Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

sodium acetate 2meq/ml 20ml [VDMC]

Facility

$30.98

Service Code	HCPCS J3490
Hospital Charge Code	10430446
Hospital Revenue Code	259
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$27.88
Rate for Payer: Aetna of IA Commercial	$27.88
Rate for Payer: Aetna of IA Medical Rental Products	$27.88
Rate for Payer: Cash Price	$24.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.24
Rate for Payer: Medical Associates Commercial	$23.24
Rate for Payer: Midlands Choice Commercial	$21.69
Rate for Payer: United Healthcare Commercial	$27.88

sodium bicarbonate 4.2% IV Sol 10 mL SDS [VDMC]

Facility

$62.65

Service Code	HCPCS J3490
Hospital Charge Code	10421208
Hospital Revenue Code	259
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$56.38
Rate for Payer: Aetna of IA Commercial	$56.38
Rate for Payer: Aetna of IA Medical Rental Products	$56.38
Rate for Payer: Aetna of IA Medicare	$35.71
Rate for Payer: Amerigroup Medicaid	$31.62
Rate for Payer: Amerigroup Medicare	$31.64
Rate for Payer: Cash Price	$50.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$46.99
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.32
Rate for Payer: Iowa Total Care Managed Medicaid	$31.31
Rate for Payer: Medical Associates Commercial	$46.99
Rate for Payer: Medical Associates Managed Medicare	$31.32
Rate for Payer: Midlands Choice Commercial	$43.86
Rate for Payer: Molina Healthcare Managed Medicaid	$31.79
Rate for Payer: Molina Healthcare Managed Medicare	$31.78
Rate for Payer: Oscar Health of IA Commercial	$46.99
Rate for Payer: Partners Health Alliance Commercial	$46.99
Rate for Payer: United Healthcare Commercial	$56.38
Rate for Payer: United Healthcare Managed Medicare	$36.96

sodium bicarbonate 4.2% IV Sol 10 mL SDS [VDMC]

Facility

$62.65

Service Code	HCPCS J3490
Hospital Charge Code	10421208
Hospital Revenue Code	259
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$56.38
Rate for Payer: Aetna of IA Commercial	$56.38
Rate for Payer: Aetna of IA Medical Rental Products	$56.38
Rate for Payer: Cash Price	$50.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$46.99
Rate for Payer: Medical Associates Commercial	$46.99
Rate for Payer: Midlands Choice Commercial	$43.86
Rate for Payer: United Healthcare Commercial	$56.38

sodium bicarbonate 4.2% IV Sol 5 mL SDV [VDMC]

Facility

$50.16

Service Code	NDC 63323-0083-05
Hospital Charge Code	10437956
Hospital Revenue Code	259
Min. Negotiated Rate	$35.11
Max. Negotiated Rate	$45.14
Rate for Payer: Aetna of IA Commercial	$45.14
Rate for Payer: Aetna of IA Medical Rental Products	$45.14
Rate for Payer: Cash Price	$40.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$37.62
Rate for Payer: Medical Associates Commercial	$37.62
Rate for Payer: Midlands Choice Commercial	$35.11
Rate for Payer: United Healthcare Commercial	$45.14

sodium bicarbonate 4.2% IV Sol 5 mL SDV [VDMC]

Facility

$50.16

Service Code	NDC 63323-0083-05
Hospital Charge Code	10437956
Hospital Revenue Code	259
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$45.14
Rate for Payer: Aetna of IA Commercial	$45.14
Rate for Payer: Aetna of IA Medical Rental Products	$45.14
Rate for Payer: Aetna of IA Medicare	$28.59
Rate for Payer: Amerigroup Medicaid	$25.32
Rate for Payer: Amerigroup Medicare	$25.33
Rate for Payer: Cash Price	$40.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$37.62
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.08
Rate for Payer: Iowa Total Care Managed Medicaid	$25.07
Rate for Payer: Medical Associates Commercial	$37.62
Rate for Payer: Medical Associates Managed Medicare	$25.08
Rate for Payer: Midlands Choice Commercial	$35.11
Rate for Payer: Molina Healthcare Managed Medicaid	$25.46
Rate for Payer: Molina Healthcare Managed Medicare	$25.44
Rate for Payer: Oscar Health of IA Commercial	$37.62
Rate for Payer: Partners Health Alliance Commercial	$37.62
Rate for Payer: United Healthcare Commercial	$45.14
Rate for Payer: United Healthcare Managed Medicare	$29.59

sodium bicarbonate 650 mg Tab [VDMC]

Facility

$1.24

Service Code	HCPCS A9270
Hospital Charge Code	10421275
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of IA Commercial	$1.12
Rate for Payer: Aetna of IA Medical Rental Products	$1.12
Rate for Payer: Aetna of IA Medicare	$0.71
Rate for Payer: Amerigroup Medicaid	$0.63
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: Cash Price	$0.99
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.93
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.62
Rate for Payer: Iowa Total Care Managed Medicaid	$0.62
Rate for Payer: Medical Associates Commercial	$0.93
Rate for Payer: Medical Associates Managed Medicare	$0.62
Rate for Payer: Midlands Choice Commercial	$0.87
Rate for Payer: Molina Healthcare Managed Medicaid	$0.63
Rate for Payer: Molina Healthcare Managed Medicare	$0.63
Rate for Payer: Oscar Health of IA Commercial	$0.93
Rate for Payer: Partners Health Alliance Commercial	$0.93
Rate for Payer: United Healthcare Commercial	$1.12
Rate for Payer: United Healthcare Managed Medicare	$0.73

sodium bicarbonate 650 mg Tab [VDMC]

Facility

$1.24

Service Code	HCPCS A9270
Hospital Charge Code	10421275
Hospital Revenue Code	259
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of IA Commercial	$1.12
Rate for Payer: Aetna of IA Medical Rental Products	$1.12
Rate for Payer: Cash Price	$0.99
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.93
Rate for Payer: Medical Associates Commercial	$0.93
Rate for Payer: Midlands Choice Commercial	$0.87
Rate for Payer: United Healthcare Commercial	$1.12

sodium bicarbonate 8.4% 50ml Syringe[VDMC]

Facility

$60.44

Service Code	HCPCS J3490
Hospital Charge Code	14019421
Hospital Revenue Code	259
Min. Negotiated Rate	$42.31
Max. Negotiated Rate	$54.40
Rate for Payer: Aetna of IA Commercial	$54.40
Rate for Payer: Aetna of IA Medical Rental Products	$54.40
Rate for Payer: Cash Price	$48.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.33
Rate for Payer: Medical Associates Commercial	$45.33
Rate for Payer: Midlands Choice Commercial	$42.31
Rate for Payer: United Healthcare Commercial	$54.40

sodium bicarbonate 8.4% 50ml Syringe[VDMC]

Facility

$60.44

Service Code	HCPCS J3490
Hospital Charge Code	14019421
Hospital Revenue Code	259
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$54.40
Rate for Payer: Aetna of IA Commercial	$54.40
Rate for Payer: Aetna of IA Medical Rental Products	$54.40
Rate for Payer: Aetna of IA Medicare	$34.45
Rate for Payer: Amerigroup Medicaid	$30.50
Rate for Payer: Amerigroup Medicare	$30.52
Rate for Payer: Cash Price	$48.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.22
Rate for Payer: Iowa Total Care Managed Medicaid	$30.21
Rate for Payer: Medical Associates Commercial	$45.33
Rate for Payer: Medical Associates Managed Medicare	$30.22
Rate for Payer: Midlands Choice Commercial	$42.31
Rate for Payer: Molina Healthcare Managed Medicaid	$30.67
Rate for Payer: Molina Healthcare Managed Medicare	$30.66
Rate for Payer: Oscar Health of IA Commercial	$45.33
Rate for Payer: Partners Health Alliance Commercial	$45.33
Rate for Payer: United Healthcare Commercial	$54.40
Rate for Payer: United Healthcare Managed Medicare	$35.66

sodium bicarbonate 8.4% IV 50 mL Vial [VDMC]

Facility

$42.08

Service Code	HCPCS J3490
Hospital Charge Code	10421344
Hospital Revenue Code	259
Min. Negotiated Rate	$21.03
Max. Negotiated Rate	$37.87
Rate for Payer: Aetna of IA Commercial	$37.87
Rate for Payer: Aetna of IA Medical Rental Products	$37.87
Rate for Payer: Aetna of IA Medicare	$23.99
Rate for Payer: Amerigroup Medicaid	$21.24
Rate for Payer: Amerigroup Medicare	$21.25
Rate for Payer: Cash Price	$33.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.04
Rate for Payer: Iowa Total Care Managed Medicaid	$21.03
Rate for Payer: Medical Associates Commercial	$31.56
Rate for Payer: Medical Associates Managed Medicare	$21.04
Rate for Payer: Midlands Choice Commercial	$29.46
Rate for Payer: Molina Healthcare Managed Medicaid	$21.36
Rate for Payer: Molina Healthcare Managed Medicare	$21.34
Rate for Payer: Oscar Health of IA Commercial	$31.56
Rate for Payer: Partners Health Alliance Commercial	$31.56
Rate for Payer: United Healthcare Commercial	$37.87
Rate for Payer: United Healthcare Managed Medicare	$24.83

sodium bicarbonate 8.4% IV 50 mL Vial [VDMC]

Facility

$42.08

Service Code	HCPCS J3490
Hospital Charge Code	10421344
Hospital Revenue Code	259
Min. Negotiated Rate	$29.46
Max. Negotiated Rate	$37.87
Rate for Payer: Aetna of IA Commercial	$37.87
Rate for Payer: Aetna of IA Medical Rental Products	$37.87
Rate for Payer: Cash Price	$33.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.56
Rate for Payer: Medical Associates Commercial	$31.56
Rate for Payer: Midlands Choice Commercial	$29.46
Rate for Payer: United Healthcare Commercial	$37.87

Sodium Chloride 0.45% IV Sol 1000 mL [VDMC]

Facility

$67.12

Service Code	NDC 00338-0043-04
Hospital Charge Code	10441171
Hospital Revenue Code	259
Min. Negotiated Rate	$33.55
Max. Negotiated Rate	$60.41
Rate for Payer: Aetna of IA Commercial	$60.41
Rate for Payer: Aetna of IA Medical Rental Products	$60.41
Rate for Payer: Aetna of IA Medicare	$38.26
Rate for Payer: Amerigroup Medicaid	$33.88
Rate for Payer: Amerigroup Medicare	$33.90
Rate for Payer: Cash Price	$53.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.34
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.56
Rate for Payer: Iowa Total Care Managed Medicaid	$33.55
Rate for Payer: Medical Associates Commercial	$50.34
Rate for Payer: Medical Associates Managed Medicare	$33.56
Rate for Payer: Midlands Choice Commercial	$46.98
Rate for Payer: Molina Healthcare Managed Medicaid	$34.06
Rate for Payer: Molina Healthcare Managed Medicare	$34.04
Rate for Payer: Oscar Health of IA Commercial	$50.34
Rate for Payer: Partners Health Alliance Commercial	$50.34
Rate for Payer: United Healthcare Commercial	$60.41
Rate for Payer: United Healthcare Managed Medicare	$39.60

Sodium Chloride 0.45% IV Sol 1000 mL [VDMC]

Facility

$67.12

Service Code	NDC 00338-0043-04
Hospital Charge Code	10441171
Hospital Revenue Code	259
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$60.41
Rate for Payer: Aetna of IA Commercial	$60.41
Rate for Payer: Aetna of IA Medical Rental Products	$60.41
Rate for Payer: Cash Price	$53.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.34
Rate for Payer: Medical Associates Commercial	$50.34
Rate for Payer: Midlands Choice Commercial	$46.98
Rate for Payer: United Healthcare Commercial	$60.41

Sodium Chloride 0.45% with KCl 20 mEq/L intravenous solution Sodium Chloride 0.45% with KCl 20 mEq/L Sol [VDMC]

Facility

$59.32

Service Code	HCPCS J3480
Hospital Charge Code	11220446
Hospital Revenue Code	259
Min. Negotiated Rate	$29.65
Max. Negotiated Rate	$53.39
Rate for Payer: Aetna of IA Commercial	$53.39
Rate for Payer: Aetna of IA Medical Rental Products	$53.39
Rate for Payer: Aetna of IA Medicare	$33.81
Rate for Payer: Amerigroup Medicaid	$29.94
Rate for Payer: Amerigroup Medicare	$29.96
Rate for Payer: Cash Price	$47.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.49
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.66
Rate for Payer: Iowa Total Care Managed Medicaid	$29.65
Rate for Payer: Medical Associates Commercial	$44.49
Rate for Payer: Medical Associates Managed Medicare	$29.66
Rate for Payer: Midlands Choice Commercial	$41.52
Rate for Payer: Molina Healthcare Managed Medicaid	$30.10
Rate for Payer: Molina Healthcare Managed Medicare	$30.09
Rate for Payer: Oscar Health of IA Commercial	$44.49
Rate for Payer: Partners Health Alliance Commercial	$44.49
Rate for Payer: United Healthcare Commercial	$53.39
Rate for Payer: United Healthcare Managed Medicare	$35.00

Sodium Chloride 0.45% with KCl 20 mEq/L intravenous solution Sodium Chloride 0.45% with KCl 20 mEq/L Sol [VDMC]

Facility

$59.32

Service Code	HCPCS J3480
Hospital Charge Code	11220446
Hospital Revenue Code	259
Min. Negotiated Rate	$41.52
Max. Negotiated Rate	$53.39
Rate for Payer: Aetna of IA Commercial	$53.39
Rate for Payer: Aetna of IA Medical Rental Products	$53.39
Rate for Payer: Cash Price	$47.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.49
Rate for Payer: Medical Associates Commercial	$44.49
Rate for Payer: Midlands Choice Commercial	$41.52
Rate for Payer: United Healthcare Commercial	$53.39

Sodium Chloride 0.9% 100 mL IV Sol [VDMC]

Facility

$65.88

Service Code	HCPCS J7050
Hospital Charge Code	11088778
Hospital Revenue Code	259
Min. Negotiated Rate	$46.12
Max. Negotiated Rate	$59.29
Rate for Payer: Aetna of IA Commercial	$59.29
Rate for Payer: Aetna of IA Medical Rental Products	$59.29
Rate for Payer: Cash Price	$52.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.41
Rate for Payer: Medical Associates Commercial	$49.41
Rate for Payer: Midlands Choice Commercial	$46.12
Rate for Payer: United Healthcare Commercial	$59.29

Sodium Chloride 0.9% 100 mL IV Sol [VDMC]

Facility

$65.88

Service Code	HCPCS J7050
Hospital Charge Code	11088778
Hospital Revenue Code	259
Min. Negotiated Rate	$32.93
Max. Negotiated Rate	$59.29
Rate for Payer: Aetna of IA Commercial	$59.29
Rate for Payer: Aetna of IA Medical Rental Products	$59.29
Rate for Payer: Aetna of IA Medicare	$37.55
Rate for Payer: Amerigroup Medicaid	$33.25
Rate for Payer: Amerigroup Medicare	$33.27
Rate for Payer: Cash Price	$52.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.41
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.94
Rate for Payer: Iowa Total Care Managed Medicaid	$32.93
Rate for Payer: Medical Associates Commercial	$49.41
Rate for Payer: Medical Associates Managed Medicare	$32.94
Rate for Payer: Midlands Choice Commercial	$46.12
Rate for Payer: Molina Healthcare Managed Medicaid	$33.43
Rate for Payer: Molina Healthcare Managed Medicare	$33.41
Rate for Payer: Oscar Health of IA Commercial	$49.41
Rate for Payer: Partners Health Alliance Commercial	$49.41
Rate for Payer: United Healthcare Commercial	$59.29
Rate for Payer: United Healthcare Managed Medicare	$38.87

Sodium Chloride 0.9% 500 ml intravenous solution [VDMC]

Facility

$66.70

Service Code	HCPCS J7040
Hospital Charge Code	10605618
Hospital Revenue Code	259
Min. Negotiated Rate	$33.34
Max. Negotiated Rate	$60.03
Rate for Payer: Aetna of IA Commercial	$60.03
Rate for Payer: Aetna of IA Medical Rental Products	$60.03
Rate for Payer: Aetna of IA Medicare	$38.02
Rate for Payer: Amerigroup Medicaid	$33.66
Rate for Payer: Amerigroup Medicare	$33.68
Rate for Payer: Cash Price	$53.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.02
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.35
Rate for Payer: Iowa Total Care Managed Medicaid	$33.34
Rate for Payer: Medical Associates Commercial	$50.02
Rate for Payer: Medical Associates Managed Medicare	$33.35
Rate for Payer: Midlands Choice Commercial	$46.69
Rate for Payer: Molina Healthcare Managed Medicaid	$33.85
Rate for Payer: Molina Healthcare Managed Medicare	$33.83
Rate for Payer: Oscar Health of IA Commercial	$50.02
Rate for Payer: Partners Health Alliance Commercial	$50.02
Rate for Payer: United Healthcare Commercial	$60.03
Rate for Payer: United Healthcare Managed Medicare	$39.35

Sodium Chloride 0.9% 500 ml intravenous solution [VDMC]

Facility

$66.70

Service Code	HCPCS J7040
Hospital Charge Code	10605618
Hospital Revenue Code	259
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$60.03
Rate for Payer: Aetna of IA Commercial	$60.03
Rate for Payer: Aetna of IA Medical Rental Products	$60.03
Rate for Payer: Cash Price	$53.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.02
Rate for Payer: Medical Associates Commercial	$50.02
Rate for Payer: Midlands Choice Commercial	$46.69
Rate for Payer: United Healthcare Commercial	$60.03

sodium chloride 0.9% Inh Sol 3 mL [VDMC]

Facility

$4.56

Service Code	NDC 76204-0300-03
Hospital Charge Code	10438086
Hospital Revenue Code	259
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna of IA Commercial	$4.10
Rate for Payer: Aetna of IA Medical Rental Products	$4.10
Rate for Payer: Aetna of IA Medicare	$2.60
Rate for Payer: Amerigroup Medicaid	$2.30
Rate for Payer: Amerigroup Medicare	$2.30
Rate for Payer: Cash Price	$3.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.28
Rate for Payer: Iowa Total Care Managed Medicaid	$2.28
Rate for Payer: Medical Associates Commercial	$3.42
Rate for Payer: Medical Associates Managed Medicare	$2.28
Rate for Payer: Midlands Choice Commercial	$3.19
Rate for Payer: Molina Healthcare Managed Medicaid	$2.31
Rate for Payer: Molina Healthcare Managed Medicare	$2.31
Rate for Payer: Oscar Health of IA Commercial	$3.42
Rate for Payer: Partners Health Alliance Commercial	$3.42
Rate for Payer: United Healthcare Commercial	$4.10
Rate for Payer: United Healthcare Managed Medicare	$2.69

sodium chloride 0.9% Inh Sol 3 mL [VDMC]

Facility

$4.56

Service Code	NDC 76204-0300-03
Hospital Charge Code	10438086
Hospital Revenue Code	259
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna of IA Commercial	$4.10
Rate for Payer: Aetna of IA Medical Rental Products	$4.10
Rate for Payer: Cash Price	$3.65
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.42
Rate for Payer: Medical Associates Commercial	$3.42
Rate for Payer: Midlands Choice Commercial	$3.19
Rate for Payer: United Healthcare Commercial	$4.10

Sodium Chloride 0.9% intravenous solution 25 mL [VDMC]

Facility

$63.66

Service Code	NDC 00409-7984-20
Hospital Charge Code	11089158
Hospital Revenue Code	259
Min. Negotiated Rate	$44.56
Max. Negotiated Rate	$57.29
Rate for Payer: Aetna of IA Commercial	$57.29
Rate for Payer: Aetna of IA Medical Rental Products	$57.29
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.74
Rate for Payer: Medical Associates Commercial	$47.74
Rate for Payer: Midlands Choice Commercial	$44.56
Rate for Payer: United Healthcare Commercial	$57.29

Sodium Chloride 0.9% intravenous solution 25 mL [VDMC]

Facility

$63.66

Service Code	NDC 00409-7984-20
Hospital Charge Code	11089158
Hospital Revenue Code	259
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$57.29
Rate for Payer: Aetna of IA Commercial	$57.29
Rate for Payer: Aetna of IA Medical Rental Products	$57.29
Rate for Payer: Aetna of IA Medicare	$36.29
Rate for Payer: Amerigroup Medicaid	$32.13
Rate for Payer: Amerigroup Medicare	$32.15
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.74
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.83
Rate for Payer: Iowa Total Care Managed Medicaid	$31.82
Rate for Payer: Medical Associates Commercial	$47.74
Rate for Payer: Medical Associates Managed Medicare	$31.83
Rate for Payer: Midlands Choice Commercial	$44.56
Rate for Payer: Molina Healthcare Managed Medicaid	$32.31
Rate for Payer: Molina Healthcare Managed Medicare	$32.29
Rate for Payer: Oscar Health of IA Commercial	$47.74
Rate for Payer: Partners Health Alliance Commercial	$47.74
Rate for Payer: United Healthcare Commercial	$57.29
Rate for Payer: United Healthcare Managed Medicare	$37.56

Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]

Facility

$66.80

Service Code	HCPCS J7030
Hospital Charge Code	10441371
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

Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]

Facility

$66.80

Service Code	HCPCS J7030
Hospital Charge Code	10441371
Hospital Revenue Code	259
Min. Negotiated Rate	$33.39
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	$33.71
Rate for Payer: Amerigroup Medicare	$33.73
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	$33.40
Rate for Payer: Iowa Total Care Managed Medicaid	$33.39
Rate for Payer: Medical Associates Commercial	$50.10
Rate for Payer: Medical Associates Managed Medicare	$33.40
Rate for Payer: Midlands Choice Commercial	$46.76
Rate for Payer: Molina Healthcare Managed Medicaid	$33.90
Rate for Payer: Molina Healthcare Managed Medicare	$33.88
Rate for Payer: Oscar Health of IA Commercial	$50.10
Rate for Payer: Partners Health Alliance Commercial	$50.10
Rate for Payer: United Healthcare Commercial	$60.12
Rate for Payer: United Healthcare Managed Medicare	$39.41

Know your out-of-pocket cost for care.

All Charges