Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Laparoscopy, surgical; cholecystectomy

Facility

$9,126.52

Service Code	CPT 47562
Hospital Revenue Code	360
Min. Negotiated Rate	$8,296.84
Max. Negotiated Rate	$9,126.52
Rate for Payer: Wellmark IA HMO	$8,296.84
Rate for Payer: Wellmark IA PPO	$9,126.52

Laparoscopy; surgical; enterolysis (separate procedure)

Professional

Both

$3,106.00

Service Code	CPT 44180
Hospital Charge Code	8069049
Hospital Revenue Code	975
Min. Negotiated Rate	$813.37
Max. Negotiated Rate	$2,174.20
Rate for Payer: Aetna of IA Medicare	$813.37
Rate for Payer: Amerigroup Medicaid	$841.02
Rate for Payer: Cash Price	$2,484.80
Rate for Payer: Cash Price	$2,484.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$976.04
Rate for Payer: Iowa Total Care Managed Medicaid	$829.64
Rate for Payer: Medical Associates Commercial	$1,545.40
Rate for Payer: Medical Associates Managed Medicare	$813.37
Rate for Payer: Midlands Choice Commercial	$2,174.20
Rate for Payer: Oscar Health of IA Commercial	$1,407.13
Rate for Payer: Partners Health Alliance Commercial	$1,220.06

Laparoscopy, surgical; repair initial inguinal hernia

Facility

$9,126.52

Service Code	CPT 49650
Hospital Revenue Code	360
Min. Negotiated Rate	$8,296.84
Max. Negotiated Rate	$9,126.52
Rate for Payer: Wellmark IA HMO	$8,296.84
Rate for Payer: Wellmark IA PPO	$9,126.52

LAPIDUS VLC GRIDLOCK PLATE NEUTRAL

Facility

$2,592.00

Service Code	CPT C1713
Hospital Charge Code	8463688
Hospital Revenue Code	278
Min. Negotiated Rate	$1,814.40
Max. Negotiated Rate	$2,332.80
Rate for Payer: Aetna of IA Commercial	$2,332.80
Rate for Payer: Aetna of IA Medical Rental Products	$2,332.80
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,944.00
Rate for Payer: Medical Associates Commercial	$1,944.00
Rate for Payer: Midlands Choice Commercial	$1,814.40
Rate for Payer: United Healthcare Commercial	$2,332.80

LAPIDUS VLC GRIDLOCK PLATE NEUTRAL

Facility

$2,592.00

Service Code	CPT C1713
Hospital Charge Code	8463688
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.48
Max. Negotiated Rate	$2,332.80
Rate for Payer: Aetna of IA Commercial	$2,332.80
Rate for Payer: Aetna of IA Medical Rental Products	$2,332.80
Rate for Payer: Aetna of IA Medicare	$1,477.44
Rate for Payer: Amerigroup Medicaid	$1,308.18
Rate for Payer: Amerigroup Medicare	$1,308.96
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,944.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,296.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,295.48
Rate for Payer: Medical Associates Commercial	$1,944.00
Rate for Payer: Medical Associates Managed Medicare	$1,296.00
Rate for Payer: Midlands Choice Commercial	$1,814.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,315.44
Rate for Payer: Molina Healthcare Managed Medicare	$1,314.66
Rate for Payer: Oscar Health of IA Commercial	$1,944.00
Rate for Payer: Partners Health Alliance Commercial	$1,944.00
Rate for Payer: United Healthcare Commercial	$2,332.80
Rate for Payer: United Healthcare Managed Medicare	$1,529.28

latanoprost Ophth 0.005% 2.5 ml Sol [VDMC]

Facility

$53.24

Service Code	HCPCS A9270
Hospital Charge Code	10435379
Hospital Revenue Code	259
Min. Negotiated Rate	$37.27
Max. Negotiated Rate	$47.92
Rate for Payer: Aetna of IA Commercial	$47.92
Rate for Payer: Aetna of IA Medical Rental Products	$47.92
Rate for Payer: Cash Price	$42.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.93
Rate for Payer: Medical Associates Commercial	$39.93
Rate for Payer: Midlands Choice Commercial	$37.27
Rate for Payer: United Healthcare Commercial	$47.92

latanoprost Ophth 0.005% 2.5 ml Sol [VDMC]

Facility

$53.24

Service Code	HCPCS A9270
Hospital Charge Code	10435379
Hospital Revenue Code	259
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$47.92
Rate for Payer: Aetna of IA Commercial	$47.92
Rate for Payer: Aetna of IA Medical Rental Products	$47.92
Rate for Payer: Aetna of IA Medicare	$30.35
Rate for Payer: Amerigroup Medicaid	$26.87
Rate for Payer: Amerigroup Medicare	$26.89
Rate for Payer: Cash Price	$42.59
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.93
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.62
Rate for Payer: Iowa Total Care Managed Medicaid	$26.61
Rate for Payer: Medical Associates Commercial	$39.93
Rate for Payer: Medical Associates Managed Medicare	$26.62
Rate for Payer: Midlands Choice Commercial	$37.27
Rate for Payer: Molina Healthcare Managed Medicaid	$27.02
Rate for Payer: Molina Healthcare Managed Medicare	$27.00
Rate for Payer: Oscar Health of IA Commercial	$39.93
Rate for Payer: Partners Health Alliance Commercial	$39.93
Rate for Payer: United Healthcare Commercial	$47.92
Rate for Payer: United Healthcare Managed Medicare	$31.41

L-carnitine 500mg Tab [VDMC]

Facility

$2.22

Service Code	HCPCS A9270
Hospital Charge Code	11521770
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna of IA Commercial	$2.00
Rate for Payer: Aetna of IA Medical Rental Products	$2.00
Rate for Payer: Cash Price	$1.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.66
Rate for Payer: Medical Associates Commercial	$1.66
Rate for Payer: Midlands Choice Commercial	$1.55
Rate for Payer: United Healthcare Commercial	$2.00

L-carnitine 500mg Tab [VDMC]

Facility

$2.22

Service Code	HCPCS A9270
Hospital Charge Code	11521770
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna of IA Commercial	$2.00
Rate for Payer: Aetna of IA Medical Rental Products	$2.00
Rate for Payer: Aetna of IA Medicare	$1.27
Rate for Payer: Amerigroup Medicaid	$1.12
Rate for Payer: Amerigroup Medicare	$1.12
Rate for Payer: Cash Price	$1.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.66
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.11
Rate for Payer: Iowa Total Care Managed Medicaid	$1.11
Rate for Payer: Medical Associates Commercial	$1.66
Rate for Payer: Medical Associates Managed Medicare	$1.11
Rate for Payer: Midlands Choice Commercial	$1.55
Rate for Payer: Molina Healthcare Managed Medicaid	$1.13
Rate for Payer: Molina Healthcare Managed Medicare	$1.13
Rate for Payer: Oscar Health of IA Commercial	$1.66
Rate for Payer: Partners Health Alliance Commercial	$1.66
Rate for Payer: United Healthcare Commercial	$2.00
Rate for Payer: United Healthcare Managed Medicare	$1.31

L-Carnitine 500mg [VDMC]

Facility

$2.36

Service Code	HCPCS A9720
Hospital Charge Code	23410802
Hospital Revenue Code	259
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna of IA Commercial	$2.12
Rate for Payer: Aetna of IA Medical Rental Products	$2.12
Rate for Payer: Aetna of IA Medicare	$1.35
Rate for Payer: Amerigroup Medicaid	$1.19
Rate for Payer: Amerigroup Medicare	$1.19
Rate for Payer: Cash Price	$1.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.77
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.18
Rate for Payer: Iowa Total Care Managed Medicaid	$1.18
Rate for Payer: Medical Associates Commercial	$1.77
Rate for Payer: Medical Associates Managed Medicare	$1.18
Rate for Payer: Midlands Choice Commercial	$1.65
Rate for Payer: Molina Healthcare Managed Medicaid	$1.20
Rate for Payer: Molina Healthcare Managed Medicare	$1.20
Rate for Payer: Oscar Health of IA Commercial	$1.77
Rate for Payer: Partners Health Alliance Commercial	$1.77
Rate for Payer: United Healthcare Commercial	$2.12
Rate for Payer: United Healthcare Managed Medicare	$1.39

L-Carnitine 500mg [VDMC]

Facility

$2.36

Service Code	HCPCS A9720
Hospital Charge Code	23410802
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna of IA Commercial	$2.12
Rate for Payer: Aetna of IA Medical Rental Products	$2.12
Rate for Payer: Cash Price	$1.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.77
Rate for Payer: Medical Associates Commercial	$1.77
Rate for Payer: Midlands Choice Commercial	$1.65
Rate for Payer: United Healthcare Commercial	$2.12

LD COMP W/FORC/VAC/3RD-4TH DEG LAC EPIS

Facility

$2,505.00

Service Code	CPT 59409
Hospital Charge Code	7984736
Hospital Revenue Code	720
Min. Negotiated Rate	$1,753.50
Max. Negotiated Rate	$2,254.50
Rate for Payer: Aetna of IA Commercial	$2,254.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,254.50
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,878.75
Rate for Payer: Medical Associates Commercial	$1,878.75
Rate for Payer: Midlands Choice Commercial	$1,753.50
Rate for Payer: United Healthcare Commercial	$2,254.50

LD COMP W/FORC/VAC/3RD-4TH DEG LAC EPIS

Facility

$2,505.00

Service Code	CPT 59409
Hospital Charge Code	7984736
Hospital Revenue Code	720
Min. Negotiated Rate	$1,252.00
Max. Negotiated Rate	$4,441.18
Rate for Payer: Aetna of IA Commercial	$2,254.50
Rate for Payer: Aetna of IA Medical Rental Products	$2,254.50
Rate for Payer: Aetna of IA Medicare	$1,427.85
Rate for Payer: Amerigroup Medicaid	$1,264.27
Rate for Payer: Amerigroup Medicare	$1,265.02
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,878.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,252.50
Rate for Payer: Iowa Total Care Managed Medicaid	$1,252.00
Rate for Payer: Medical Associates Commercial	$1,878.75
Rate for Payer: Medical Associates Managed Medicare	$1,252.50
Rate for Payer: Midlands Choice Commercial	$1,753.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,271.29
Rate for Payer: Molina Healthcare Managed Medicare	$1,270.54
Rate for Payer: Oscar Health of IA Commercial	$1,878.75
Rate for Payer: Partners Health Alliance Commercial	$1,878.75
Rate for Payer: United Healthcare Commercial	$2,254.50
Rate for Payer: United Healthcare Managed Medicare	$1,477.95
Rate for Payer: Wellmark IA HMO	$4,037.44
Rate for Payer: Wellmark IA PPO	$4,441.18

LDH

Facility

$58.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

LDH

Facility

$58.00

Service Code	CPT 83615
Hospital Charge Code	4022826
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$29.27
Rate for Payer: Amerigroup Medicare	$29.29
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.00
Rate for Payer: Iowa Total Care Managed Medicaid	$28.99
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$29.00
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$29.44
Rate for Payer: Molina Healthcare Managed Medicare	$29.42
Rate for Payer: Oscar Health of IA Commercial	$43.50
Rate for Payer: Partners Health Alliance Commercial	$43.50
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

LDH

Facility

$58.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$29.27
Rate for Payer: Amerigroup Medicare	$29.29
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.00
Rate for Payer: Iowa Total Care Managed Medicaid	$28.99
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$29.00
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$29.44
Rate for Payer: Molina Healthcare Managed Medicare	$29.42
Rate for Payer: Oscar Health of IA Commercial	$43.50
Rate for Payer: Partners Health Alliance Commercial	$43.50
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

LDH

Facility

$58.00

Service Code	CPT 83615
Hospital Charge Code	4022826
Hospital Revenue Code	301
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

LD W/O COMPLICATIONS 1ST-2ND DEG LAC

Facility

$1,490.00

Service Code	CPT 59409
Hospital Charge Code	7984737
Hospital Revenue Code	722
Min. Negotiated Rate	$744.70
Max. Negotiated Rate	$4,441.18
Rate for Payer: Aetna of IA Commercial	$1,341.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,341.00
Rate for Payer: Aetna of IA Medicare	$849.30
Rate for Payer: Amerigroup Medicaid	$752.00
Rate for Payer: Amerigroup Medicare	$752.45
Rate for Payer: Cash Price	$1,192.00
Rate for Payer: Cash Price	$1,192.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,117.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$745.00
Rate for Payer: Iowa Total Care Managed Medicaid	$744.70
Rate for Payer: Medical Associates Commercial	$1,117.50
Rate for Payer: Medical Associates Managed Medicare	$745.00
Rate for Payer: Midlands Choice Commercial	$1,043.00
Rate for Payer: Molina Healthcare Managed Medicaid	$756.18
Rate for Payer: Molina Healthcare Managed Medicare	$755.73
Rate for Payer: Oscar Health of IA Commercial	$1,117.50
Rate for Payer: Partners Health Alliance Commercial	$1,117.50
Rate for Payer: United Healthcare Commercial	$1,341.00
Rate for Payer: United Healthcare Managed Medicare	$879.10
Rate for Payer: Wellmark IA HMO	$4,037.44
Rate for Payer: Wellmark IA PPO	$4,441.18

LD W/O COMPLICATIONS 1ST-2ND DEG LAC

Facility

$1,490.00

Service Code	CPT 59409
Hospital Charge Code	7984737
Hospital Revenue Code	722
Min. Negotiated Rate	$1,043.00
Max. Negotiated Rate	$1,341.00
Rate for Payer: Aetna of IA Commercial	$1,341.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,341.00
Rate for Payer: Cash Price	$1,192.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,117.50
Rate for Payer: Medical Associates Commercial	$1,117.50
Rate for Payer: Midlands Choice Commercial	$1,043.00
Rate for Payer: United Healthcare Commercial	$1,341.00

LEAD

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8094268
Hospital Revenue Code	301
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: United Healthcare Commercial	$73.80

LEAD

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8094268
Hospital Revenue Code	301
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Aetna of IA Medicare	$46.74
Rate for Payer: Amerigroup Medicaid	$41.39
Rate for Payer: Amerigroup Medicare	$41.41
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.00
Rate for Payer: Iowa Total Care Managed Medicaid	$40.98
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Medical Associates Managed Medicare	$41.00
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: Molina Healthcare Managed Medicaid	$41.62
Rate for Payer: Molina Healthcare Managed Medicare	$41.59
Rate for Payer: Oscar Health of IA Commercial	$61.50
Rate for Payer: Partners Health Alliance Commercial	$61.50
Rate for Payer: United Healthcare Commercial	$73.80
Rate for Payer: United Healthcare Managed Medicare	$48.38
Rate for Payer: Wellmark IA HMO	$37.20
Rate for Payer: Wellmark IA PPO	$40.92

Lead Level Screen

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8487747
Hospital Revenue Code	301
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Aetna of IA Medicare	$46.74
Rate for Payer: Amerigroup Medicaid	$41.39
Rate for Payer: Amerigroup Medicare	$41.41
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.00
Rate for Payer: Iowa Total Care Managed Medicaid	$40.98
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Medical Associates Managed Medicare	$41.00
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: Molina Healthcare Managed Medicaid	$41.62
Rate for Payer: Molina Healthcare Managed Medicare	$41.59
Rate for Payer: Oscar Health of IA Commercial	$61.50
Rate for Payer: Partners Health Alliance Commercial	$61.50
Rate for Payer: United Healthcare Commercial	$73.80
Rate for Payer: United Healthcare Managed Medicare	$48.38
Rate for Payer: Wellmark IA HMO	$37.20
Rate for Payer: Wellmark IA PPO	$40.92

Lead Level Screen

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8487747
Hospital Revenue Code	301
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: United Healthcare Commercial	$73.80

Lead Level Screen DMCL

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8037723
Hospital Revenue Code	301
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Aetna of IA Medicare	$46.74
Rate for Payer: Amerigroup Medicaid	$41.39
Rate for Payer: Amerigroup Medicare	$41.41
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.00
Rate for Payer: Iowa Total Care Managed Medicaid	$40.98
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Medical Associates Managed Medicare	$41.00
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: Molina Healthcare Managed Medicaid	$41.62
Rate for Payer: Molina Healthcare Managed Medicare	$41.59
Rate for Payer: Oscar Health of IA Commercial	$61.50
Rate for Payer: Partners Health Alliance Commercial	$61.50
Rate for Payer: United Healthcare Commercial	$73.80
Rate for Payer: United Healthcare Managed Medicare	$48.38
Rate for Payer: Wellmark IA HMO	$37.20
Rate for Payer: Wellmark IA PPO	$40.92

Lead Level Screen DMCL

Facility

$82.00

Service Code	CPT 83655
Hospital Charge Code	8037723
Hospital Revenue Code	301
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: United Healthcare Commercial	$73.80

Know your out-of-pocket cost for care.

All Charges