$143.14
Rate for Payer: Aetna of IA Medical Rental Products	$143.14
Rate for Payer: Aetna of IA Medicare	$90.65
Rate for Payer: Amerigroup Medicaid	$80.27
Rate for Payer: Amerigroup Medicare	$80.32
Rate for Payer: Cash Price	$127.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.52
Rate for Payer: Iowa Total Care Managed Medicaid	$79.49
Rate for Payer: Medical Associates Commercial	$119.28
Rate for Payer: Medical Associates Managed Medicare	$79.52
Rate for Payer: Midlands Choice Commercial	$111.33
Rate for Payer: Molina Healthcare Managed Medicaid	$80.71
Rate for Payer: Molina Healthcare Managed Medicare	$80.67
Rate for Payer: Oscar Health of IA Commercial	$119.28
Rate for Payer: Partners Health Alliance Commercial	$119.28
Rate for Payer: United Healthcare Commercial	$143.14
Rate for Payer: United Healthcare Managed Medicare	$93.83

atropine Ophth 1% Sol 5mL [VDMC]

Facility

$159.04

Service Code	HCPCS A9270
Hospital Charge Code	11555809
Hospital Revenue Code	259
Min. Negotiated Rate	$111.33
Max. Negotiated Rate	$143.14
Rate for Payer: Aetna of IA Commercial	$143.14
Rate for Payer: Aetna of IA Medical Rental Products	$143.14
Rate for Payer: Cash Price	$127.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.28
Rate for Payer: Medical Associates Commercial	$119.28
Rate for Payer: Midlands Choice Commercial	$111.33
Rate for Payer: United Healthcare Commercial	$143.14

Know your out-of-pocket cost for care.

All Charges