Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

chlorhexidine gluconate 0.12% Liq 15 mL [VDMC]

Facility

$6.31

Service Code	HCPCS A9270
Hospital Charge Code	10433870
Hospital Revenue Code	259
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.68
Rate for Payer: Aetna of IA Commercial	$5.68
Rate for Payer: Aetna of IA Medical Rental Products	$5.68
Rate for Payer: Aetna of IA Medicare	$3.60
Rate for Payer: Amerigroup Medicaid	$3.18
Rate for Payer: Amerigroup Medicare	$3.19
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.16
Rate for Payer: Iowa Total Care Managed Medicaid	$3.15
Rate for Payer: Medical Associates Commercial	$4.73
Rate for Payer: Medical Associates Managed Medicare	$3.16
Rate for Payer: Midlands Choice Commercial	$4.42
Rate for Payer: Molina Healthcare Managed Medicaid	$3.20
Rate for Payer: Molina Healthcare Managed Medicare	$3.20
Rate for Payer: Oscar Health of IA Commercial	$4.73
Rate for Payer: Partners Health Alliance Commercial	$4.73
Rate for Payer: United Healthcare Commercial	$5.68
Rate for Payer: United Healthcare Managed Medicare	$3.72

chlorhexidine gluconate 0.12% Liq 15 mL [VDMC]

Facility

$6.31

Service Code	HCPCS A9270
Hospital Charge Code	10433870
Hospital Revenue Code	259
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$5.68
Rate for Payer: Aetna of IA Commercial	$5.68
Rate for Payer: Aetna of IA Medical Rental Products	$5.68
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.73
Rate for Payer: Medical Associates Commercial	$4.73
Rate for Payer: Midlands Choice Commercial	$4.42
Rate for Payer: United Healthcare Commercial	$5.68

chlorhexidine gluconate Top 0.12% Liq 473 mL [VDMC]

Facility

$23.44

Service Code	HCPCS A9270
Hospital Charge Code	11558983
Hospital Revenue Code	259
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$21.10
Rate for Payer: Aetna of IA Commercial	$21.10
Rate for Payer: Aetna of IA Medical Rental Products	$21.10
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.58
Rate for Payer: Medical Associates Commercial	$17.58
Rate for Payer: Midlands Choice Commercial	$16.41
Rate for Payer: United Healthcare Commercial	$21.10

chlorhexidine gluconate Top 0.12% Liq 473 mL [VDMC]

Facility

$23.44

Service Code	HCPCS A9270
Hospital Charge Code	11558983
Hospital Revenue Code	259
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$21.10
Rate for Payer: Aetna of IA Commercial	$21.10
Rate for Payer: Aetna of IA Medical Rental Products	$21.10
Rate for Payer: Aetna of IA Medicare	$13.36
Rate for Payer: Amerigroup Medicaid	$11.83
Rate for Payer: Amerigroup Medicare	$11.84
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.72
Rate for Payer: Iowa Total Care Managed Medicaid	$11.72
Rate for Payer: Medical Associates Commercial	$17.58
Rate for Payer: Medical Associates Managed Medicare	$11.72
Rate for Payer: Midlands Choice Commercial	$16.41
Rate for Payer: Molina Healthcare Managed Medicaid	$11.90
Rate for Payer: Molina Healthcare Managed Medicare	$11.89
Rate for Payer: Oscar Health of IA Commercial	$17.58
Rate for Payer: Partners Health Alliance Commercial	$17.58
Rate for Payer: United Healthcare Commercial	$21.10
Rate for Payer: United Healthcare Managed Medicare	$13.83

CHLORIDE LEVEL

Facility

$44.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: United Healthcare Commercial	$39.60

CHLORIDE LEVEL

Facility

$44.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Aetna of IA Medicare	$25.08
Rate for Payer: Amerigroup Medicaid	$22.21
Rate for Payer: Amerigroup Medicare	$22.22
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$22.00
Rate for Payer: Iowa Total Care Managed Medicaid	$21.99
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Medical Associates Managed Medicare	$22.00
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: Molina Healthcare Managed Medicaid	$22.33
Rate for Payer: Molina Healthcare Managed Medicare	$22.32
Rate for Payer: Oscar Health of IA Commercial	$33.00
Rate for Payer: Partners Health Alliance Commercial	$33.00
Rate for Payer: United Healthcare Commercial	$39.60
Rate for Payer: United Healthcare Managed Medicare	$25.96
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

chloroprocaine 10 mg/mL 5ml SDV [VDMC]

Facility

$75.47

Service Code	HCPCS J2400
Hospital Charge Code	20223788
Hospital Revenue Code	259
Min. Negotiated Rate	$52.83
Max. Negotiated Rate	$67.92
Rate for Payer: Aetna of IA Commercial	$67.92
Rate for Payer: Aetna of IA Medical Rental Products	$67.92
Rate for Payer: Cash Price	$60.38
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.60
Rate for Payer: Medical Associates Commercial	$56.60
Rate for Payer: Midlands Choice Commercial	$52.83
Rate for Payer: United Healthcare Commercial	$67.92

chloroprocaine 10 mg/mL 5ml SDV [VDMC]

Facility

$75.47

Service Code	HCPCS J2400
Hospital Charge Code	20223788
Hospital Revenue Code	259
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$67.92
Rate for Payer: Aetna of IA Commercial	$67.92
Rate for Payer: Aetna of IA Medical Rental Products	$67.92
Rate for Payer: Aetna of IA Medicare	$43.02
Rate for Payer: Amerigroup Medicaid	$38.09
Rate for Payer: Amerigroup Medicare	$38.11
Rate for Payer: Cash Price	$60.38
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.60
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.74
Rate for Payer: Iowa Total Care Managed Medicaid	$37.72
Rate for Payer: Medical Associates Commercial	$56.60
Rate for Payer: Medical Associates Managed Medicare	$37.74
Rate for Payer: Midlands Choice Commercial	$52.83
Rate for Payer: Molina Healthcare Managed Medicaid	$38.30
Rate for Payer: Molina Healthcare Managed Medicare	$38.28
Rate for Payer: Oscar Health of IA Commercial	$56.60
Rate for Payer: Partners Health Alliance Commercial	$56.60
Rate for Payer: United Healthcare Commercial	$67.92
Rate for Payer: United Healthcare Managed Medicare	$44.53

chloroprocaine 1% MDV 300mg/30ml [VDMC]

Facility

$80.08

Service Code	HCPCS J2400
Hospital Charge Code	20803797
Hospital Revenue Code	259
Min. Negotiated Rate	$40.02
Max. Negotiated Rate	$72.07
Rate for Payer: Aetna of IA Commercial	$72.07
Rate for Payer: Aetna of IA Medical Rental Products	$72.07
Rate for Payer: Aetna of IA Medicare	$45.65
Rate for Payer: Amerigroup Medicaid	$40.42
Rate for Payer: Amerigroup Medicare	$40.44
Rate for Payer: Cash Price	$64.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$60.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.04
Rate for Payer: Iowa Total Care Managed Medicaid	$40.02
Rate for Payer: Medical Associates Commercial	$60.06
Rate for Payer: Medical Associates Managed Medicare	$40.04
Rate for Payer: Midlands Choice Commercial	$56.06
Rate for Payer: Molina Healthcare Managed Medicaid	$40.64
Rate for Payer: Molina Healthcare Managed Medicare	$40.62
Rate for Payer: Oscar Health of IA Commercial	$60.06
Rate for Payer: Partners Health Alliance Commercial	$60.06
Rate for Payer: United Healthcare Commercial	$72.07
Rate for Payer: United Healthcare Managed Medicare	$47.25

chloroprocaine 1% MDV 300mg/30ml [VDMC]

Facility

$80.08

Service Code	HCPCS J2400
Hospital Charge Code	20803797
Hospital Revenue Code	259
Min. Negotiated Rate	$56.06
Max. Negotiated Rate	$72.07
Rate for Payer: Aetna of IA Commercial	$72.07
Rate for Payer: Aetna of IA Medical Rental Products	$72.07
Rate for Payer: Cash Price	$64.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$60.06
Rate for Payer: Medical Associates Commercial	$60.06
Rate for Payer: Midlands Choice Commercial	$56.06
Rate for Payer: United Healthcare Commercial	$72.07

chloroprocaine 3% PF 600mg/20ml SDV [VDMC]

Facility

$69.29

Service Code	HCPCS J2400
Hospital Charge Code	20830338
Hospital Revenue Code	259
Min. Negotiated Rate	$48.50
Max. Negotiated Rate	$62.36
Rate for Payer: Midlands Choice Commercial	$48.50
Rate for Payer: Aetna of IA Commercial	$62.36
Rate for Payer: Aetna of IA Medical Rental Products	$62.36
Rate for Payer: Cash Price	$55.43
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.97
Rate for Payer: Medical Associates Commercial	$51.97
Rate for Payer: United Healthcare Commercial	$62.36

chloroprocaine 3% PF 600mg/20ml SDV [VDMC]

Facility

$69.29

Service Code	HCPCS J2400
Hospital Charge Code	20830338
Hospital Revenue Code	259
Min. Negotiated Rate	$34.63
Max. Negotiated Rate	$62.36
Rate for Payer: Aetna of IA Commercial	$62.36
Rate for Payer: Aetna of IA Medical Rental Products	$62.36
Rate for Payer: Aetna of IA Medicare	$39.50
Rate for Payer: Amerigroup Medicaid	$34.97
Rate for Payer: Amerigroup Medicare	$34.99
Rate for Payer: Cash Price	$55.43
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$51.97
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.64
Rate for Payer: Iowa Total Care Managed Medicaid	$34.63
Rate for Payer: Medical Associates Commercial	$51.97
Rate for Payer: Medical Associates Managed Medicare	$34.64
Rate for Payer: Midlands Choice Commercial	$48.50
Rate for Payer: Molina Healthcare Managed Medicaid	$35.16
Rate for Payer: Molina Healthcare Managed Medicare	$35.14
Rate for Payer: Oscar Health of IA Commercial	$51.97
Rate for Payer: Partners Health Alliance Commercial	$51.97
Rate for Payer: United Healthcare Commercial	$62.36
Rate for Payer: United Healthcare Managed Medicare	$40.88

chlorpheniramine 4 mg Tab [VDMC]

Facility

$1.03

Service Code	HCPCS A9270
Hospital Charge Code	10377433
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.93
Rate for Payer: Aetna of IA Commercial	$0.93
Rate for Payer: Aetna of IA Medical Rental Products	$0.93
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.77
Rate for Payer: Medical Associates Commercial	$0.77
Rate for Payer: Midlands Choice Commercial	$0.72
Rate for Payer: United Healthcare Commercial	$0.93

chlorpheniramine 4 mg Tab [VDMC]

Facility

$1.03

Service Code	HCPCS A9270
Hospital Charge Code	10377433
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.93
Rate for Payer: Aetna of IA Commercial	$0.93
Rate for Payer: Aetna of IA Medical Rental Products	$0.93
Rate for Payer: Aetna of IA Medicare	$0.59
Rate for Payer: Amerigroup Medicaid	$0.52
Rate for Payer: Amerigroup Medicare	$0.52
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.77
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	$0.51
Rate for Payer: Medical Associates Commercial	$0.77
Rate for Payer: Medical Associates Managed Medicare	$0.52
Rate for Payer: Midlands Choice Commercial	$0.72
Rate for Payer: Molina Healthcare Managed Medicaid	$0.52
Rate for Payer: Molina Healthcare Managed Medicare	$0.52
Rate for Payer: Oscar Health of IA Commercial	$0.77
Rate for Payer: Partners Health Alliance Commercial	$0.77
Rate for Payer: United Healthcare Commercial	$0.93
Rate for Payer: United Healthcare Managed Medicare	$0.61

chlorproMAZINE 25 mg/mL 1ml SDV Inj Amp [VDMC]

Facility

$87.01

Service Code	HCPCS J3230
Hospital Charge Code	10377571
Hospital Revenue Code	259
Min. Negotiated Rate	$60.91
Max. Negotiated Rate	$78.31
Rate for Payer: Aetna of IA Commercial	$78.31
Rate for Payer: Aetna of IA Medical Rental Products	$78.31
Rate for Payer: Cash Price	$69.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$65.26
Rate for Payer: Medical Associates Commercial	$65.26
Rate for Payer: Midlands Choice Commercial	$60.91
Rate for Payer: United Healthcare Commercial	$78.31

chlorproMAZINE 25 mg/mL 1ml SDV Inj Amp [VDMC]

Facility

$87.01

Service Code	HCPCS J3230
Hospital Charge Code	10377571
Hospital Revenue Code	259
Min. Negotiated Rate	$43.49
Max. Negotiated Rate	$78.31
Rate for Payer: Aetna of IA Commercial	$78.31
Rate for Payer: Aetna of IA Medical Rental Products	$78.31
Rate for Payer: Aetna of IA Medicare	$49.60
Rate for Payer: Amerigroup Medicaid	$43.91
Rate for Payer: Amerigroup Medicare	$43.94
Rate for Payer: Cash Price	$69.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$65.26
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$43.50
Rate for Payer: Iowa Total Care Managed Medicaid	$43.49
Rate for Payer: Medical Associates Commercial	$65.26
Rate for Payer: Medical Associates Managed Medicare	$43.50
Rate for Payer: Midlands Choice Commercial	$60.91
Rate for Payer: Molina Healthcare Managed Medicaid	$44.16
Rate for Payer: Molina Healthcare Managed Medicare	$44.13
Rate for Payer: Oscar Health of IA Commercial	$65.26
Rate for Payer: Partners Health Alliance Commercial	$65.26
Rate for Payer: United Healthcare Commercial	$78.31
Rate for Payer: United Healthcare Managed Medicare	$51.34

chlorthalidone 25 mg Tab [VDMC]

Facility

$1.35

Service Code	HCPCS A9270
Hospital Charge Code	10377640
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$1.22
Rate for Payer: Aetna of IA Commercial	$1.22
Rate for Payer: Aetna of IA Medical Rental Products	$1.22
Rate for Payer: Aetna of IA Medicare	$0.77
Rate for Payer: Amerigroup Medicaid	$0.68
Rate for Payer: Amerigroup Medicare	$0.68
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.01
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.68
Rate for Payer: Iowa Total Care Managed Medicaid	$0.67
Rate for Payer: Medical Associates Commercial	$1.01
Rate for Payer: Medical Associates Managed Medicare	$0.68
Rate for Payer: Midlands Choice Commercial	$0.95
Rate for Payer: Molina Healthcare Managed Medicaid	$0.69
Rate for Payer: Molina Healthcare Managed Medicare	$0.68
Rate for Payer: Oscar Health of IA Commercial	$1.01
Rate for Payer: Partners Health Alliance Commercial	$1.01
Rate for Payer: United Healthcare Commercial	$1.22
Rate for Payer: United Healthcare Managed Medicare	$0.80

chlorthalidone 25 mg Tab [VDMC]

Facility

$1.35

Service Code	HCPCS A9270
Hospital Charge Code	10377640
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.22
Rate for Payer: Aetna of IA Commercial	$1.22
Rate for Payer: Aetna of IA Medical Rental Products	$1.22
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.01
Rate for Payer: Medical Associates Commercial	$1.01
Rate for Payer: Midlands Choice Commercial	$0.95
Rate for Payer: United Healthcare Commercial	$1.22

cholecalciferol 125 mcg (5000 intl units) Cap [VDMC]

Facility

$1.07

Service Code	HCPCS A9270
Hospital Charge Code	10431573
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of IA Commercial	$0.96
Rate for Payer: Aetna of IA Medical Rental Products	$0.96
Rate for Payer: Aetna of IA Medicare	$0.61
Rate for Payer: Amerigroup Medicaid	$0.54
Rate for Payer: Amerigroup Medicare	$0.54
Rate for Payer: Cash Price	$0.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.80
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.54
Rate for Payer: Iowa Total Care Managed Medicaid	$0.53
Rate for Payer: Medical Associates Commercial	$0.80
Rate for Payer: Medical Associates Managed Medicare	$0.54
Rate for Payer: Midlands Choice Commercial	$0.75
Rate for Payer: Molina Healthcare Managed Medicaid	$0.54
Rate for Payer: Molina Healthcare Managed Medicare	$0.54
Rate for Payer: Oscar Health of IA Commercial	$0.80
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$0.96
Rate for Payer: United Healthcare Managed Medicare	$0.63

cholecalciferol 125 mcg (5000 intl units) Cap [VDMC]

Facility

$1.07

Service Code	HCPCS A9270
Hospital Charge Code	10431573
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of IA Commercial	$0.96
Rate for Payer: Aetna of IA Medical Rental Products	$0.96
Rate for Payer: Cash Price	$0.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.80
Rate for Payer: Medical Associates Commercial	$0.80
Rate for Payer: Midlands Choice Commercial	$0.75
Rate for Payer: United Healthcare Commercial	$0.96

cholecalciferol 25mcg (1000 intl units) tablet [VDMC]

Facility

$1.07

Service Code	HCPCS A9270
Hospital Charge Code	10431441
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.96
Rate for Payer: United Healthcare Commercial	$0.96
Rate for Payer: Aetna of IA Commercial	$0.96
Rate for Payer: Aetna of IA Medical Rental Products	$0.96
Rate for Payer: Aetna of IA Medicare	$0.61
Rate for Payer: Amerigroup Medicaid	$0.54
Rate for Payer: Amerigroup Medicare	$0.54
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.80
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.54
Rate for Payer: Iowa Total Care Managed Medicaid	$0.53
Rate for Payer: Medical Associates Commercial	$0.80
Rate for Payer: Medical Associates Managed Medicare	$0.54
Rate for Payer: Midlands Choice Commercial	$0.75
Rate for Payer: Molina Healthcare Managed Medicaid	$0.54
Rate for Payer: Molina Healthcare Managed Medicare	$0.54
Rate for Payer: Oscar Health of IA Commercial	$0.80
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Managed Medicare	$0.63

cholecalciferol 25mcg (1000 intl units) tablet [VDMC]

Facility

$1.07

Service Code	HCPCS A9270
Hospital Charge Code	10431441
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of IA Commercial	$0.96
Rate for Payer: Aetna of IA Medical Rental Products	$0.96
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.80
Rate for Payer: Medical Associates Commercial	$0.80
Rate for Payer: Midlands Choice Commercial	$0.75
Rate for Payer: United Healthcare Commercial	$0.96

cholecalciferol 50 mcg (2000 intl units) Cap [VDMC]

Facility

$1.16

Service Code	HCPCS A9270
Hospital Charge Code	10431508
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

cholecalciferol 50 mcg (2000 intl units) Cap [VDMC]

Facility

$1.16

Service Code	HCPCS A9270
Hospital Charge Code	10431508
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

Cholecystectomy;

Facility

$12,406.26

Service Code	CPT 47600
Hospital Revenue Code	360
Min. Negotiated Rate	$11,278.42
Max. Negotiated Rate	$12,406.26
Rate for Payer: Wellmark IA HMO	$11,278.42
Rate for Payer: Wellmark IA PPO	$12,406.26

Know your out-of-pocket cost for care.

All Charges