Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

VITAL CAPACITY, TOTAL

Facility

$260.00

Service Code	CPT 94150
Hospital Charge Code	5338941
Hospital Revenue Code	460
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Aetna of IA Medicare	$148.20
Rate for Payer: Amerigroup Medicaid	$149.97
Rate for Payer: Amerigroup Medicare	$118.17
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$117.00
Rate for Payer: Iowa Total Care Managed Medicaid	$148.51
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Medical Associates Managed Medicare	$117.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: Molina Healthcare Managed Medicaid	$150.70
Rate for Payer: Partners Health Alliance Commercial	$134.55
Rate for Payer: United Healthcare Commercial	$234.00
Rate for Payer: United Healthcare Managed Medicare	$153.40
Rate for Payer: Wellmark IA HMO WHPI	$185.05
Rate for Payer: Wellmark IA PPO	$203.84

VITAL CAPACITY, TOTAL

Facility

$260.00

Service Code	CPT 94150
Hospital Charge Code	7980861
Hospital Revenue Code	460
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Aetna of IA Medicare	$148.20
Rate for Payer: Amerigroup Medicaid	$149.97
Rate for Payer: Amerigroup Medicare	$118.17
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$117.00
Rate for Payer: Iowa Total Care Managed Medicaid	$148.51
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Medical Associates Managed Medicare	$117.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: Molina Healthcare Managed Medicaid	$150.70
Rate for Payer: Partners Health Alliance Commercial	$134.55
Rate for Payer: United Healthcare Commercial	$234.00
Rate for Payer: United Healthcare Managed Medicare	$153.40
Rate for Payer: Wellmark IA HMO WHPI	$185.05
Rate for Payer: Wellmark IA PPO	$203.84

Vitamin A DMCL

Facility

$139.00

Service Code	CPT 84590
Hospital Charge Code	8037824
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

Vitamin A DMCL

Facility

$139.00

Service Code	CPT 84590
Hospital Charge Code	8037824
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
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	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
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	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

vitamin A & D Top Oint [VDMC]

Facility

$26.71

Service Code	HCPCS A9270
Hospital Charge Code	10428349
Hospital Revenue Code	259
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$24.04
Rate for Payer: Aetna of IA Commercial	$24.04
Rate for Payer: Aetna of IA Medical Rental Products	$24.04
Rate for Payer: Cash Price	$21.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.03
Rate for Payer: Medical Associates Commercial	$20.03
Rate for Payer: Midlands Choice Commercial	$18.69
Rate for Payer: United Healthcare Commercial	$24.04

vitamin A & D Top Oint [VDMC]

Facility

$26.71

Service Code	HCPCS A9270
Hospital Charge Code	10428349
Hospital Revenue Code	259
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$24.04
Rate for Payer: Aetna of IA Commercial	$24.04
Rate for Payer: Aetna of IA Medical Rental Products	$24.04
Rate for Payer: Aetna of IA Medicare	$15.22
Rate for Payer: Amerigroup Medicaid	$15.40
Rate for Payer: Amerigroup Medicare	$12.14
Rate for Payer: Cash Price	$21.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.03
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.02
Rate for Payer: Iowa Total Care Managed Medicaid	$15.25
Rate for Payer: Medical Associates Commercial	$20.03
Rate for Payer: Medical Associates Managed Medicare	$12.02
Rate for Payer: Midlands Choice Commercial	$18.69
Rate for Payer: Molina Healthcare Managed Medicaid	$15.48
Rate for Payer: Partners Health Alliance Commercial	$13.82
Rate for Payer: United Healthcare Commercial	$24.04
Rate for Payer: United Healthcare Managed Medicare	$15.76

Vitamin B-12

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8146790
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Aetna of IA Medicare	$58.71
Rate for Payer: Amerigroup Medicaid	$59.41
Rate for Payer: Amerigroup Medicare	$46.81
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.35
Rate for Payer: Iowa Total Care Managed Medicaid	$58.83
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Medical Associates Managed Medicare	$46.35
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: Molina Healthcare Managed Medicaid	$59.70
Rate for Payer: Partners Health Alliance Commercial	$53.30
Rate for Payer: United Healthcare Commercial	$92.70
Rate for Payer: United Healthcare Managed Medicare	$60.77
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Vitamin B-12

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8146790
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: United Healthcare Commercial	$92.70

Vitamin B12 and Folate DMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8037826
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Aetna of IA Medicare	$58.71
Rate for Payer: Amerigroup Medicaid	$59.41
Rate for Payer: Amerigroup Medicare	$46.81
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.35
Rate for Payer: Iowa Total Care Managed Medicaid	$58.83
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Medical Associates Managed Medicare	$46.35
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: Molina Healthcare Managed Medicaid	$59.70
Rate for Payer: Partners Health Alliance Commercial	$53.30
Rate for Payer: United Healthcare Commercial	$92.70
Rate for Payer: United Healthcare Managed Medicare	$60.77
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Vitamin B12 and Folate DMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8037826
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: United Healthcare Commercial	$92.70

Vitamin B12 Level DMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8037827
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: United Healthcare Commercial	$92.70

Vitamin B12 Level DMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	8037827
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Aetna of IA Medicare	$58.71
Rate for Payer: Amerigroup Medicaid	$59.41
Rate for Payer: Amerigroup Medicare	$46.81
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.35
Rate for Payer: Iowa Total Care Managed Medicaid	$58.83
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Medical Associates Managed Medicare	$46.35
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: Molina Healthcare Managed Medicaid	$59.70
Rate for Payer: Partners Health Alliance Commercial	$53.30
Rate for Payer: United Healthcare Commercial	$92.70
Rate for Payer: United Healthcare Managed Medicare	$60.77
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Vitamin B12 Lvl TMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	4008786
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Aetna of IA Medicare	$58.71
Rate for Payer: Amerigroup Medicaid	$59.41
Rate for Payer: Amerigroup Medicare	$46.81
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.35
Rate for Payer: Iowa Total Care Managed Medicaid	$58.83
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Medical Associates Managed Medicare	$46.35
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: Molina Healthcare Managed Medicaid	$59.70
Rate for Payer: Partners Health Alliance Commercial	$53.30
Rate for Payer: United Healthcare Commercial	$92.70
Rate for Payer: United Healthcare Managed Medicare	$60.77
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Vitamin B12 Lvl TMCL

Facility

$103.00

Service Code	CPT 82607
Hospital Charge Code	4008786
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of IA Commercial	$92.70
Rate for Payer: Aetna of IA Medical Rental Products	$92.70
Rate for Payer: Cash Price	$82.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$77.25
Rate for Payer: Medical Associates Commercial	$77.25
Rate for Payer: Midlands Choice Commercial	$72.10
Rate for Payer: United Healthcare Commercial	$92.70

Vitamin B1 Level DMCL

Facility

$173.00

Service Code	CPT 84425
Hospital Charge Code	8037825
Hospital Revenue Code	301
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of IA Commercial	$155.70
Rate for Payer: Aetna of IA Medical Rental Products	$155.70
Rate for Payer: Cash Price	$138.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$129.75
Rate for Payer: Medical Associates Commercial	$129.75
Rate for Payer: Midlands Choice Commercial	$121.10
Rate for Payer: United Healthcare Commercial	$155.70

Vitamin B1 Level DMCL

Facility

$173.00

Service Code	CPT 84425
Hospital Charge Code	8037825
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of IA Commercial	$155.70
Rate for Payer: Aetna of IA Medical Rental Products	$155.70
Rate for Payer: Aetna of IA Medicare	$98.61
Rate for Payer: Amerigroup Medicaid	$99.79
Rate for Payer: Amerigroup Medicare	$78.63
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$129.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$77.85
Rate for Payer: Iowa Total Care Managed Medicaid	$98.82
Rate for Payer: Medical Associates Commercial	$129.75
Rate for Payer: Medical Associates Managed Medicare	$77.85
Rate for Payer: Midlands Choice Commercial	$121.10
Rate for Payer: Molina Healthcare Managed Medicaid	$100.27
Rate for Payer: Partners Health Alliance Commercial	$89.53
Rate for Payer: United Healthcare Commercial	$155.70
Rate for Payer: United Healthcare Managed Medicare	$102.07
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Vitamin B6 Level

Facility

$139.00

Service Code	CPT 84207
Hospital Charge Code	8519185
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$134.33
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	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
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	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$121.95
Rate for Payer: Wellmark IA PPO	$134.33

Vitamin B6 Level

Facility

$139.00

Service Code	CPT 84207
Hospital Charge Code	8519185
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

Vitamin D 1 25 Dihydroxy DMCL

Facility

$139.00

Service Code	CPT 82652
Hospital Charge Code	8037828
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$134.33
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	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
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	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$121.95
Rate for Payer: Wellmark IA PPO	$134.33

Vitamin D 1 25 Dihydroxy DMCL

Facility

$139.00

Service Code	CPT 82652
Hospital Charge Code	8037828
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

Vitamin D 25 Hydroxy DMCL

Facility

$139.00

Service Code	CPT 82306
Hospital Charge Code	8037829
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$134.33
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	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
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	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$121.95
Rate for Payer: Wellmark IA PPO	$134.33

Vitamin D 25 Hydroxy DMCL

Facility

$139.00

Service Code	CPT 82306
Hospital Charge Code	8037829
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

vitamin E 400 intl units Cap [VDMC]

Facility

$1.17

Service Code	HCPCS A9270
Hospital Charge Code	10428414
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.05
Rate for Payer: Aetna of IA Commercial	$1.05
Rate for Payer: Aetna of IA Medical Rental Products	$1.05
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.88
Rate for Payer: Medical Associates Commercial	$0.88
Rate for Payer: Midlands Choice Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$1.05

vitamin E 400 intl units Cap [VDMC]

Facility

$1.17

Service Code	HCPCS A9270
Hospital Charge Code	10428414
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.05
Rate for Payer: Aetna of IA Commercial	$1.05
Rate for Payer: Aetna of IA Medical Rental Products	$1.05
Rate for Payer: Aetna of IA Medicare	$0.67
Rate for Payer: Amerigroup Medicaid	$0.68
Rate for Payer: Amerigroup Medicare	$0.53
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.53
Rate for Payer: Iowa Total Care Managed Medicaid	$0.67
Rate for Payer: Medical Associates Commercial	$0.88
Rate for Payer: Medical Associates Managed Medicare	$0.53
Rate for Payer: Midlands Choice Commercial	$0.82
Rate for Payer: Molina Healthcare Managed Medicaid	$0.68
Rate for Payer: Partners Health Alliance Commercial	$0.61
Rate for Payer: United Healthcare Commercial	$1.05
Rate for Payer: United Healthcare Managed Medicare	$0.69

VRE CULTURE

Facility

$56.00

Service Code	CPT 87081
Hospital Charge Code	4024793
Hospital Revenue Code	306
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

Know your out-of-pocket cost for care.

All Charges