Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

L15 FRAME PLATE

Facility

$2,006.00

Service Code	HCPCS C1713
Hospital Charge Code	8955187
Hospital Revenue Code	276
Min. Negotiated Rate	$1,404.20
Max. Negotiated Rate	$1,805.40
Rate for Payer: Aetna of IA Commercial	$1,805.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,805.40
Rate for Payer: Cash Price	$1,604.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,504.50
Rate for Payer: Medical Associates Commercial	$1,504.50
Rate for Payer: Midlands Choice Commercial	$1,404.20
Rate for Payer: United Healthcare Commercial	$1,805.40

labetalol 100 mg Tab [VDMC]

Facility

$2.04

Service Code	HCPCS A9270
Hospital Charge Code	10398611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.83
Rate for Payer: Aetna of IA Commercial	$1.83
Rate for Payer: Aetna of IA Medical Rental Products	$1.83
Rate for Payer: Aetna of IA Medicare	$1.16
Rate for Payer: Amerigroup Medicaid	$1.17
Rate for Payer: Amerigroup Medicare	$0.93
Rate for Payer: Cash Price	$1.63
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.53
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.92
Rate for Payer: Iowa Total Care Managed Medicaid	$1.16
Rate for Payer: Medical Associates Commercial	$1.53
Rate for Payer: Medical Associates Managed Medicare	$0.92
Rate for Payer: Midlands Choice Commercial	$1.42
Rate for Payer: Molina Healthcare Managed Medicaid	$1.18
Rate for Payer: Partners Health Alliance Commercial	$1.05
Rate for Payer: United Healthcare Commercial	$1.83
Rate for Payer: United Healthcare Managed Medicare	$1.20

labetalol 100 mg Tab [VDMC]

Facility

$2.04

Service Code	HCPCS A9270
Hospital Charge Code	10398611
Hospital Revenue Code	259
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.83
Rate for Payer: Aetna of IA Commercial	$1.83
Rate for Payer: Aetna of IA Medical Rental Products	$1.83
Rate for Payer: Cash Price	$1.63
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.53
Rate for Payer: Medical Associates Commercial	$1.53
Rate for Payer: Midlands Choice Commercial	$1.42
Rate for Payer: United Healthcare Commercial	$1.83

labetalol 5 mg/mL 20 ml IV MDV [VDMC]

Facility

$33.28

Service Code	HCPCS J1920
Hospital Charge Code	10398680
Hospital Revenue Code	259
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$29.95
Rate for Payer: Aetna of IA Commercial	$29.95
Rate for Payer: Aetna of IA Medical Rental Products	$29.95
Rate for Payer: Aetna of IA Medicare	$18.97
Rate for Payer: Amerigroup Medicaid	$19.20
Rate for Payer: Amerigroup Medicare	$15.13
Rate for Payer: Cash Price	$26.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.96
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.98
Rate for Payer: Iowa Total Care Managed Medicaid	$19.01
Rate for Payer: Medical Associates Commercial	$24.96
Rate for Payer: Medical Associates Managed Medicare	$14.98
Rate for Payer: Midlands Choice Commercial	$23.30
Rate for Payer: Molina Healthcare Managed Medicaid	$19.29
Rate for Payer: Partners Health Alliance Commercial	$17.22
Rate for Payer: United Healthcare Commercial	$29.95
Rate for Payer: United Healthcare Managed Medicare	$19.64

labetalol 5 mg/mL 20 ml IV MDV [VDMC]

Facility

$33.28

Service Code	HCPCS J1920
Hospital Charge Code	10398680
Hospital Revenue Code	259
Min. Negotiated Rate	$23.30
Max. Negotiated Rate	$29.95
Rate for Payer: Aetna of IA Commercial	$29.95
Rate for Payer: Aetna of IA Medical Rental Products	$29.95
Rate for Payer: Cash Price	$26.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.96
Rate for Payer: Medical Associates Commercial	$24.96
Rate for Payer: Midlands Choice Commercial	$23.30
Rate for Payer: United Healthcare Commercial	$29.95

LABOR DIRECT ADMIT

Facility

$460.00

Service Code	HCPCS G0379
Hospital Charge Code	7984750
Hospital Revenue Code	721
Min. Negotiated Rate	$322.00
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of IA Commercial	$414.00
Rate for Payer: Aetna of IA Medical Rental Products	$414.00
Rate for Payer: Cash Price	$368.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$345.00
Rate for Payer: Medical Associates Commercial	$345.00
Rate for Payer: Midlands Choice Commercial	$322.00
Rate for Payer: United Healthcare Commercial	$414.00

LABOR DIRECT ADMIT

Facility

$460.00

Service Code	HCPCS G0379
Hospital Charge Code	7984750
Hospital Revenue Code	721
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of IA Commercial	$414.00
Rate for Payer: Aetna of IA Medical Rental Products	$414.00
Rate for Payer: Aetna of IA Medicare	$262.20
Rate for Payer: Amerigroup Medicaid	$265.33
Rate for Payer: Amerigroup Medicare	$209.07
Rate for Payer: Cash Price	$368.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$345.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$207.00
Rate for Payer: Iowa Total Care Managed Medicaid	$262.75
Rate for Payer: Medical Associates Commercial	$345.00
Rate for Payer: Medical Associates Managed Medicare	$207.00
Rate for Payer: Midlands Choice Commercial	$322.00
Rate for Payer: Molina Healthcare Managed Medicaid	$266.62
Rate for Payer: Partners Health Alliance Commercial	$238.05
Rate for Payer: United Healthcare Commercial	$414.00
Rate for Payer: United Healthcare Managed Medicare	$271.40

LABOR PER HOUR

Facility

$62.00

Service Code	HCPCS G0378
Hospital Charge Code	7984749
Hospital Revenue Code	721
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of IA Commercial	$55.80
Rate for Payer: Aetna of IA Medical Rental Products	$55.80
Rate for Payer: Cash Price	$49.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$46.50
Rate for Payer: Medical Associates Commercial	$46.50
Rate for Payer: Midlands Choice Commercial	$43.40
Rate for Payer: United Healthcare Commercial	$55.80

LABOR PER HOUR

Facility

$62.00

Service Code	HCPCS G0378
Hospital Charge Code	7984749
Hospital Revenue Code	721
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of IA Commercial	$55.80
Rate for Payer: Aetna of IA Medical Rental Products	$55.80
Rate for Payer: Aetna of IA Medicare	$35.34
Rate for Payer: Amerigroup Medicaid	$35.76
Rate for Payer: Amerigroup Medicare	$28.18
Rate for Payer: Cash Price	$49.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$46.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.90
Rate for Payer: Iowa Total Care Managed Medicaid	$35.41
Rate for Payer: Medical Associates Commercial	$46.50
Rate for Payer: Medical Associates Managed Medicare	$27.90
Rate for Payer: Midlands Choice Commercial	$43.40
Rate for Payer: Molina Healthcare Managed Medicaid	$35.94
Rate for Payer: Partners Health Alliance Commercial	$32.09
Rate for Payer: United Healthcare Commercial	$55.80
Rate for Payer: United Healthcare Managed Medicare	$36.58

LAC COMPLEX <2.5 CM CHOLE CHARGE

Professional

Both

$828.00

Hospital Charge Code	8069097
Hospital Revenue Code	981
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$621.00
Rate for Payer: Cash Price	$662.40
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: Partners Health Alliance Commercial	$621.00

LAC COMPLEX 2.6-7.5 CM CHARGE

Professional

Both

$1,152.00

Hospital Charge Code	8069062
Hospital Revenue Code	981
Min. Negotiated Rate	$806.40
Max. Negotiated Rate	$864.00
Rate for Payer: Cash Price	$921.60
Rate for Payer: Medical Associates Commercial	$864.00
Rate for Payer: Midlands Choice Commercial	$806.40
Rate for Payer: Partners Health Alliance Commercial	$864.00

LAC COMPLEX EACH ADDT'L >7.6CM CHARGE

Professional

Both

$472.00

Hospital Charge Code	8069182
Hospital Revenue Code	981
Min. Negotiated Rate	$330.40
Max. Negotiated Rate	$354.00
Rate for Payer: Cash Price	$377.60
Rate for Payer: Medical Associates Commercial	$354.00
Rate for Payer: Midlands Choice Commercial	$330.40
Rate for Payer: Partners Health Alliance Commercial	$354.00

LAC INTERMEDIATE 12.6-20 CM CHARGE

Professional

Both

$1,006.00

Hospital Charge Code	8069136
Hospital Revenue Code	981
Min. Negotiated Rate	$704.20
Max. Negotiated Rate	$754.50
Rate for Payer: Cash Price	$804.80
Rate for Payer: Medical Associates Commercial	$754.50
Rate for Payer: Midlands Choice Commercial	$704.20
Rate for Payer: Partners Health Alliance Commercial	$754.50

LAC INTERMEDIATE 20.1-30 CM CHARGE

Professional

Both

$930.00

Hospital Charge Code	8069157
Hospital Revenue Code	981
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$697.50
Rate for Payer: Cash Price	$744.00
Rate for Payer: Medical Associates Commercial	$697.50
Rate for Payer: Midlands Choice Commercial	$651.00
Rate for Payer: Partners Health Alliance Commercial	$697.50

LAC INTERMEDIATE <2.5 CM CHARGE

Professional

Both

$565.00

Hospital Charge Code	8068966
Hospital Revenue Code	981
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$423.75
Rate for Payer: Cash Price	$452.00
Rate for Payer: Medical Associates Commercial	$423.75
Rate for Payer: Midlands Choice Commercial	$395.50
Rate for Payer: Partners Health Alliance Commercial	$423.75

LAC INTERMEDIATE 2.6-7.5 CM CHARGE

Professional

Both

$639.00

Hospital Charge Code	8068984
Hospital Revenue Code	981
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$479.25
Rate for Payer: Cash Price	$511.20
Rate for Payer: Medical Associates Commercial	$479.25
Rate for Payer: Midlands Choice Commercial	$447.30
Rate for Payer: Partners Health Alliance Commercial	$479.25

LAC INTERMEDIATE >30.1 CM CHARGE

Professional

Both

$1,260.00

Hospital Charge Code	8069044
Hospital Revenue Code	981
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$945.00
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Medical Associates Commercial	$945.00
Rate for Payer: Midlands Choice Commercial	$882.00
Rate for Payer: Partners Health Alliance Commercial	$945.00

LAC INTERMEDIATE 7.6-12.5 CM CHARGE

Professional

Both

$757.00

Hospital Charge Code	8069058
Hospital Revenue Code	981
Min. Negotiated Rate	$529.90
Max. Negotiated Rate	$567.75
Rate for Payer: Cash Price	$605.60
Rate for Payer: Medical Associates Commercial	$567.75
Rate for Payer: Midlands Choice Commercial	$529.90
Rate for Payer: Partners Health Alliance Commercial	$567.75

LAC SIMPLE 7.6-12.5 CM CHARGE

Professional

Both

$331.00

Hospital Charge Code	8069026
Hospital Revenue Code	981
Min. Negotiated Rate	$231.70
Max. Negotiated Rate	$248.25
Rate for Payer: Cash Price	$264.80
Rate for Payer: Medical Associates Commercial	$248.25
Rate for Payer: Midlands Choice Commercial	$231.70
Rate for Payer: Partners Health Alliance Commercial	$248.25

Lactated Ringers IV Sol 1000 mL [VDMC]

Facility

$66.80

Service Code	HCPCS J7120
Hospital Charge Code	10431110
Hospital Revenue Code	259
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$60.12
Rate for Payer: Aetna of IA Commercial	$60.12
Rate for Payer: Aetna of IA Medical Rental Products	$60.12
Rate for Payer: Aetna of IA Medicare	$38.08
Rate for Payer: Amerigroup Medicaid	$38.53
Rate for Payer: Amerigroup Medicare	$30.36
Rate for Payer: Cash Price	$53.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.06
Rate for Payer: Iowa Total Care Managed Medicaid	$38.16
Rate for Payer: Medical Associates Commercial	$50.10
Rate for Payer: Medical Associates Managed Medicare	$30.06
Rate for Payer: Midlands Choice Commercial	$46.76
Rate for Payer: Molina Healthcare Managed Medicaid	$38.72
Rate for Payer: Partners Health Alliance Commercial	$34.57
Rate for Payer: United Healthcare Commercial	$60.12
Rate for Payer: United Healthcare Managed Medicare	$39.41

Lactated Ringers IV Sol 1000 mL [VDMC]

Facility

$66.80

Service Code	HCPCS J7120
Hospital Charge Code	10431110
Hospital Revenue Code	259
Min. Negotiated Rate	$46.76
Max. Negotiated Rate	$60.12
Rate for Payer: Aetna of IA Commercial	$60.12
Rate for Payer: Aetna of IA Medical Rental Products	$60.12
Rate for Payer: Cash Price	$53.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.10
Rate for Payer: Medical Associates Commercial	$50.10
Rate for Payer: Midlands Choice Commercial	$46.76
Rate for Payer: United Healthcare Commercial	$60.12

Lactated Ringers IV Sol 500 mL [VDMC]

Facility

$74.52

Service Code	HCPCS J7120
Hospital Charge Code	10431177
Hospital Revenue Code	259
Min. Negotiated Rate	$33.53
Max. Negotiated Rate	$67.07
Rate for Payer: Aetna of IA Commercial	$67.07
Rate for Payer: Aetna of IA Medical Rental Products	$67.07
Rate for Payer: Aetna of IA Medicare	$42.48
Rate for Payer: Amerigroup Medicaid	$42.98
Rate for Payer: Amerigroup Medicare	$33.87
Rate for Payer: Cash Price	$59.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.89
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.53
Rate for Payer: Iowa Total Care Managed Medicaid	$42.57
Rate for Payer: Medical Associates Commercial	$55.89
Rate for Payer: Medical Associates Managed Medicare	$33.53
Rate for Payer: Midlands Choice Commercial	$52.16
Rate for Payer: Molina Healthcare Managed Medicaid	$43.19
Rate for Payer: Partners Health Alliance Commercial	$38.56
Rate for Payer: United Healthcare Commercial	$67.07
Rate for Payer: United Healthcare Managed Medicare	$43.97

Lactated Ringers IV Sol 500 mL [VDMC]

Facility

$74.52

Service Code	HCPCS J7120
Hospital Charge Code	10431177
Hospital Revenue Code	259
Min. Negotiated Rate	$52.16
Max. Negotiated Rate	$67.07
Rate for Payer: Aetna of IA Commercial	$67.07
Rate for Payer: Aetna of IA Medical Rental Products	$67.07
Rate for Payer: Cash Price	$59.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.89
Rate for Payer: Medical Associates Commercial	$55.89
Rate for Payer: Midlands Choice Commercial	$52.16
Rate for Payer: United Healthcare Commercial	$67.07

LACTIC ACID

Facility

$139.00

Service Code	CPT 83605
Hospital Charge Code	1503766
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
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: 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

LACTIC ACID

Facility

$139.00

Service Code	CPT 83605
Hospital Charge Code	1503766
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

Know your out-of-pocket cost for care.

All Charges