Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

sodium hypochlorite 0.125% topical soln [VDMC]

Facility

$65.53

Service Code	NDC 00436-0672-16
Hospital Charge Code	10439067
Hospital Revenue Code	259
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$58.97
Rate for Payer: Aetna of IA Commercial	$58.97
Rate for Payer: Aetna of IA Medical Rental Products	$58.97
Rate for Payer: Cash Price	$52.42
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.14
Rate for Payer: Medical Associates Commercial	$49.14
Rate for Payer: Midlands Choice Commercial	$45.87
Rate for Payer: United Healthcare Commercial	$58.97

sodium hypochlorite 0.125% topical soln [VDMC]

Facility

$65.53

Service Code	NDC 00436-0672-16
Hospital Charge Code	10439067
Hospital Revenue Code	259
Min. Negotiated Rate	$29.49
Max. Negotiated Rate	$58.97
Rate for Payer: Aetna of IA Commercial	$58.97
Rate for Payer: Aetna of IA Medical Rental Products	$58.97
Rate for Payer: Aetna of IA Medicare	$37.35
Rate for Payer: Amerigroup Medicaid	$37.79
Rate for Payer: Amerigroup Medicare	$29.78
Rate for Payer: Cash Price	$52.42
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.14
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.49
Rate for Payer: Iowa Total Care Managed Medicaid	$37.43
Rate for Payer: Medical Associates Commercial	$49.14
Rate for Payer: Medical Associates Managed Medicare	$29.49
Rate for Payer: Midlands Choice Commercial	$45.87
Rate for Payer: Molina Healthcare Managed Medicaid	$37.98
Rate for Payer: Partners Health Alliance Commercial	$33.91
Rate for Payer: United Healthcare Commercial	$58.97
Rate for Payer: United Healthcare Managed Medicare	$38.66

Sodium-K+-Mag-CA-Chlor-Acetate IV Sol 20 mL [VDMC]

Facility

$57.05

Service Code	NDC 00409-5779-01
Hospital Charge Code	10401994
Hospital Revenue Code	259
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$51.34
Rate for Payer: Aetna of IA Commercial	$51.34
Rate for Payer: Aetna of IA Medical Rental Products	$51.34
Rate for Payer: Cash Price	$45.64
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.79
Rate for Payer: Medical Associates Commercial	$42.79
Rate for Payer: Midlands Choice Commercial	$39.93
Rate for Payer: United Healthcare Commercial	$51.34

Sodium-K+-Mag-CA-Chlor-Acetate IV Sol 20 mL [VDMC]

Facility

$57.05

Service Code	NDC 00409-5779-01
Hospital Charge Code	10401994
Hospital Revenue Code	259
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$51.34
Rate for Payer: Aetna of IA Commercial	$51.34
Rate for Payer: Aetna of IA Medical Rental Products	$51.34
Rate for Payer: Aetna of IA Medicare	$32.52
Rate for Payer: Amerigroup Medicaid	$32.91
Rate for Payer: Amerigroup Medicare	$25.93
Rate for Payer: Cash Price	$45.64
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.79
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.67
Rate for Payer: Iowa Total Care Managed Medicaid	$32.59
Rate for Payer: Medical Associates Commercial	$42.79
Rate for Payer: Medical Associates Managed Medicare	$25.67
Rate for Payer: Midlands Choice Commercial	$39.93
Rate for Payer: Molina Healthcare Managed Medicaid	$33.07
Rate for Payer: Partners Health Alliance Commercial	$29.52
Rate for Payer: United Healthcare Commercial	$51.34
Rate for Payer: United Healthcare Managed Medicare	$33.66

Sodium Nitroprusside 25 mg/mL 2ml SDV [VDMC]

Facility

$67.60

Service Code	HCPCS J3490
Hospital Charge Code	10409275
Hospital Revenue Code	259
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$60.84
Rate for Payer: Aetna of IA Commercial	$60.84
Rate for Payer: Aetna of IA Medical Rental Products	$60.84
Rate for Payer: Aetna of IA Medicare	$38.53
Rate for Payer: Amerigroup Medicaid	$38.99
Rate for Payer: Amerigroup Medicare	$30.72
Rate for Payer: Cash Price	$54.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.70
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.42
Rate for Payer: Iowa Total Care Managed Medicaid	$38.61
Rate for Payer: Medical Associates Commercial	$50.70
Rate for Payer: Medical Associates Managed Medicare	$30.42
Rate for Payer: Midlands Choice Commercial	$47.32
Rate for Payer: Molina Healthcare Managed Medicaid	$39.18
Rate for Payer: Partners Health Alliance Commercial	$34.98
Rate for Payer: United Healthcare Commercial	$60.84
Rate for Payer: United Healthcare Managed Medicare	$39.88

Sodium Nitroprusside 25 mg/mL 2ml SDV [VDMC]

Facility

$67.60

Service Code	HCPCS J3490
Hospital Charge Code	10409275
Hospital Revenue Code	259
Min. Negotiated Rate	$47.32
Max. Negotiated Rate	$60.84
Rate for Payer: Aetna of IA Commercial	$60.84
Rate for Payer: Aetna of IA Medical Rental Products	$60.84
Rate for Payer: Cash Price	$54.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.70
Rate for Payer: Medical Associates Commercial	$50.70
Rate for Payer: Midlands Choice Commercial	$47.32
Rate for Payer: United Healthcare Commercial	$60.84

sodium phosphate 3 mmol/mL Sol [VDMC]

Facility

$74.16

Service Code	NDC 00409-7391-72
Hospital Charge Code	28442909
Hospital Revenue Code	259
Min. Negotiated Rate	$51.91
Max. Negotiated Rate	$66.74
Rate for Payer: Aetna of IA Commercial	$66.74
Rate for Payer: Aetna of IA Medical Rental Products	$66.74
Rate for Payer: Cash Price	$59.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.62
Rate for Payer: Medical Associates Commercial	$55.62
Rate for Payer: Midlands Choice Commercial	$51.91
Rate for Payer: United Healthcare Commercial	$66.74

sodium phosphate 3 mmol/mL Sol [VDMC]

Facility

$74.16

Service Code	NDC 00409-7391-72
Hospital Charge Code	28442909
Hospital Revenue Code	259
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$66.74
Rate for Payer: Aetna of IA Commercial	$66.74
Rate for Payer: Aetna of IA Medical Rental Products	$66.74
Rate for Payer: Aetna of IA Medicare	$42.27
Rate for Payer: Amerigroup Medicaid	$42.78
Rate for Payer: Amerigroup Medicare	$33.71
Rate for Payer: Cash Price	$59.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.62
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.37
Rate for Payer: Iowa Total Care Managed Medicaid	$42.36
Rate for Payer: Medical Associates Commercial	$55.62
Rate for Payer: Medical Associates Managed Medicare	$33.37
Rate for Payer: Midlands Choice Commercial	$51.91
Rate for Payer: Molina Healthcare Managed Medicaid	$42.98
Rate for Payer: Partners Health Alliance Commercial	$38.38
Rate for Payer: United Healthcare Commercial	$66.74
Rate for Payer: United Healthcare Managed Medicare	$43.75

sodium phosphate-sodium biphosphate 18%-48% Oral Sol 45 mL [VDMC]

Facility

$20.12

Service Code	HCPCS A9270
Hospital Charge Code	10421497
Hospital Revenue Code	259
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$18.11
Rate for Payer: Aetna of IA Commercial	$18.11
Rate for Payer: Aetna of IA Medical Rental Products	$18.11
Rate for Payer: Aetna of IA Medicare	$11.47
Rate for Payer: Amerigroup Medicaid	$11.61
Rate for Payer: Amerigroup Medicare	$9.15
Rate for Payer: Cash Price	$16.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.09
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.05
Rate for Payer: Iowa Total Care Managed Medicaid	$11.49
Rate for Payer: Medical Associates Commercial	$15.09
Rate for Payer: Medical Associates Managed Medicare	$9.05
Rate for Payer: Midlands Choice Commercial	$14.09
Rate for Payer: Molina Healthcare Managed Medicaid	$11.66
Rate for Payer: Partners Health Alliance Commercial	$10.41
Rate for Payer: United Healthcare Commercial	$18.11
Rate for Payer: United Healthcare Managed Medicare	$11.87

sodium phosphate-sodium biphosphate 18%-48% Oral Sol 45 mL [VDMC]

Facility

$20.12

Service Code	HCPCS A9270
Hospital Charge Code	10421497
Hospital Revenue Code	259
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$18.11
Rate for Payer: Aetna of IA Commercial	$18.11
Rate for Payer: Aetna of IA Medical Rental Products	$18.11
Rate for Payer: Cash Price	$16.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.09
Rate for Payer: Medical Associates Commercial	$15.09
Rate for Payer: Midlands Choice Commercial	$14.09
Rate for Payer: United Healthcare Commercial	$18.11

sodium polystyrene sulfonate 15 g/60 mL Oral Susp [VDMC]

Facility

$75.74

Service Code	HCPCS A9270
Hospital Charge Code	10421822
Hospital Revenue Code	259
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna of IA Commercial	$68.17
Rate for Payer: Aetna of IA Medical Rental Products	$68.17
Rate for Payer: Aetna of IA Medicare	$43.17
Rate for Payer: Amerigroup Medicaid	$43.69
Rate for Payer: Amerigroup Medicare	$34.42
Rate for Payer: Cash Price	$60.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.80
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.08
Rate for Payer: Iowa Total Care Managed Medicaid	$43.26
Rate for Payer: Medical Associates Commercial	$56.80
Rate for Payer: Medical Associates Managed Medicare	$34.08
Rate for Payer: Midlands Choice Commercial	$53.02
Rate for Payer: Molina Healthcare Managed Medicaid	$43.90
Rate for Payer: Partners Health Alliance Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$68.17
Rate for Payer: United Healthcare Managed Medicare	$44.69

sodium polystyrene sulfonate 15 g/60 mL Oral Susp [VDMC]

Facility

$75.74

Service Code	HCPCS A9270
Hospital Charge Code	10421822
Hospital Revenue Code	259
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna of IA Commercial	$68.17
Rate for Payer: Aetna of IA Medical Rental Products	$68.17
Rate for Payer: Cash Price	$60.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.80
Rate for Payer: Medical Associates Commercial	$56.80
Rate for Payer: Midlands Choice Commercial	$53.02
Rate for Payer: United Healthcare Commercial	$68.17

sodium thiosulfate 25% SDV Sol[VDMC]

Facility

$406.00

Service Code	HCPCS J0209
Hospital Charge Code	12817991
Hospital Revenue Code	259
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$365.40
Rate for Payer: Aetna of IA Commercial	$365.40
Rate for Payer: Aetna of IA Medical Rental Products	$365.40
Rate for Payer: Aetna of IA Medicare	$231.42
Rate for Payer: Amerigroup Medicaid	$234.18
Rate for Payer: Amerigroup Medicare	$184.53
Rate for Payer: Cash Price	$324.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$304.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.70
Rate for Payer: Iowa Total Care Managed Medicaid	$231.91
Rate for Payer: Medical Associates Commercial	$304.50
Rate for Payer: Medical Associates Managed Medicare	$182.70
Rate for Payer: Midlands Choice Commercial	$284.20
Rate for Payer: Molina Healthcare Managed Medicaid	$235.32
Rate for Payer: Partners Health Alliance Commercial	$210.10
Rate for Payer: United Healthcare Commercial	$365.40
Rate for Payer: United Healthcare Managed Medicare	$239.54

sodium thiosulfate 25% SDV Sol[VDMC]

Facility

$406.00

Service Code	HCPCS J0209
Hospital Charge Code	12817991
Hospital Revenue Code	259
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$365.40
Rate for Payer: Aetna of IA Commercial	$365.40
Rate for Payer: Aetna of IA Medical Rental Products	$365.40
Rate for Payer: Cash Price	$324.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$304.50
Rate for Payer: Medical Associates Commercial	$304.50
Rate for Payer: Midlands Choice Commercial	$284.20
Rate for Payer: United Healthcare Commercial	$365.40

Sodium, Urine

Facility

$61.00

Service Code	CPT 84300
Hospital Charge Code	4021359
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99

Sodium, Urine

Facility

$61.00

Service Code	CPT 84300
Hospital Charge Code	4021359
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

solifenacin 5 mg Tab [VDMC]

Facility

$3.55

Service Code	HCPCS A9270
Hospital Charge Code	10421889
Hospital Revenue Code	259
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna of IA Commercial	$3.20
Rate for Payer: Aetna of IA Medical Rental Products	$3.20
Rate for Payer: Aetna of IA Medicare	$2.03
Rate for Payer: Amerigroup Medicaid	$2.05
Rate for Payer: Amerigroup Medicare	$1.62
Rate for Payer: Cash Price	$2.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.67
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.60
Rate for Payer: Iowa Total Care Managed Medicaid	$2.03
Rate for Payer: Medical Associates Commercial	$2.67
Rate for Payer: Medical Associates Managed Medicare	$1.60
Rate for Payer: Midlands Choice Commercial	$2.49
Rate for Payer: Molina Healthcare Managed Medicaid	$2.06
Rate for Payer: Partners Health Alliance Commercial	$1.84
Rate for Payer: United Healthcare Commercial	$3.20
Rate for Payer: United Healthcare Managed Medicare	$2.10

solifenacin 5 mg Tab [VDMC]

Facility

$3.55

Service Code	HCPCS A9270
Hospital Charge Code	10421889
Hospital Revenue Code	259
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna of IA Commercial	$3.20
Rate for Payer: Aetna of IA Medical Rental Products	$3.20
Rate for Payer: Cash Price	$2.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.67
Rate for Payer: Medical Associates Commercial	$2.67
Rate for Payer: Midlands Choice Commercial	$2.49
Rate for Payer: United Healthcare Commercial	$3.20

Soluble Transferrin Receptor DMCL

Facility

$139.00

Service Code	CPT 84238
Hospital Charge Code	8820558
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

Soluble Transferrin Receptor DMCL

Facility

$139.00

Service Code	CPT 84238
Hospital Charge Code	8820558
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

SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0

Facility

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	8470642
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: United Healthcare Commercial	$623.70

SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0

Facility

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	8470642
Hospital Revenue Code	278
Min. Negotiated Rate	$311.85
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Aetna of IA Medicare	$395.01
Rate for Payer: Amerigroup Medicaid	$399.72
Rate for Payer: Amerigroup Medicare	$314.97
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$311.85
Rate for Payer: Iowa Total Care Managed Medicaid	$395.84
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Medical Associates Managed Medicare	$311.85
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: Molina Healthcare Managed Medicaid	$401.66
Rate for Payer: Partners Health Alliance Commercial	$358.63
Rate for Payer: United Healthcare Commercial	$623.70
Rate for Payer: United Healthcare Managed Medicare	$408.87

SORBAFIX ABSORBABLE FIXATION SYSTEM

Facility

$711.00

Service Code	HCPCS C1713
Hospital Charge Code	8773701
Hospital Revenue Code	278
Min. Negotiated Rate	$319.95
Max. Negotiated Rate	$639.90
Rate for Payer: Aetna of IA Commercial	$639.90
Rate for Payer: Aetna of IA Medical Rental Products	$639.90
Rate for Payer: Aetna of IA Medicare	$405.27
Rate for Payer: Amerigroup Medicaid	$410.10
Rate for Payer: Amerigroup Medicare	$323.15
Rate for Payer: Cash Price	$568.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$533.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$319.95
Rate for Payer: Iowa Total Care Managed Medicaid	$406.12
Rate for Payer: Medical Associates Commercial	$533.25
Rate for Payer: Medical Associates Managed Medicare	$319.95
Rate for Payer: Midlands Choice Commercial	$497.70
Rate for Payer: Molina Healthcare Managed Medicaid	$412.10
Rate for Payer: Partners Health Alliance Commercial	$367.94
Rate for Payer: United Healthcare Commercial	$639.90
Rate for Payer: United Healthcare Managed Medicare	$419.49

SORBAFIX ABSORBABLE FIXATION SYSTEM

Facility

$711.00

Service Code	HCPCS C1713
Hospital Charge Code	8773701
Hospital Revenue Code	278
Min. Negotiated Rate	$497.70
Max. Negotiated Rate	$639.90
Rate for Payer: Aetna of IA Commercial	$639.90
Rate for Payer: Aetna of IA Medical Rental Products	$639.90
Rate for Payer: Cash Price	$568.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$533.25
Rate for Payer: Medical Associates Commercial	$533.25
Rate for Payer: Midlands Choice Commercial	$497.70
Rate for Payer: United Healthcare Commercial	$639.90

sotalol 120 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	17311425
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

Know your out-of-pocket cost for care.

All Charges