Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

E4533 Aph RBC ACDA AS1 LR 2

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8053740
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4538 Aph RBC Trima AS3 LR Irr

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018879
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4538 Aph RBC Trima AS3 LR Irr

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018879
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4539 Aph RBC Trima AS3 LR Irr 1

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018885
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4539 Aph RBC Trima AS3 LR Irr 1

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018885
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4540 Aph RBC Trima AS3 LR Irr 2

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018883
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4540 Aph RBC Trima AS3 LR Irr 2

Facility

$532.00

Service Code	CPT P9040
Hospital Charge Code	8018883
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4543 Aph RBC Trima AS3 LR

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018887
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4543 Aph RBC Trima AS3 LR

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018887
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4544 Aph RBC Trima AS3 LR 1

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018888
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4544 Aph RBC Trima AS3 LR 1

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018888
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4545 Aph RBC Trima AS3 LR 2

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018891
Hospital Revenue Code	390
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: United Healthcare Commercial	$478.80

E4545 Aph RBC Trima AS3 LR 2

Facility

$532.00

Service Code	CPT P9016
Hospital Charge Code	8018891
Hospital Revenue Code	390
Min. Negotiated Rate	$265.89
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$478.80
Rate for Payer: Aetna of IA Medical Rental Products	$478.80
Rate for Payer: Aetna of IA Medicare	$303.24
Rate for Payer: Amerigroup Medicaid	$268.50
Rate for Payer: Amerigroup Medicare	$268.66
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$399.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$266.00
Rate for Payer: Iowa Total Care Managed Medicaid	$265.89
Rate for Payer: Medical Associates Commercial	$399.00
Rate for Payer: Medical Associates Managed Medicare	$266.00
Rate for Payer: Midlands Choice Commercial	$372.40
Rate for Payer: Molina Healthcare Managed Medicaid	$269.99
Rate for Payer: Molina Healthcare Managed Medicare	$269.83
Rate for Payer: Oscar Health of IA Commercial	$399.00
Rate for Payer: Partners Health Alliance Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$478.80
Rate for Payer: United Healthcare Managed Medicare	$313.88
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4713 Thawed Aph FFP ACDA 1

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702792
Hospital Revenue Code	390
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$98.92
Rate for Payer: Amerigroup Medicare	$98.98
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$98.00
Rate for Payer: Iowa Total Care Managed Medicaid	$97.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$98.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$99.47
Rate for Payer: Molina Healthcare Managed Medicare	$99.41
Rate for Payer: Oscar Health of IA Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4713 Thawed Aph FFP ACDA 1

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702792
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E4717 Thawed Aph FFP ACDA 2

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702787
Hospital Revenue Code	390
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$98.92
Rate for Payer: Amerigroup Medicare	$98.98
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$98.00
Rate for Payer: Iowa Total Care Managed Medicaid	$97.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$98.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$99.47
Rate for Payer: Molina Healthcare Managed Medicare	$99.41
Rate for Payer: Oscar Health of IA Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4717 Thawed Aph FFP ACDA 2

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702787
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E4721 Thawed Aph FFP ACDA 3

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702800
Hospital Revenue Code	390
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$98.92
Rate for Payer: Amerigroup Medicare	$98.98
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$98.00
Rate for Payer: Iowa Total Care Managed Medicaid	$97.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$98.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$99.47
Rate for Payer: Molina Healthcare Managed Medicare	$99.41
Rate for Payer: Oscar Health of IA Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E4721 Thawed Aph FFP ACDA 3

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	6702800
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5548 Thawed Aph Plasma ACDA <24h 1

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	8072797
Hospital Revenue Code	390
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$98.92
Rate for Payer: Amerigroup Medicare	$98.98
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$98.00
Rate for Payer: Iowa Total Care Managed Medicaid	$97.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$98.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$99.47
Rate for Payer: Molina Healthcare Managed Medicare	$99.41
Rate for Payer: Oscar Health of IA Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E5548 Thawed Aph Plasma ACDA <24h 1

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	8072797
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5549 Thawed Aph Plasma ACDA <24h 2

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	8405423
Hospital Revenue Code	390
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$98.92
Rate for Payer: Amerigroup Medicare	$98.98
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$98.00
Rate for Payer: Iowa Total Care Managed Medicaid	$97.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$98.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$99.47
Rate for Payer: Molina Healthcare Managed Medicare	$99.41
Rate for Payer: Oscar Health of IA Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

E5549 Thawed Aph Plasma ACDA <24h 2

Facility

$196.00

Service Code	CPT P9017
Hospital Charge Code	8405423
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5709 Pooled Plt CP2D LR Irr

Facility

$881.00

Service Code	CPT P9037
Hospital Charge Code	6702807
Hospital Revenue Code	390
Min. Negotiated Rate	$616.70
Max. Negotiated Rate	$792.90
Rate for Payer: Aetna of IA Commercial	$792.90
Rate for Payer: Aetna of IA Medical Rental Products	$792.90
Rate for Payer: Cash Price	$704.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$660.75
Rate for Payer: Medical Associates Commercial	$660.75
Rate for Payer: Midlands Choice Commercial	$616.70
Rate for Payer: United Healthcare Commercial	$792.90

E5709 Pooled Plt CP2D LR Irr

Facility

$881.00

Service Code	CPT P9037
Hospital Charge Code	6702807
Hospital Revenue Code	390
Min. Negotiated Rate	$440.32
Max. Negotiated Rate	$1,444.48
Rate for Payer: Aetna of IA Commercial	$792.90
Rate for Payer: Aetna of IA Medical Rental Products	$792.90
Rate for Payer: Aetna of IA Medicare	$502.17
Rate for Payer: Amerigroup Medicaid	$444.64
Rate for Payer: Amerigroup Medicare	$444.90
Rate for Payer: Cash Price	$704.80
Rate for Payer: Cash Price	$704.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$660.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$440.50
Rate for Payer: Iowa Total Care Managed Medicaid	$440.32
Rate for Payer: Medical Associates Commercial	$660.75
Rate for Payer: Medical Associates Managed Medicare	$440.50
Rate for Payer: Midlands Choice Commercial	$616.70
Rate for Payer: Molina Healthcare Managed Medicaid	$447.11
Rate for Payer: Molina Healthcare Managed Medicare	$446.84
Rate for Payer: Oscar Health of IA Commercial	$660.75
Rate for Payer: Partners Health Alliance Commercial	$660.75
Rate for Payer: United Healthcare Commercial	$792.90
Rate for Payer: United Healthcare Managed Medicare	$519.79
Rate for Payer: Wellmark IA HMO	$1,313.16
Rate for Payer: Wellmark IA PPO	$1,444.48

Know your out-of-pocket cost for care.

All Charges