Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

caffeine citrated soln 60mg/3ml SDV [VDMC]

Facility

$107.84

Service Code	HCPCS J0706
Hospital Charge Code	10372698
Hospital Revenue Code	259
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$97.06
Rate for Payer: Aetna of IA Commercial	$97.06
Rate for Payer: Aetna of IA Medical Rental Products	$97.06
Rate for Payer: Aetna of IA Medicare	$61.47
Rate for Payer: Amerigroup Medicaid	$54.43
Rate for Payer: Amerigroup Medicare	$54.46
Rate for Payer: Cash Price	$86.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$53.92
Rate for Payer: Iowa Total Care Managed Medicaid	$53.90
Rate for Payer: Medical Associates Commercial	$80.88
Rate for Payer: Medical Associates Managed Medicare	$53.92
Rate for Payer: Midlands Choice Commercial	$75.49
Rate for Payer: Molina Healthcare Managed Medicaid	$54.73
Rate for Payer: Molina Healthcare Managed Medicare	$54.70
Rate for Payer: Oscar Health of IA Commercial	$80.88
Rate for Payer: Partners Health Alliance Commercial	$80.88
Rate for Payer: United Healthcare Commercial	$97.06
Rate for Payer: United Healthcare Managed Medicare	$63.63

calamine-zinc oxide Top 8% susp [VDMC]

Facility

$9.92

Service Code	HCPCS A9270
Hospital Charge Code	11558119
Hospital Revenue Code	259
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$8.93
Rate for Payer: Aetna of IA Commercial	$8.93
Rate for Payer: Aetna of IA Medical Rental Products	$8.93
Rate for Payer: Cash Price	$7.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.44
Rate for Payer: Medical Associates Commercial	$7.44
Rate for Payer: Midlands Choice Commercial	$6.94
Rate for Payer: United Healthcare Commercial	$8.93

calamine-zinc oxide Top 8% susp [VDMC]

Facility

$9.92

Service Code	HCPCS A9270
Hospital Charge Code	11558119
Hospital Revenue Code	259
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$8.93
Rate for Payer: Aetna of IA Commercial	$8.93
Rate for Payer: Aetna of IA Medical Rental Products	$8.93
Rate for Payer: Aetna of IA Medicare	$5.65
Rate for Payer: Amerigroup Medicaid	$5.01
Rate for Payer: Amerigroup Medicare	$5.01
Rate for Payer: Cash Price	$7.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.44
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.96
Rate for Payer: Iowa Total Care Managed Medicaid	$4.96
Rate for Payer: Medical Associates Commercial	$7.44
Rate for Payer: Medical Associates Managed Medicare	$4.96
Rate for Payer: Midlands Choice Commercial	$6.94
Rate for Payer: Molina Healthcare Managed Medicaid	$5.03
Rate for Payer: Molina Healthcare Managed Medicare	$5.03
Rate for Payer: Oscar Health of IA Commercial	$7.44
Rate for Payer: Partners Health Alliance Commercial	$7.44
Rate for Payer: United Healthcare Commercial	$8.93
Rate for Payer: United Healthcare Managed Medicare	$5.85

calcitonin 200 intl units/inh 3.7ml nasal spray bottle [VDMC]

Facility

$186.48

Service Code	HCPCS A9270
Hospital Charge Code	21526388
Hospital Revenue Code	259
Min. Negotiated Rate	$93.20
Max. Negotiated Rate	$167.83
Rate for Payer: Aetna of IA Commercial	$167.83
Rate for Payer: Aetna of IA Medical Rental Products	$167.83
Rate for Payer: Aetna of IA Medicare	$106.29
Rate for Payer: Amerigroup Medicaid	$94.12
Rate for Payer: Amerigroup Medicare	$94.17
Rate for Payer: Cash Price	$149.18
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$139.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$93.24
Rate for Payer: Iowa Total Care Managed Medicaid	$93.20
Rate for Payer: Medical Associates Commercial	$139.86
Rate for Payer: Medical Associates Managed Medicare	$93.24
Rate for Payer: Midlands Choice Commercial	$130.54
Rate for Payer: Molina Healthcare Managed Medicaid	$94.64
Rate for Payer: Molina Healthcare Managed Medicare	$94.58
Rate for Payer: Oscar Health of IA Commercial	$139.86
Rate for Payer: Partners Health Alliance Commercial	$139.86
Rate for Payer: United Healthcare Commercial	$167.83
Rate for Payer: United Healthcare Managed Medicare	$110.02

calcitonin 200 intl units/inh 3.7ml nasal spray bottle [VDMC]

Facility

$186.48

Service Code	HCPCS A9270
Hospital Charge Code	21526388
Hospital Revenue Code	259
Min. Negotiated Rate	$130.54
Max. Negotiated Rate	$167.83
Rate for Payer: Aetna of IA Commercial	$167.83
Rate for Payer: Aetna of IA Medical Rental Products	$167.83
Rate for Payer: Cash Price	$149.18
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$139.86
Rate for Payer: Medical Associates Commercial	$139.86
Rate for Payer: Midlands Choice Commercial	$130.54
Rate for Payer: United Healthcare Commercial	$167.83

calcitonin 200 intl units/mL 2ml MDV Inj Sol [VDMC]

Facility

$4,569.76

Service Code	HCPCS J0630
Hospital Charge Code	10431376
Hospital Revenue Code	259
Min. Negotiated Rate	$3,198.83
Max. Negotiated Rate	$4,112.78
Rate for Payer: Aetna of IA Commercial	$4,112.78
Rate for Payer: Aetna of IA Medical Rental Products	$4,112.78
Rate for Payer: Cash Price	$3,655.81
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,427.32
Rate for Payer: Medical Associates Commercial	$3,427.32
Rate for Payer: Midlands Choice Commercial	$3,198.83
Rate for Payer: United Healthcare Commercial	$4,112.78

calcitonin 200 intl units/mL 2ml MDV Inj Sol [VDMC]

Facility

$4,569.76

Service Code	HCPCS J0630
Hospital Charge Code	10431376
Hospital Revenue Code	259
Min. Negotiated Rate	$2,283.97
Max. Negotiated Rate	$4,112.78
Rate for Payer: Aetna of IA Commercial	$4,112.78
Rate for Payer: Aetna of IA Medical Rental Products	$4,112.78
Rate for Payer: Aetna of IA Medicare	$2,604.76
Rate for Payer: Amerigroup Medicaid	$2,306.36
Rate for Payer: Amerigroup Medicare	$2,307.73
Rate for Payer: Cash Price	$3,655.81
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,427.32
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,284.88
Rate for Payer: Iowa Total Care Managed Medicaid	$2,283.97
Rate for Payer: Medical Associates Commercial	$3,427.32
Rate for Payer: Medical Associates Managed Medicare	$2,284.88
Rate for Payer: Midlands Choice Commercial	$3,198.83
Rate for Payer: Molina Healthcare Managed Medicaid	$2,319.15
Rate for Payer: Molina Healthcare Managed Medicare	$2,317.78
Rate for Payer: Oscar Health of IA Commercial	$3,427.32
Rate for Payer: Partners Health Alliance Commercial	$3,427.32
Rate for Payer: United Healthcare Commercial	$4,112.78
Rate for Payer: United Healthcare Managed Medicare	$2,696.16

calcitriol 0.25 mcg Oral Cap [VDMC]

Facility

$2.07

Service Code	HCPCS A9270
Hospital Charge Code	10372828
Hospital Revenue Code	259
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna of IA Commercial	$1.86
Rate for Payer: Aetna of IA Medical Rental Products	$1.86
Rate for Payer: Cash Price	$1.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.55
Rate for Payer: Medical Associates Commercial	$1.55
Rate for Payer: Midlands Choice Commercial	$1.45
Rate for Payer: United Healthcare Commercial	$1.86

calcitriol 0.25 mcg Oral Cap [VDMC]

Facility

$2.07

Service Code	HCPCS A9270
Hospital Charge Code	10372828
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna of IA Commercial	$1.86
Rate for Payer: Aetna of IA Medical Rental Products	$1.86
Rate for Payer: Aetna of IA Medicare	$1.18
Rate for Payer: Amerigroup Medicaid	$1.04
Rate for Payer: Amerigroup Medicare	$1.05
Rate for Payer: Cash Price	$1.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.55
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.04
Rate for Payer: Iowa Total Care Managed Medicaid	$1.03
Rate for Payer: Medical Associates Commercial	$1.55
Rate for Payer: Medical Associates Managed Medicare	$1.04
Rate for Payer: Midlands Choice Commercial	$1.45
Rate for Payer: Molina Healthcare Managed Medicaid	$1.05
Rate for Payer: Molina Healthcare Managed Medicare	$1.05
Rate for Payer: Oscar Health of IA Commercial	$1.55
Rate for Payer: Partners Health Alliance Commercial	$1.55
Rate for Payer: United Healthcare Commercial	$1.86
Rate for Payer: United Healthcare Managed Medicare	$1.22

CALCIUM

Facility

$49.00

Service Code	CPT 82310
Hospital Charge Code	1628887
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

CALCIUM

Facility

$49.00

Service Code	CPT 82310
Hospital Charge Code	1628887
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

calcium acetate 667 mg Cap [VDMC]

Facility

$2.09

Service Code	HCPCS A9270
Hospital Charge Code	10373031
Hospital Revenue Code	259
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of IA Commercial	$1.88
Rate for Payer: Aetna of IA Medical Rental Products	$1.88
Rate for Payer: Cash Price	$1.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.57
Rate for Payer: Medical Associates Commercial	$1.57
Rate for Payer: Midlands Choice Commercial	$1.46
Rate for Payer: United Healthcare Commercial	$1.88

calcium acetate 667 mg Cap [VDMC]

Facility

$2.09

Service Code	HCPCS A9270
Hospital Charge Code	10373031
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of IA Commercial	$1.88
Rate for Payer: Aetna of IA Medical Rental Products	$1.88
Rate for Payer: Aetna of IA Medicare	$1.19
Rate for Payer: Amerigroup Medicaid	$1.05
Rate for Payer: Amerigroup Medicare	$1.06
Rate for Payer: Cash Price	$1.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.57
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.04
Rate for Payer: Iowa Total Care Managed Medicaid	$1.04
Rate for Payer: Medical Associates Commercial	$1.57
Rate for Payer: Medical Associates Managed Medicare	$1.04
Rate for Payer: Midlands Choice Commercial	$1.46
Rate for Payer: Molina Healthcare Managed Medicaid	$1.06
Rate for Payer: Molina Healthcare Managed Medicare	$1.06
Rate for Payer: Oscar Health of IA Commercial	$1.57
Rate for Payer: Partners Health Alliance Commercial	$1.57
Rate for Payer: United Healthcare Commercial	$1.88
Rate for Payer: United Healthcare Managed Medicare	$1.23

calcium carbonate 500 mg(1250mg) Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10373100
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

calcium carbonate 500 mg(1250mg) Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10373100
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

calcium carbonate 500 mg Chew Tab [VDMC]

Facility

$1.04

Service Code	HCPCS A9270
Hospital Charge Code	10373169
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of IA Commercial	$0.94
Rate for Payer: Aetna of IA Medical Rental Products	$0.94
Rate for Payer: Aetna of IA Medicare	$0.59
Rate for Payer: Amerigroup Medicaid	$0.52
Rate for Payer: Amerigroup Medicare	$0.53
Rate for Payer: Cash Price	$0.83
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.52
Rate for Payer: Iowa Total Care Managed Medicaid	$0.52
Rate for Payer: Medical Associates Commercial	$0.78
Rate for Payer: Medical Associates Managed Medicare	$0.52
Rate for Payer: Midlands Choice Commercial	$0.73
Rate for Payer: Molina Healthcare Managed Medicaid	$0.53
Rate for Payer: Molina Healthcare Managed Medicare	$0.53
Rate for Payer: Oscar Health of IA Commercial	$0.78
Rate for Payer: Partners Health Alliance Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$0.94
Rate for Payer: United Healthcare Managed Medicare	$0.61

calcium carbonate 500 mg Chew Tab [VDMC]

Facility

$1.04

Service Code	HCPCS A9270
Hospital Charge Code	10373169
Hospital Revenue Code	259
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of IA Commercial	$0.94
Rate for Payer: Aetna of IA Medical Rental Products	$0.94
Rate for Payer: Cash Price	$0.83
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.78
Rate for Payer: Medical Associates Commercial	$0.78
Rate for Payer: Midlands Choice Commercial	$0.73
Rate for Payer: United Healthcare Commercial	$0.94

calcium chloride 100 mg/mL 10ml SDV Inj Sol [VDMC]

Facility

$51.29

Service Code	HCPCS J3490
Hospital Charge Code	10373376
Hospital Revenue Code	259
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$46.16
Rate for Payer: Aetna of IA Commercial	$46.16
Rate for Payer: Aetna of IA Medical Rental Products	$46.16
Rate for Payer: Cash Price	$41.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.47
Rate for Payer: Medical Associates Commercial	$38.47
Rate for Payer: Midlands Choice Commercial	$35.90
Rate for Payer: United Healthcare Commercial	$46.16

calcium chloride 100 mg/mL 10ml SDV Inj Sol [VDMC]

Facility

$51.29

Service Code	HCPCS J3490
Hospital Charge Code	10373376
Hospital Revenue Code	259
Min. Negotiated Rate	$25.63
Max. Negotiated Rate	$46.16
Rate for Payer: Aetna of IA Commercial	$46.16
Rate for Payer: Aetna of IA Medical Rental Products	$46.16
Rate for Payer: Aetna of IA Medicare	$29.24
Rate for Payer: Amerigroup Medicaid	$25.89
Rate for Payer: Amerigroup Medicare	$25.90
Rate for Payer: Cash Price	$41.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.47
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.64
Rate for Payer: Iowa Total Care Managed Medicaid	$25.63
Rate for Payer: Medical Associates Commercial	$38.47
Rate for Payer: Medical Associates Managed Medicare	$25.64
Rate for Payer: Midlands Choice Commercial	$35.90
Rate for Payer: Molina Healthcare Managed Medicaid	$26.03
Rate for Payer: Molina Healthcare Managed Medicare	$26.01
Rate for Payer: Oscar Health of IA Commercial	$38.47
Rate for Payer: Partners Health Alliance Commercial	$38.47
Rate for Payer: United Healthcare Commercial	$46.16
Rate for Payer: United Healthcare Managed Medicare	$30.26

calcium gluconate 100 mg/mL 10 ml Inj SDV Sol [VDMC]

Facility

$54.81

Service Code	HCPCS J0612
Hospital Charge Code	10373447
Hospital Revenue Code	259
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$49.33
Rate for Payer: Aetna of IA Commercial	$49.33
Rate for Payer: Aetna of IA Medical Rental Products	$49.33
Rate for Payer: Aetna of IA Medicare	$31.24
Rate for Payer: Amerigroup Medicaid	$27.66
Rate for Payer: Amerigroup Medicare	$27.68
Rate for Payer: Cash Price	$43.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.40
Rate for Payer: Iowa Total Care Managed Medicaid	$27.39
Rate for Payer: Medical Associates Commercial	$41.11
Rate for Payer: Medical Associates Managed Medicare	$27.40
Rate for Payer: Midlands Choice Commercial	$38.37
Rate for Payer: Molina Healthcare Managed Medicaid	$27.82
Rate for Payer: Molina Healthcare Managed Medicare	$27.80
Rate for Payer: Oscar Health of IA Commercial	$41.11
Rate for Payer: Partners Health Alliance Commercial	$41.11
Rate for Payer: United Healthcare Commercial	$49.33
Rate for Payer: United Healthcare Managed Medicare	$32.34

calcium gluconate 100 mg/mL 10 ml Inj SDV Sol [VDMC]

Facility

$54.81

Service Code	HCPCS J0612
Hospital Charge Code	10373447
Hospital Revenue Code	259
Min. Negotiated Rate	$38.37
Max. Negotiated Rate	$49.33
Rate for Payer: Aetna of IA Commercial	$49.33
Rate for Payer: Aetna of IA Medical Rental Products	$49.33
Rate for Payer: Cash Price	$43.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.11
Rate for Payer: Medical Associates Commercial	$41.11
Rate for Payer: Midlands Choice Commercial	$38.37
Rate for Payer: United Healthcare Commercial	$49.33

Calcium Urine Timed DMCL

Facility

$58.00

Service Code	CPT 82340
Hospital Charge Code	8037507
Hospital Revenue Code	301
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

Calcium Urine Timed DMCL

Facility

$58.00

Service Code	CPT 82340
Hospital Charge Code	8037507
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$29.27
Rate for Payer: Amerigroup Medicare	$29.29
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.00
Rate for Payer: Iowa Total Care Managed Medicaid	$28.99
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$29.00
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$29.44
Rate for Payer: Molina Healthcare Managed Medicare	$29.42
Rate for Payer: Oscar Health of IA Commercial	$43.50
Rate for Payer: Partners Health Alliance Commercial	$43.50
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

calcium-vitamin D 500 mg-200 intl units Tab [VDMC]

Facility

$1.16

Service Code	HCPCS A9270
Hospital Charge Code	10373240
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of IA Commercial	$1.04
Rate for Payer: Aetna of IA Medical Rental Products	$1.04
Rate for Payer: Aetna of IA Medicare	$0.66
Rate for Payer: Amerigroup Medicaid	$0.59
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.87
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.58
Rate for Payer: Iowa Total Care Managed Medicaid	$0.58
Rate for Payer: Medical Associates Commercial	$0.87
Rate for Payer: Medical Associates Managed Medicare	$0.58
Rate for Payer: Midlands Choice Commercial	$0.81
Rate for Payer: Molina Healthcare Managed Medicaid	$0.59
Rate for Payer: Molina Healthcare Managed Medicare	$0.59
Rate for Payer: Oscar Health of IA Commercial	$0.87
Rate for Payer: Partners Health Alliance Commercial	$0.87
Rate for Payer: United Healthcare Commercial	$1.04
Rate for Payer: United Healthcare Managed Medicare	$0.68

calcium-vitamin D 500 mg-200 intl units Tab [VDMC]

Facility

$1.16

Service Code	HCPCS A9270
Hospital Charge Code	10373240
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of IA Commercial	$1.04
Rate for Payer: Aetna of IA Medical Rental Products	$1.04
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.87
Rate for Payer: Medical Associates Commercial	$0.87
Rate for Payer: Midlands Choice Commercial	$0.81
Rate for Payer: United Healthcare Commercial	$1.04

Know your out-of-pocket cost for care.

All Charges