Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

LO-PRO SCREW, TI, 3.5MMX10MM

Facility

$108.00

Service Code	CPT C1713
Hospital Charge Code	8783218
Hospital Revenue Code	278
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$54.51
Rate for Payer: Amerigroup Medicare	$54.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$54.00
Rate for Payer: Iowa Total Care Managed Medicaid	$53.98
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$54.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$54.81
Rate for Payer: Molina Healthcare Managed Medicare	$54.78
Rate for Payer: Oscar Health of IA Commercial	$81.00
Rate for Payer: Partners Health Alliance Commercial	$81.00
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

LO-PRO SCREW,TI,3.5MMX14MM

Facility

$108.00

Service Code	CPT C1713
Hospital Charge Code	8783220
Hospital Revenue Code	278
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: United Healthcare Commercial	$97.20

LO-PRO SCREW,TI,3.5MMX14MM

Facility

$108.00

Service Code	CPT C1713
Hospital Charge Code	8783220
Hospital Revenue Code	278
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$54.51
Rate for Payer: Amerigroup Medicare	$54.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$54.00
Rate for Payer: Iowa Total Care Managed Medicaid	$53.98
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$54.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$54.81
Rate for Payer: Molina Healthcare Managed Medicare	$54.78
Rate for Payer: Oscar Health of IA Commercial	$81.00
Rate for Payer: Partners Health Alliance Commercial	$81.00
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

loratadine 10 mg Tab [VDMC]

Facility

$1.75

Service Code	HCPCS A9270
Hospital Charge Code	10401437
Hospital Revenue Code	259
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of IA Commercial	$1.58
Rate for Payer: Aetna of IA Medical Rental Products	$1.58
Rate for Payer: Aetna of IA Medicare	$1.00
Rate for Payer: Amerigroup Medicaid	$0.88
Rate for Payer: Amerigroup Medicare	$0.88
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.88
Rate for Payer: Iowa Total Care Managed Medicaid	$0.87
Rate for Payer: Medical Associates Commercial	$1.31
Rate for Payer: Medical Associates Managed Medicare	$0.88
Rate for Payer: Midlands Choice Commercial	$1.22
Rate for Payer: Molina Healthcare Managed Medicaid	$0.89
Rate for Payer: Molina Healthcare Managed Medicare	$0.89
Rate for Payer: Oscar Health of IA Commercial	$1.31
Rate for Payer: Partners Health Alliance Commercial	$1.31
Rate for Payer: United Healthcare Commercial	$1.58
Rate for Payer: United Healthcare Managed Medicare	$1.03

loratadine 10 mg Tab [VDMC]

Facility

$1.75

Service Code	HCPCS A9270
Hospital Charge Code	10401437
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of IA Commercial	$1.58
Rate for Payer: Aetna of IA Medical Rental Products	$1.58
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.31
Rate for Payer: Medical Associates Commercial	$1.31
Rate for Payer: Midlands Choice Commercial	$1.22
Rate for Payer: United Healthcare Commercial	$1.58

LORazepam 0.5 mg Tab [VDMC]

Facility

$3.25

Service Code	HCPCS A9270
Hospital Charge Code	10401508
Hospital Revenue Code	259
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of IA Commercial	$2.92
Rate for Payer: Aetna of IA Medical Rental Products	$2.92
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.44
Rate for Payer: Medical Associates Commercial	$2.44
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: United Healthcare Commercial	$2.92

LORazepam 0.5 mg Tab [VDMC]

Facility

$3.25

Service Code	HCPCS A9270
Hospital Charge Code	10401508
Hospital Revenue Code	259
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of IA Commercial	$2.92
Rate for Payer: Aetna of IA Medical Rental Products	$2.92
Rate for Payer: Aetna of IA Medicare	$1.85
Rate for Payer: Amerigroup Medicaid	$1.64
Rate for Payer: Amerigroup Medicare	$1.64
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.44
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.62
Rate for Payer: Iowa Total Care Managed Medicaid	$1.62
Rate for Payer: Medical Associates Commercial	$2.44
Rate for Payer: Medical Associates Managed Medicare	$1.62
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: Molina Healthcare Managed Medicaid	$1.65
Rate for Payer: Molina Healthcare Managed Medicare	$1.65
Rate for Payer: Oscar Health of IA Commercial	$2.44
Rate for Payer: Partners Health Alliance Commercial	$2.44
Rate for Payer: United Healthcare Commercial	$2.92
Rate for Payer: United Healthcare Managed Medicare	$1.92

LORazepam 1 mg Tab [VDMC]

Facility

$3.15

Service Code	HCPCS A9270
Hospital Charge Code	10401577
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna of IA Commercial	$2.84
Rate for Payer: Aetna of IA Medical Rental Products	$2.84
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.36
Rate for Payer: Medical Associates Commercial	$2.36
Rate for Payer: Midlands Choice Commercial	$2.20
Rate for Payer: United Healthcare Commercial	$2.84

LORazepam 1 mg Tab [VDMC]

Facility

$3.15

Service Code	HCPCS A9270
Hospital Charge Code	10401577
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna of IA Commercial	$2.84
Rate for Payer: Aetna of IA Medical Rental Products	$2.84
Rate for Payer: Aetna of IA Medicare	$1.80
Rate for Payer: Amerigroup Medicaid	$1.59
Rate for Payer: Amerigroup Medicare	$1.59
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.36
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.58
Rate for Payer: Iowa Total Care Managed Medicaid	$1.57
Rate for Payer: Medical Associates Commercial	$2.36
Rate for Payer: Medical Associates Managed Medicare	$1.58
Rate for Payer: Midlands Choice Commercial	$2.20
Rate for Payer: Molina Healthcare Managed Medicaid	$1.60
Rate for Payer: Molina Healthcare Managed Medicare	$1.60
Rate for Payer: Oscar Health of IA Commercial	$2.36
Rate for Payer: Partners Health Alliance Commercial	$2.36
Rate for Payer: United Healthcare Commercial	$2.84
Rate for Payer: United Healthcare Managed Medicare	$1.86

LORazepam 2 mg/mL 1ml MDV [VDMC]

Facility

$44.20

Service Code	HCPCS J2060
Hospital Charge Code	10401707
Hospital Revenue Code	259
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$39.78
Rate for Payer: Aetna of IA Commercial	$39.78
Rate for Payer: Aetna of IA Medical Rental Products	$39.78
Rate for Payer: Aetna of IA Medicare	$25.19
Rate for Payer: Amerigroup Medicaid	$22.31
Rate for Payer: Amerigroup Medicare	$22.32
Rate for Payer: Cash Price	$35.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$22.10
Rate for Payer: Iowa Total Care Managed Medicaid	$22.09
Rate for Payer: Medical Associates Commercial	$33.15
Rate for Payer: Medical Associates Managed Medicare	$22.10
Rate for Payer: Midlands Choice Commercial	$30.94
Rate for Payer: Molina Healthcare Managed Medicaid	$22.43
Rate for Payer: Molina Healthcare Managed Medicare	$22.42
Rate for Payer: Oscar Health of IA Commercial	$33.15
Rate for Payer: Partners Health Alliance Commercial	$33.15
Rate for Payer: United Healthcare Commercial	$39.78
Rate for Payer: United Healthcare Managed Medicare	$26.08

LORazepam 2 mg/mL 1ml MDV [VDMC]

Facility

$44.20

Service Code	HCPCS J2060
Hospital Charge Code	10401707
Hospital Revenue Code	259
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$39.78
Rate for Payer: Aetna of IA Commercial	$39.78
Rate for Payer: Aetna of IA Medical Rental Products	$39.78
Rate for Payer: Cash Price	$35.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.15
Rate for Payer: Medical Associates Commercial	$33.15
Rate for Payer: Midlands Choice Commercial	$30.94
Rate for Payer: United Healthcare Commercial	$39.78

LORazepam 2 mg/mL 1ml Syringe [VDMC]

Facility

$52.92

Service Code	HCPCS J2060
Hospital Charge Code	11729055
Hospital Revenue Code	259
Min. Negotiated Rate	$26.45
Max. Negotiated Rate	$47.63
Rate for Payer: Aetna of IA Commercial	$47.63
Rate for Payer: Aetna of IA Medical Rental Products	$47.63
Rate for Payer: Aetna of IA Medicare	$30.16
Rate for Payer: Amerigroup Medicaid	$26.71
Rate for Payer: Amerigroup Medicare	$26.72
Rate for Payer: Cash Price	$42.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.69
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.46
Rate for Payer: Iowa Total Care Managed Medicaid	$26.45
Rate for Payer: Medical Associates Commercial	$39.69
Rate for Payer: Medical Associates Managed Medicare	$26.46
Rate for Payer: Midlands Choice Commercial	$37.04
Rate for Payer: Molina Healthcare Managed Medicaid	$26.86
Rate for Payer: Molina Healthcare Managed Medicare	$26.84
Rate for Payer: Oscar Health of IA Commercial	$39.69
Rate for Payer: Partners Health Alliance Commercial	$39.69
Rate for Payer: United Healthcare Commercial	$47.63
Rate for Payer: United Healthcare Managed Medicare	$31.22

LORazepam 2 mg/mL 1ml Syringe [VDMC]

Facility

$52.92

Service Code	HCPCS J2060
Hospital Charge Code	11729055
Hospital Revenue Code	259
Min. Negotiated Rate	$37.04
Max. Negotiated Rate	$47.63
Rate for Payer: Aetna of IA Commercial	$47.63
Rate for Payer: Aetna of IA Medical Rental Products	$47.63
Rate for Payer: Cash Price	$42.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.69
Rate for Payer: Medical Associates Commercial	$39.69
Rate for Payer: Midlands Choice Commercial	$37.04
Rate for Payer: United Healthcare Commercial	$47.63

LORazepam 2 mg/mL 30 ml Oral Conc [VDMC]

Facility

$42.48

Service Code	HCPCS A9270
Hospital Charge Code	10401791
Hospital Revenue Code	259
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$38.23
Rate for Payer: Aetna of IA Commercial	$38.23
Rate for Payer: Aetna of IA Medical Rental Products	$38.23
Rate for Payer: Aetna of IA Medicare	$24.21
Rate for Payer: Amerigroup Medicaid	$21.44
Rate for Payer: Amerigroup Medicare	$21.45
Rate for Payer: Cash Price	$33.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.24
Rate for Payer: Iowa Total Care Managed Medicaid	$21.23
Rate for Payer: Medical Associates Commercial	$31.86
Rate for Payer: Medical Associates Managed Medicare	$21.24
Rate for Payer: Midlands Choice Commercial	$29.74
Rate for Payer: Molina Healthcare Managed Medicaid	$21.56
Rate for Payer: Molina Healthcare Managed Medicare	$21.55
Rate for Payer: Oscar Health of IA Commercial	$31.86
Rate for Payer: Partners Health Alliance Commercial	$31.86
Rate for Payer: United Healthcare Commercial	$38.23
Rate for Payer: United Healthcare Managed Medicare	$25.06

LORazepam 2 mg/mL 30 ml Oral Conc [VDMC]

Facility

$42.48

Service Code	HCPCS A9270
Hospital Charge Code	10401791
Hospital Revenue Code	259
Min. Negotiated Rate	$29.74
Max. Negotiated Rate	$38.23
Rate for Payer: Aetna of IA Commercial	$38.23
Rate for Payer: Aetna of IA Medical Rental Products	$38.23
Rate for Payer: Cash Price	$33.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.86
Rate for Payer: Medical Associates Commercial	$31.86
Rate for Payer: Midlands Choice Commercial	$29.74
Rate for Payer: United Healthcare Commercial	$38.23

losartan 50 mg Tab [VDMC]

Facility

$2.31

Service Code	HCPCS A9270
Hospital Charge Code	10401856
Hospital Revenue Code	259
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of IA Commercial	$2.08
Rate for Payer: Aetna of IA Medical Rental Products	$2.08
Rate for Payer: Aetna of IA Medicare	$1.32
Rate for Payer: Amerigroup Medicaid	$1.17
Rate for Payer: Amerigroup Medicare	$1.17
Rate for Payer: Cash Price	$1.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.16
Rate for Payer: Iowa Total Care Managed Medicaid	$1.15
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Medical Associates Managed Medicare	$1.16
Rate for Payer: Midlands Choice Commercial	$1.62
Rate for Payer: Molina Healthcare Managed Medicaid	$1.17
Rate for Payer: Molina Healthcare Managed Medicare	$1.17
Rate for Payer: Oscar Health of IA Commercial	$1.73
Rate for Payer: Partners Health Alliance Commercial	$1.73
Rate for Payer: United Healthcare Commercial	$2.08
Rate for Payer: United Healthcare Managed Medicare	$1.36

losartan 50 mg Tab [VDMC]

Facility

$2.31

Service Code	HCPCS A9270
Hospital Charge Code	10401856
Hospital Revenue Code	259
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of IA Commercial	$2.08
Rate for Payer: Aetna of IA Medical Rental Products	$2.08
Rate for Payer: Cash Price	$1.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Midlands Choice Commercial	$1.62
Rate for Payer: United Healthcare Commercial	$2.08

losartan-hydrochlorothiazide 50 mg- 12.5 mg-Tab [VDMC]

Facility

$1.77

Service Code	HCPCS A9270
Hospital Charge Code	10394043
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of IA Commercial	$1.59
Rate for Payer: Aetna of IA Medical Rental Products	$1.59
Rate for Payer: Cash Price	$1.41
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.33
Rate for Payer: Medical Associates Commercial	$1.33
Rate for Payer: Midlands Choice Commercial	$1.24
Rate for Payer: United Healthcare Commercial	$1.59

losartan-hydrochlorothiazide 50 mg- 12.5 mg-Tab [VDMC]

Facility

$1.77

Service Code	HCPCS A9270
Hospital Charge Code	10394043
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of IA Commercial	$1.59
Rate for Payer: Aetna of IA Medical Rental Products	$1.59
Rate for Payer: Aetna of IA Medicare	$1.01
Rate for Payer: Amerigroup Medicaid	$0.89
Rate for Payer: Amerigroup Medicare	$0.89
Rate for Payer: Cash Price	$1.41
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.89
Rate for Payer: Iowa Total Care Managed Medicaid	$0.88
Rate for Payer: Medical Associates Commercial	$1.33
Rate for Payer: Medical Associates Managed Medicare	$0.89
Rate for Payer: Midlands Choice Commercial	$1.24
Rate for Payer: Molina Healthcare Managed Medicaid	$0.90
Rate for Payer: Molina Healthcare Managed Medicare	$0.90
Rate for Payer: Oscar Health of IA Commercial	$1.33
Rate for Payer: Partners Health Alliance Commercial	$1.33
Rate for Payer: United Healthcare Commercial	$1.59
Rate for Payer: United Healthcare Managed Medicare	$1.04

Lower Extremity and Humerus Procedures Except Hip, Foot and Femur With CC

Facility

$21,225.17

Service Code	MS-DRG 493
Hospital Charge Code	310
Min. Negotiated Rate	$20,917.56
Max. Negotiated Rate	$21,225.17
Rate for Payer: Amerigroup Medicaid	$21,122.63
Rate for Payer: Iowa Total Care Managed Medicaid	$20,917.56
Rate for Payer: Molina Healthcare Managed Medicaid	$21,225.17

Lower Extremity and Humerus Procedures Except Hip, Foot and Femur With MCC

Facility

$35,623.63

Service Code	MS-DRG 492
Hospital Charge Code	309
Min. Negotiated Rate	$35,107.35
Max. Negotiated Rate	$35,623.63
Rate for Payer: Amerigroup Medicaid	$35,451.54
Rate for Payer: Iowa Total Care Managed Medicaid	$35,107.35
Rate for Payer: Molina Healthcare Managed Medicaid	$35,623.63

Lower Extremity and Humerus Procedures Except Hip, Foot and Femur Without CC/MCC

Facility

$14,642.56

Service Code	MS-DRG 494
Hospital Charge Code	311
Min. Negotiated Rate	$14,430.35
Max. Negotiated Rate	$14,642.56
Rate for Payer: Amerigroup Medicaid	$14,571.82
Rate for Payer: Iowa Total Care Managed Medicaid	$14,430.35
Rate for Payer: Molina Healthcare Managed Medicaid	$14,642.56

lubiprostone 24 mcg oral capsule [VDMC]

Facility

$4.68

Service Code	HCPCS A9270
Hospital Charge Code	10401925
Hospital Revenue Code	259
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna of IA Commercial	$4.21
Rate for Payer: Aetna of IA Medical Rental Products	$4.21
Rate for Payer: Aetna of IA Medicare	$2.67
Rate for Payer: Amerigroup Medicaid	$2.36
Rate for Payer: Amerigroup Medicare	$2.36
Rate for Payer: Cash Price	$3.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.51
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.34
Rate for Payer: Iowa Total Care Managed Medicaid	$2.34
Rate for Payer: Medical Associates Commercial	$3.51
Rate for Payer: Medical Associates Managed Medicare	$2.34
Rate for Payer: Midlands Choice Commercial	$3.28
Rate for Payer: Molina Healthcare Managed Medicaid	$2.38
Rate for Payer: Molina Healthcare Managed Medicare	$2.37
Rate for Payer: Oscar Health of IA Commercial	$3.51
Rate for Payer: Partners Health Alliance Commercial	$3.51
Rate for Payer: United Healthcare Commercial	$4.21
Rate for Payer: United Healthcare Managed Medicare	$2.76

lubiprostone 24 mcg oral capsule [VDMC]

Facility

$4.68

Service Code	HCPCS A9270
Hospital Charge Code	10401925
Hospital Revenue Code	259
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna of IA Commercial	$4.21
Rate for Payer: Aetna of IA Medical Rental Products	$4.21
Rate for Payer: Cash Price	$3.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.51
Rate for Payer: Medical Associates Commercial	$3.51
Rate for Payer: Midlands Choice Commercial	$3.28
Rate for Payer: United Healthcare Commercial	$4.21

Lung Transplant

Facility

$151,601.74

Service Code	MS-DRG 007
Hospital Charge Code	698
Min. Negotiated Rate	$149,404.61
Max. Negotiated Rate	$151,601.74
Rate for Payer: Amerigroup Medicaid	$150,869.36
Rate for Payer: Iowa Total Care Managed Medicaid	$149,404.61
Rate for Payer: Molina Healthcare Managed Medicaid	$151,601.74

Know your out-of-pocket cost for care.

All Charges