Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

2cmx3cm THIN GRAFT

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Charge Code	8781513
Hospital Revenue Code	278
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,863.00
Rate for Payer: Aetna of IA Commercial	$1,863.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,863.00
Rate for Payer: Aetna of IA Medicare	$1,179.90
Rate for Payer: Amerigroup Medicaid	$1,193.98
Rate for Payer: Amerigroup Medicare	$940.82
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,552.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$931.50
Rate for Payer: Iowa Total Care Managed Medicaid	$1,182.38
Rate for Payer: Medical Associates Commercial	$1,552.50
Rate for Payer: Medical Associates Managed Medicare	$931.50
Rate for Payer: Midlands Choice Commercial	$1,449.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,199.77
Rate for Payer: Partners Health Alliance Commercial	$1,071.22
Rate for Payer: United Healthcare Commercial	$1,863.00
Rate for Payer: United Healthcare Managed Medicare	$1,221.30

30 minutes or less 99497

Facility

$140.00

Service Code	CPT 99497
Hospital Charge Code	8398016
Hospital Revenue Code	769
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$277.26
Rate for Payer: Aetna of IA Commercial	$126.00
Rate for Payer: Aetna of IA Medical Rental Products	$126.00
Rate for Payer: Aetna of IA Medicare	$79.80
Rate for Payer: Amerigroup Medicaid	$80.75
Rate for Payer: Amerigroup Medicare	$63.63
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$63.00
Rate for Payer: Iowa Total Care Managed Medicaid	$79.97
Rate for Payer: Medical Associates Commercial	$105.00
Rate for Payer: Medical Associates Managed Medicare	$63.00
Rate for Payer: Midlands Choice Commercial	$98.00
Rate for Payer: Molina Healthcare Managed Medicaid	$81.14
Rate for Payer: Partners Health Alliance Commercial	$72.45
Rate for Payer: United Healthcare Commercial	$126.00
Rate for Payer: United Healthcare Managed Medicare	$82.60
Rate for Payer: Wellmark IA HMO WHPI	$251.70
Rate for Payer: Wellmark IA PPO	$277.26

30 minutes or less 99497

Facility

$140.00

Service Code	CPT 99497
Hospital Charge Code	8398016
Hospital Revenue Code	769
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of IA Commercial	$126.00
Rate for Payer: Aetna of IA Medical Rental Products	$126.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.00
Rate for Payer: Medical Associates Commercial	$105.00
Rate for Payer: Midlands Choice Commercial	$98.00
Rate for Payer: United Healthcare Commercial	$126.00

3.0MMX12MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463692
Hospital Revenue Code	278
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$197.27
Rate for Payer: Amerigroup Medicare	$155.44
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$153.90
Rate for Payer: Iowa Total Care Managed Medicaid	$195.35
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$153.90
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$198.22
Rate for Payer: Partners Health Alliance Commercial	$176.98
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0MMX12MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463692
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MMX16MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463694
Hospital Revenue Code	278
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$197.27
Rate for Payer: Amerigroup Medicare	$155.44
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$153.90
Rate for Payer: Iowa Total Care Managed Medicaid	$195.35
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$153.90
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$198.22
Rate for Payer: Partners Health Alliance Commercial	$176.98
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0MMX16MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463694
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MM X 16MM GL SCREW

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8463690
Hospital Revenue Code	278
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: United Healthcare Commercial	$153.90

3.0MM X 16MM GL SCREW

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8463690
Hospital Revenue Code	278
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Aetna of IA Medicare	$97.47
Rate for Payer: Amerigroup Medicaid	$98.63
Rate for Payer: Amerigroup Medicare	$77.72
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.95
Rate for Payer: Iowa Total Care Managed Medicaid	$97.68
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Medical Associates Managed Medicare	$76.95
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: Molina Healthcare Managed Medicaid	$99.11
Rate for Payer: Partners Health Alliance Commercial	$88.49
Rate for Payer: United Healthcare Commercial	$153.90
Rate for Payer: United Healthcare Managed Medicare	$100.89

3.0MMX18MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463696
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MMX18MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463696
Hospital Revenue Code	278
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$197.27
Rate for Payer: Amerigroup Medicare	$155.44
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$153.90
Rate for Payer: Iowa Total Care Managed Medicaid	$195.35
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$153.90
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$198.22
Rate for Payer: Partners Health Alliance Commercial	$176.98
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0MMX24MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463698
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MMX24MM GL LOCKING SCREW

Facility

$342.00

Service Code	HCPCS C1713
Hospital Charge Code	8463698
Hospital Revenue Code	278
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$197.27
Rate for Payer: Amerigroup Medicare	$155.44
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$153.90
Rate for Payer: Iowa Total Care Managed Medicaid	$195.35
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$153.90
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$198.22
Rate for Payer: Partners Health Alliance Commercial	$176.98
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0X10MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783212
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

3.0X10MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783212
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

3.0X12MM TIGER CANNULATED SCREWS

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8465016
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

3.0X12MM TIGER CANNULATED SCREWS

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8465016
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

3.0X18MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783214
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

3.0X18MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783214
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

3.0X20MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783216
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

3.0X20MM VAL SCREW TI

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8783216
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

3.0X24MM TIGER CANNULATED SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8465018
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

3.0X24MM TIGER CANNULATED SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8465018
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

31575 Nasopharyngoscopy flexible fiberoptic

Professional

Both

$175.00

Service Code	CPT 31575
Hospital Charge Code	8799165
Hospital Revenue Code	975
Min. Negotiated Rate	$104.79
Max. Negotiated Rate	$287.10
Rate for Payer: Amerigroup Medicaid	$105.82
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Iowa Total Care Managed Medicaid	$104.79
Rate for Payer: Medical Associates Commercial	$131.25
Rate for Payer: Midlands Choice Commercial	$122.50
Rate for Payer: Molina Healthcare Managed Medicaid	$105.31
Rate for Payer: Partners Health Alliance Commercial	$131.25
Rate for Payer: United Healthcare Commercial	$184.48
Rate for Payer: Wellmark IA HMO WHPI	$244.10
Rate for Payer: Wellmark IA PPO	$287.10

32421 THORACENTESIS IN ED

Professional

Both

$302.00

Hospital Charge Code	8069160
Hospital Revenue Code	981
Min. Negotiated Rate	$211.40
Max. Negotiated Rate	$226.50
Rate for Payer: Cash Price	$241.60
Rate for Payer: Medical Associates Commercial	$226.50
Rate for Payer: Midlands Choice Commercial	$211.40
Rate for Payer: Partners Health Alliance Commercial	$226.50

Know your out-of-pocket cost for care.

All Charges