Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

citalopram 20 mg Tab [VDMC]

Facility

$1.18

Service Code	HCPCS A9270
Hospital Charge Code	10378190
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.06
Rate for Payer: Aetna of IA Commercial	$1.06
Rate for Payer: Aetna of IA Medical Rental Products	$1.06
Rate for Payer: Aetna of IA Medicare	$0.67
Rate for Payer: Amerigroup Medicaid	$0.68
Rate for Payer: Amerigroup Medicare	$0.54
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.89
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.53
Rate for Payer: Iowa Total Care Managed Medicaid	$0.68
Rate for Payer: Medical Associates Commercial	$0.89
Rate for Payer: Medical Associates Managed Medicare	$0.53
Rate for Payer: Midlands Choice Commercial	$0.83
Rate for Payer: Molina Healthcare Managed Medicaid	$0.69
Rate for Payer: Partners Health Alliance Commercial	$0.61
Rate for Payer: United Healthcare Commercial	$1.06
Rate for Payer: United Healthcare Managed Medicare	$0.70

citalopram 20 mg Tab [VDMC]

Facility

$1.18

Service Code	HCPCS A9270
Hospital Charge Code	10378190
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.06
Rate for Payer: Aetna of IA Commercial	$1.06
Rate for Payer: Aetna of IA Medical Rental Products	$1.06
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.89
Rate for Payer: Medical Associates Commercial	$0.89
Rate for Payer: Midlands Choice Commercial	$0.83
Rate for Payer: United Healthcare Commercial	$1.06

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	4010788
Hospital Revenue Code	301
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Aetna of IA Medicare	$40.47
Rate for Payer: Amerigroup Medicaid	$40.95
Rate for Payer: Amerigroup Medicare	$32.27
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.95
Rate for Payer: Iowa Total Care Managed Medicaid	$40.56
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Medical Associates Managed Medicare	$31.95
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: Molina Healthcare Managed Medicaid	$41.15
Rate for Payer: Partners Health Alliance Commercial	$36.74
Rate for Payer: United Healthcare Commercial	$63.90
Rate for Payer: United Healthcare Managed Medicare	$41.89

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	4010788
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: United Healthcare Commercial	$63.90

CKMB

Facility

$139.00

Service Code	CPT 82553
Hospital Charge Code	8093949
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

CKMB

Facility

$139.00

Service Code	CPT 82553
Hospital Charge Code	8093949
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

CKMB and Index DMCL

Facility

$139.00

Service Code	CPT 82553
Hospital Charge Code	8037513
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

CKMB and Index DMCL

Facility

$139.00

Service Code	CPT 82553
Hospital Charge Code	8037513
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

CK MB DMCL

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	8037511
Hospital Revenue Code	301
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Aetna of IA Medicare	$40.47
Rate for Payer: Amerigroup Medicaid	$40.95
Rate for Payer: Amerigroup Medicare	$32.27
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.95
Rate for Payer: Iowa Total Care Managed Medicaid	$40.56
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Medical Associates Managed Medicare	$31.95
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: Molina Healthcare Managed Medicaid	$41.15
Rate for Payer: Partners Health Alliance Commercial	$36.74
Rate for Payer: United Healthcare Commercial	$63.90
Rate for Payer: United Healthcare Managed Medicare	$41.89

CK MB DMCL

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	8037511
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: United Healthcare Commercial	$63.90

CK Total DMCL

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	8037512
Hospital Revenue Code	301
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Aetna of IA Medicare	$40.47
Rate for Payer: Amerigroup Medicaid	$40.95
Rate for Payer: Amerigroup Medicare	$32.27
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.95
Rate for Payer: Iowa Total Care Managed Medicaid	$40.56
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Medical Associates Managed Medicare	$31.95
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: Molina Healthcare Managed Medicaid	$41.15
Rate for Payer: Partners Health Alliance Commercial	$36.74
Rate for Payer: United Healthcare Commercial	$63.90
Rate for Payer: United Healthcare Managed Medicare	$41.89

CK Total DMCL

Facility

$71.00

Service Code	CPT 82550
Hospital Charge Code	8037512
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: United Healthcare Commercial	$63.90

CLEAR OUTER EAR CANAL

Facility

$144.00

Service Code	CPT 69200
Hospital Charge Code	4866849
Hospital Revenue Code	450
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of IA Commercial	$129.60
Rate for Payer: Aetna of IA Medical Rental Products	$129.60
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.00
Rate for Payer: Medical Associates Commercial	$108.00
Rate for Payer: Midlands Choice Commercial	$100.80
Rate for Payer: United Healthcare Commercial	$129.60

CLEAR OUTER EAR CANAL

Facility

$144.00

Service Code	CPT 69200
Hospital Charge Code	4866849
Hospital Revenue Code	450
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of IA Commercial	$129.60
Rate for Payer: Aetna of IA Medical Rental Products	$129.60
Rate for Payer: Aetna of IA Medicare	$82.08
Rate for Payer: Amerigroup Medicaid	$83.06
Rate for Payer: Amerigroup Medicare	$65.45
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$64.80
Rate for Payer: Iowa Total Care Managed Medicaid	$82.25
Rate for Payer: Medical Associates Commercial	$108.00
Rate for Payer: Medical Associates Managed Medicare	$64.80
Rate for Payer: Midlands Choice Commercial	$100.80
Rate for Payer: Molina Healthcare Managed Medicaid	$83.46
Rate for Payer: Partners Health Alliance Commercial	$74.52
Rate for Payer: United Healthcare Commercial	$129.60
Rate for Payer: United Healthcare Managed Medicare	$84.96

clindamycin 150 mg Cap [VDMC]

Facility

$1.86

Service Code	HCPCS A9270
Hospital Charge Code	10378332
Hospital Revenue Code	259
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna of IA Commercial	$1.67
Rate for Payer: Aetna of IA Medical Rental Products	$1.67
Rate for Payer: Cash Price	$1.49
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	$1.30
Rate for Payer: United Healthcare Commercial	$1.67

clindamycin 150 mg Cap [VDMC]

Facility

$1.86

Service Code	HCPCS A9270
Hospital Charge Code	10378332
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna of IA Commercial	$1.67
Rate for Payer: Aetna of IA Medical Rental Products	$1.67
Rate for Payer: Aetna of IA Medicare	$1.06
Rate for Payer: Amerigroup Medicaid	$1.07
Rate for Payer: Amerigroup Medicare	$0.85
Rate for Payer: Cash Price	$1.49
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	$0.84
Rate for Payer: Iowa Total Care Managed Medicaid	$1.06
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Medical Associates Managed Medicare	$0.84
Rate for Payer: Midlands Choice Commercial	$1.30
Rate for Payer: Molina Healthcare Managed Medicaid	$1.08
Rate for Payer: Partners Health Alliance Commercial	$0.96
Rate for Payer: United Healthcare Commercial	$1.67
Rate for Payer: United Healthcare Managed Medicare	$1.10

clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]

Facility

$76.05

Service Code	HCPCS J0736
Hospital Charge Code	10378403
Hospital Revenue Code	259
Min. Negotiated Rate	$53.23
Max. Negotiated Rate	$68.44
Rate for Payer: Aetna of IA Commercial	$68.44
Rate for Payer: Aetna of IA Medical Rental Products	$68.44
Rate for Payer: Cash Price	$60.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.04
Rate for Payer: Medical Associates Commercial	$57.04
Rate for Payer: Midlands Choice Commercial	$53.23
Rate for Payer: United Healthcare Commercial	$68.44

clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]

Facility

$76.05

Service Code	HCPCS J0736
Hospital Charge Code	10378403
Hospital Revenue Code	259
Min. Negotiated Rate	$34.22
Max. Negotiated Rate	$68.44
Rate for Payer: Aetna of IA Commercial	$68.44
Rate for Payer: Aetna of IA Medical Rental Products	$68.44
Rate for Payer: Aetna of IA Medicare	$43.35
Rate for Payer: Amerigroup Medicaid	$43.87
Rate for Payer: Amerigroup Medicare	$34.56
Rate for Payer: Cash Price	$60.84
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.04
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.22
Rate for Payer: Iowa Total Care Managed Medicaid	$43.44
Rate for Payer: Medical Associates Commercial	$57.04
Rate for Payer: Medical Associates Managed Medicare	$34.22
Rate for Payer: Midlands Choice Commercial	$53.23
Rate for Payer: Molina Healthcare Managed Medicaid	$44.08
Rate for Payer: Partners Health Alliance Commercial	$39.36
Rate for Payer: United Healthcare Commercial	$68.44
Rate for Payer: United Healthcare Managed Medicare	$44.87

clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]

Facility

$66.38

Service Code	HCPCS J0736
Hospital Charge Code	10378474
Hospital Revenue Code	259
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$59.74
Rate for Payer: Aetna of IA Commercial	$59.74
Rate for Payer: Aetna of IA Medical Rental Products	$59.74
Rate for Payer: Aetna of IA Medicare	$37.83
Rate for Payer: Amerigroup Medicaid	$38.29
Rate for Payer: Amerigroup Medicare	$30.17
Rate for Payer: Cash Price	$53.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.87
Rate for Payer: Iowa Total Care Managed Medicaid	$37.91
Rate for Payer: Medical Associates Commercial	$49.78
Rate for Payer: Medical Associates Managed Medicare	$29.87
Rate for Payer: Midlands Choice Commercial	$46.46
Rate for Payer: Molina Healthcare Managed Medicaid	$38.47
Rate for Payer: Partners Health Alliance Commercial	$34.35
Rate for Payer: United Healthcare Commercial	$59.74
Rate for Payer: United Healthcare Managed Medicare	$39.16

clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]

Facility

$66.38

Service Code	HCPCS J0736
Hospital Charge Code	10378474
Hospital Revenue Code	259
Min. Negotiated Rate	$46.46
Max. Negotiated Rate	$59.74
Rate for Payer: Aetna of IA Commercial	$59.74
Rate for Payer: Aetna of IA Medical Rental Products	$59.74
Rate for Payer: Cash Price	$53.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.78
Rate for Payer: Medical Associates Commercial	$49.78
Rate for Payer: Midlands Choice Commercial	$46.46
Rate for Payer: United Healthcare Commercial	$59.74

clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]

Facility

$98.02

Service Code	HCPCS J0736
Hospital Charge Code	11881828
Hospital Revenue Code	259
Min. Negotiated Rate	$44.11
Max. Negotiated Rate	$88.21
Rate for Payer: Aetna of IA Commercial	$88.21
Rate for Payer: Aetna of IA Medical Rental Products	$88.21
Rate for Payer: Aetna of IA Medicare	$55.87
Rate for Payer: Amerigroup Medicaid	$56.54
Rate for Payer: Amerigroup Medicare	$44.55
Rate for Payer: Cash Price	$78.41
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$73.51
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$44.11
Rate for Payer: Iowa Total Care Managed Medicaid	$55.99
Rate for Payer: Medical Associates Commercial	$73.51
Rate for Payer: Medical Associates Managed Medicare	$44.11
Rate for Payer: Midlands Choice Commercial	$68.61
Rate for Payer: Molina Healthcare Managed Medicaid	$56.81
Rate for Payer: Partners Health Alliance Commercial	$50.72
Rate for Payer: United Healthcare Commercial	$88.21
Rate for Payer: United Healthcare Managed Medicare	$57.83

clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]

Facility

$98.02

Service Code	HCPCS J0736
Hospital Charge Code	11881828
Hospital Revenue Code	259
Min. Negotiated Rate	$68.61
Max. Negotiated Rate	$88.21
Rate for Payer: Aetna of IA Commercial	$88.21
Rate for Payer: Aetna of IA Medical Rental Products	$88.21
Rate for Payer: Cash Price	$78.41
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$73.51
Rate for Payer: Medical Associates Commercial	$73.51
Rate for Payer: Midlands Choice Commercial	$68.61
Rate for Payer: United Healthcare Commercial	$88.21

clobetasol propionate topical 0.05% Sol 50ml [VDMC]

Facility

$108.00

Service Code	HCPCS A9270
Hospital Charge Code	21028886
Hospital Revenue Code	259
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

clobetasol propionate topical 0.05% Sol 50ml [VDMC]

Facility

$108.00

Service Code	HCPCS A9270
Hospital Charge Code	21028886
Hospital Revenue Code	259
Min. Negotiated Rate	$48.60
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: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$62.29
Rate for Payer: Amerigroup Medicare	$49.09
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	$48.60
Rate for Payer: Iowa Total Care Managed Medicaid	$61.69
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$48.60
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$62.60
Rate for Payer: Partners Health Alliance Commercial	$55.89
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

clonazePAM 0.25 mg Dis Tab [VDMC]

Facility

$4.53

Service Code	HCPCS A9270
Hospital Charge Code	10378545
Hospital Revenue Code	259
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna of IA Commercial	$4.07
Rate for Payer: Aetna of IA Medical Rental Products	$4.07
Rate for Payer: Cash Price	$3.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.39
Rate for Payer: Medical Associates Commercial	$3.39
Rate for Payer: Midlands Choice Commercial	$3.17
Rate for Payer: United Healthcare Commercial	$4.07

Know your out-of-pocket cost for care.

All Charges