Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

MG Mammogram Digital Screening Right.

Facility

$302.00

Service Code	CPT 77067 52
Hospital Charge Code	4570787
Hospital Revenue Code	403
Min. Negotiated Rate	$211.40
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of IA Commercial	$271.80
Rate for Payer: Aetna of IA Medical Rental Products	$271.80
Rate for Payer: Cash Price	$241.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$226.50
Rate for Payer: Medical Associates Commercial	$226.50
Rate for Payer: Midlands Choice Commercial	$211.40
Rate for Payer: United Healthcare Commercial	$271.80

miconazole Top 2% Crm 15gm [VDMC]

Facility

$13.70

Service Code	HCPCS A9270
Hospital Charge Code	10436187
Hospital Revenue Code	259
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$12.33
Rate for Payer: Aetna of IA Commercial	$12.33
Rate for Payer: Aetna of IA Medical Rental Products	$12.33
Rate for Payer: Cash Price	$10.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.28
Rate for Payer: Medical Associates Commercial	$10.28
Rate for Payer: Midlands Choice Commercial	$9.59
Rate for Payer: United Healthcare Commercial	$12.33

miconazole Top 2% Crm 15gm [VDMC]

Facility

$13.70

Service Code	HCPCS A9270
Hospital Charge Code	10436187
Hospital Revenue Code	259
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$12.33
Rate for Payer: Aetna of IA Commercial	$12.33
Rate for Payer: Aetna of IA Medical Rental Products	$12.33
Rate for Payer: Aetna of IA Medicare	$7.81
Rate for Payer: Amerigroup Medicaid	$6.91
Rate for Payer: Amerigroup Medicare	$6.92
Rate for Payer: Cash Price	$10.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.85
Rate for Payer: Iowa Total Care Managed Medicaid	$6.85
Rate for Payer: Medical Associates Commercial	$10.28
Rate for Payer: Medical Associates Managed Medicare	$6.85
Rate for Payer: Midlands Choice Commercial	$9.59
Rate for Payer: Molina Healthcare Managed Medicaid	$6.95
Rate for Payer: Molina Healthcare Managed Medicare	$6.95
Rate for Payer: Oscar Health of IA Commercial	$10.28
Rate for Payer: Partners Health Alliance Commercial	$10.28
Rate for Payer: United Healthcare Commercial	$12.33
Rate for Payer: United Healthcare Managed Medicare	$8.08

miconazole topical 2% Cre 45 gm [VDMC]

Facility

$22.08

Service Code	HCPCS A9270
Hospital Charge Code	11222554
Hospital Revenue Code	259
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$19.87
Rate for Payer: Aetna of IA Commercial	$19.87
Rate for Payer: Aetna of IA Medical Rental Products	$19.87
Rate for Payer: Cash Price	$17.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.56
Rate for Payer: Medical Associates Commercial	$16.56
Rate for Payer: Midlands Choice Commercial	$15.46
Rate for Payer: United Healthcare Commercial	$19.87

miconazole topical 2% Cre 45 gm [VDMC]

Facility

$22.08

Service Code	HCPCS A9270
Hospital Charge Code	11222554
Hospital Revenue Code	259
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$19.87
Rate for Payer: Aetna of IA Commercial	$19.87
Rate for Payer: Aetna of IA Medical Rental Products	$19.87
Rate for Payer: Aetna of IA Medicare	$12.59
Rate for Payer: Amerigroup Medicaid	$11.14
Rate for Payer: Amerigroup Medicare	$11.15
Rate for Payer: Cash Price	$17.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.04
Rate for Payer: Iowa Total Care Managed Medicaid	$11.04
Rate for Payer: Medical Associates Commercial	$16.56
Rate for Payer: Medical Associates Managed Medicare	$11.04
Rate for Payer: Midlands Choice Commercial	$15.46
Rate for Payer: Molina Healthcare Managed Medicaid	$11.21
Rate for Payer: Molina Healthcare Managed Medicare	$11.20
Rate for Payer: Oscar Health of IA Commercial	$16.56
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$19.87
Rate for Payer: United Healthcare Managed Medicare	$13.03

midazolam 1 mg/mL 2 ML SDV [VDMC]

Facility

$41.09

Service Code	HCPCS J2250
Hospital Charge Code	10406011
Hospital Revenue Code	259
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$36.98
Rate for Payer: Aetna of IA Commercial	$36.98
Rate for Payer: Aetna of IA Medical Rental Products	$36.98
Rate for Payer: Aetna of IA Medicare	$23.42
Rate for Payer: Amerigroup Medicaid	$20.74
Rate for Payer: Amerigroup Medicare	$20.75
Rate for Payer: Cash Price	$32.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.54
Rate for Payer: Iowa Total Care Managed Medicaid	$20.54
Rate for Payer: Medical Associates Commercial	$30.82
Rate for Payer: Medical Associates Managed Medicare	$20.54
Rate for Payer: Midlands Choice Commercial	$28.76
Rate for Payer: Molina Healthcare Managed Medicaid	$20.85
Rate for Payer: Molina Healthcare Managed Medicare	$20.84
Rate for Payer: Oscar Health of IA Commercial	$30.82
Rate for Payer: Partners Health Alliance Commercial	$30.82
Rate for Payer: United Healthcare Commercial	$36.98
Rate for Payer: United Healthcare Managed Medicare	$24.24

midazolam 1 mg/mL 2 ML SDV [VDMC]

Facility

$41.09

Service Code	HCPCS J2250
Hospital Charge Code	10406011
Hospital Revenue Code	259
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$36.98
Rate for Payer: Aetna of IA Commercial	$36.98
Rate for Payer: Aetna of IA Medical Rental Products	$36.98
Rate for Payer: Cash Price	$32.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.82
Rate for Payer: Medical Associates Commercial	$30.82
Rate for Payer: Midlands Choice Commercial	$28.76
Rate for Payer: United Healthcare Commercial	$36.98

midazolam 1 mg/mL Inj 5 ML SDV [VDMC]

Facility

$42.87

Service Code	HCPCS J2250
Hospital Charge Code	10405940
Hospital Revenue Code	259
Min. Negotiated Rate	$30.01
Max. Negotiated Rate	$38.58
Rate for Payer: Aetna of IA Commercial	$38.58
Rate for Payer: Aetna of IA Medical Rental Products	$38.58
Rate for Payer: Cash Price	$34.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.15
Rate for Payer: Medical Associates Commercial	$32.15
Rate for Payer: Midlands Choice Commercial	$30.01
Rate for Payer: United Healthcare Commercial	$38.58

midazolam 1 mg/mL Inj 5 ML SDV [VDMC]

Facility

$42.87

Service Code	HCPCS J2250
Hospital Charge Code	10405940
Hospital Revenue Code	259
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$38.58
Rate for Payer: Aetna of IA Commercial	$38.58
Rate for Payer: Aetna of IA Medical Rental Products	$38.58
Rate for Payer: Aetna of IA Medicare	$24.44
Rate for Payer: Amerigroup Medicaid	$21.64
Rate for Payer: Amerigroup Medicare	$21.65
Rate for Payer: Cash Price	$34.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.44
Rate for Payer: Iowa Total Care Managed Medicaid	$21.43
Rate for Payer: Medical Associates Commercial	$32.15
Rate for Payer: Medical Associates Managed Medicare	$21.44
Rate for Payer: Midlands Choice Commercial	$30.01
Rate for Payer: Molina Healthcare Managed Medicaid	$21.76
Rate for Payer: Molina Healthcare Managed Medicare	$21.74
Rate for Payer: Oscar Health of IA Commercial	$32.15
Rate for Payer: Partners Health Alliance Commercial	$32.15
Rate for Payer: United Healthcare Commercial	$38.58
Rate for Payer: United Healthcare Managed Medicare	$25.29

midazolam 1 mg/mL MDV 5 ML vial [VDMC]

Facility

$43.61

Service Code	HCPCS J2250
Hospital Charge Code	13683949
Hospital Revenue Code	259
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$39.25
Rate for Payer: Aetna of IA Commercial	$39.25
Rate for Payer: Aetna of IA Medical Rental Products	$39.25
Rate for Payer: Cash Price	$34.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.71
Rate for Payer: Medical Associates Commercial	$32.71
Rate for Payer: Midlands Choice Commercial	$30.53
Rate for Payer: United Healthcare Commercial	$39.25

midazolam 1 mg/mL MDV 5 ML vial [VDMC]

Facility

$43.61

Service Code	HCPCS J2250
Hospital Charge Code	13683949
Hospital Revenue Code	259
Min. Negotiated Rate	$21.80
Max. Negotiated Rate	$39.25
Rate for Payer: Aetna of IA Commercial	$39.25
Rate for Payer: Aetna of IA Medical Rental Products	$39.25
Rate for Payer: Aetna of IA Medicare	$24.86
Rate for Payer: Amerigroup Medicaid	$22.01
Rate for Payer: Amerigroup Medicare	$22.02
Rate for Payer: Cash Price	$34.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.71
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.80
Rate for Payer: Iowa Total Care Managed Medicaid	$21.80
Rate for Payer: Medical Associates Commercial	$32.71
Rate for Payer: Medical Associates Managed Medicare	$21.80
Rate for Payer: Midlands Choice Commercial	$30.53
Rate for Payer: Molina Healthcare Managed Medicaid	$22.13
Rate for Payer: Molina Healthcare Managed Medicare	$22.12
Rate for Payer: Oscar Health of IA Commercial	$32.71
Rate for Payer: Partners Health Alliance Commercial	$32.71
Rate for Payer: United Healthcare Commercial	$39.25
Rate for Payer: United Healthcare Managed Medicare	$25.73

midazolam 2 mg/mL Oral Syrup [VDMC]

Facility

$9.67

Service Code	HCPCS A9270GY
Hospital Charge Code	10406082
Hospital Revenue Code	259
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$8.70
Rate for Payer: Aetna of IA Commercial	$8.70
Rate for Payer: Aetna of IA Medical Rental Products	$8.70
Rate for Payer: Aetna of IA Medicare	$5.51
Rate for Payer: Amerigroup Medicaid	$4.88
Rate for Payer: Amerigroup Medicare	$4.88
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.84
Rate for Payer: Iowa Total Care Managed Medicaid	$4.83
Rate for Payer: Medical Associates Commercial	$7.25
Rate for Payer: Medical Associates Managed Medicare	$4.84
Rate for Payer: Midlands Choice Commercial	$6.77
Rate for Payer: Molina Healthcare Managed Medicaid	$4.91
Rate for Payer: Molina Healthcare Managed Medicare	$4.90
Rate for Payer: Oscar Health of IA Commercial	$7.25
Rate for Payer: Partners Health Alliance Commercial	$7.25
Rate for Payer: United Healthcare Commercial	$8.70
Rate for Payer: United Healthcare Managed Medicare	$5.71

midazolam 2 mg/mL Oral Syrup [VDMC]

Facility

$9.67

Service Code	HCPCS A9270GY
Hospital Charge Code	10406082
Hospital Revenue Code	259
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$8.70
Rate for Payer: Aetna of IA Commercial	$8.70
Rate for Payer: Aetna of IA Medical Rental Products	$8.70
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.25
Rate for Payer: Medical Associates Commercial	$7.25
Rate for Payer: Midlands Choice Commercial	$6.77
Rate for Payer: United Healthcare Commercial	$8.70

midodrine 5 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10406147
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna of IA Commercial	$1.43
Rate for Payer: Aetna of IA Medical Rental Products	$1.43
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: United Healthcare Commercial	$1.43

midodrine 5 mg Tab [VDMC]

Facility

$1.59

Service Code	HCPCS A9270
Hospital Charge Code	10406147
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna of IA Commercial	$1.43
Rate for Payer: Aetna of IA Medical Rental Products	$1.43
Rate for Payer: Aetna of IA Medicare	$0.91
Rate for Payer: Amerigroup Medicaid	$0.80
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.80
Rate for Payer: Iowa Total Care Managed Medicaid	$0.79
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Medical Associates Managed Medicare	$0.80
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: Molina Healthcare Managed Medicaid	$0.81
Rate for Payer: Molina Healthcare Managed Medicare	$0.81
Rate for Payer: Oscar Health of IA Commercial	$1.19
Rate for Payer: Partners Health Alliance Commercial	$1.19
Rate for Payer: United Healthcare Commercial	$1.43
Rate for Payer: United Healthcare Managed Medicare	$0.94

MILEAGE GROUND PER 10TH OF A MILE

Facility

$2.00

Service Code	CPT A0425 QN
Hospital Charge Code	5966784
Hospital Revenue Code	540
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of IA Commercial	$1.80
Rate for Payer: Aetna of IA Medical Rental Products	$1.80
Rate for Payer: Aetna of IA Medicare	$1.14
Rate for Payer: Amerigroup Medicaid	$1.01
Rate for Payer: Amerigroup Medicare	$1.01
Rate for Payer: Cash Price	$1.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1.00
Rate for Payer: Medical Associates Commercial	$1.50
Rate for Payer: Medical Associates Managed Medicare	$1.00
Rate for Payer: Midlands Choice Commercial	$1.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1.02
Rate for Payer: Molina Healthcare Managed Medicare	$1.01
Rate for Payer: Oscar Health of IA Commercial	$1.50
Rate for Payer: Partners Health Alliance Commercial	$1.50
Rate for Payer: United Healthcare Commercial	$1.80
Rate for Payer: United Healthcare Managed Medicare	$1.70

MILEAGE GROUND PER 10TH OF A MILE

Facility

$2.00

Service Code	CPT A0425 QN
Hospital Charge Code	5966784
Hospital Revenue Code	540
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of IA Commercial	$1.80
Rate for Payer: Aetna of IA Medical Rental Products	$1.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.50
Rate for Payer: Medical Associates Commercial	$1.50
Rate for Payer: Midlands Choice Commercial	$1.40
Rate for Payer: United Healthcare Commercial	$1.80

mineral oil 100% Liq 473 ml [VDMC]

Facility

$19.42

Service Code	HCPCS A9270
Hospital Charge Code	11221127
Hospital Revenue Code	259
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$17.48
Rate for Payer: Aetna of IA Commercial	$17.48
Rate for Payer: Aetna of IA Medical Rental Products	$17.48
Rate for Payer: Aetna of IA Medicare	$11.07
Rate for Payer: Amerigroup Medicaid	$9.80
Rate for Payer: Amerigroup Medicare	$9.81
Rate for Payer: Cash Price	$15.54
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.71
Rate for Payer: Iowa Total Care Managed Medicaid	$9.71
Rate for Payer: Medical Associates Commercial	$14.56
Rate for Payer: Medical Associates Managed Medicare	$9.71
Rate for Payer: Midlands Choice Commercial	$13.59
Rate for Payer: Molina Healthcare Managed Medicaid	$9.86
Rate for Payer: Molina Healthcare Managed Medicare	$9.85
Rate for Payer: Oscar Health of IA Commercial	$14.56
Rate for Payer: Partners Health Alliance Commercial	$14.56
Rate for Payer: United Healthcare Commercial	$17.48
Rate for Payer: United Healthcare Managed Medicare	$11.46

mineral oil 100% Liq 473 ml [VDMC]

Facility

$19.42

Service Code	HCPCS A9270
Hospital Charge Code	11221127
Hospital Revenue Code	259
Min. Negotiated Rate	$13.59
Max. Negotiated Rate	$17.48
Rate for Payer: Aetna of IA Commercial	$17.48
Rate for Payer: Aetna of IA Medical Rental Products	$17.48
Rate for Payer: Cash Price	$15.54
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.56
Rate for Payer: Medical Associates Commercial	$14.56
Rate for Payer: Midlands Choice Commercial	$13.59
Rate for Payer: United Healthcare Commercial	$17.48

MINI 4 HOLE ST

Facility

$133.00

Service Code	CPT C1713
Hospital Charge Code	8046726
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: United Healthcare Commercial	$119.70

MINI 4 HOLE ST

Facility

$133.00

Service Code	CPT C1713
Hospital Charge Code	8046726
Hospital Revenue Code	278
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Aetna of IA Medicare	$75.81
Rate for Payer: Amerigroup Medicaid	$67.13
Rate for Payer: Amerigroup Medicare	$67.16
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$66.50
Rate for Payer: Iowa Total Care Managed Medicaid	$66.47
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Medical Associates Managed Medicare	$66.50
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: Molina Healthcare Managed Medicaid	$67.50
Rate for Payer: Molina Healthcare Managed Medicare	$67.46
Rate for Payer: Oscar Health of IA Commercial	$99.75
Rate for Payer: Partners Health Alliance Commercial	$99.75
Rate for Payer: United Healthcare Commercial	$119.70
Rate for Payer: United Healthcare Managed Medicare	$78.47

minocycline 50 mg Cap [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10406269
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Aetna of IA Medicare	$1.07
Rate for Payer: Amerigroup Medicaid	$0.94
Rate for Payer: Amerigroup Medicare	$0.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.94
Rate for Payer: Iowa Total Care Managed Medicaid	$0.93
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Medical Associates Managed Medicare	$0.94
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: Molina Healthcare Managed Medicaid	$0.95
Rate for Payer: Molina Healthcare Managed Medicare	$0.95
Rate for Payer: Oscar Health of IA Commercial	$1.40
Rate for Payer: Partners Health Alliance Commercial	$1.40
Rate for Payer: United Healthcare Commercial	$1.68
Rate for Payer: United Healthcare Managed Medicare	$1.10

minocycline 50 mg Cap [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10406269
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: United Healthcare Commercial	$1.68

Minor Bladder Procedures With CC

Facility

$9,209.54

Service Code	MS-DRG 663
Hospital Charge Code	445
Min. Negotiated Rate	$9,076.07
Max. Negotiated Rate	$9,209.54
Rate for Payer: Amerigroup Medicaid	$9,165.05
Rate for Payer: Iowa Total Care Managed Medicaid	$9,076.07
Rate for Payer: Molina Healthcare Managed Medicaid	$9,209.54

Minor Bladder Procedures With MCC

Facility

$28,844.19

Service Code	MS-DRG 662
Hospital Charge Code	444
Min. Negotiated Rate	$28,426.16
Max. Negotiated Rate	$28,844.19
Rate for Payer: Amerigroup Medicaid	$28,704.84
Rate for Payer: Iowa Total Care Managed Medicaid	$28,426.16
Rate for Payer: Molina Healthcare Managed Medicaid	$28,844.19

Know your out-of-pocket cost for care.

All Charges