Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

INJ TRIGGER POINT 1/2 MUSCL

Professional

Both

$151.00

Service Code	CPT 20552
Hospital Charge Code	7982816
Hospital Revenue Code	981
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$116.90
Rate for Payer: Amerigroup Medicaid	$59.17
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Iowa Total Care Managed Medicaid	$58.60
Rate for Payer: Medical Associates Commercial	$113.25
Rate for Payer: Midlands Choice Commercial	$105.70
Rate for Payer: Molina Healthcare Managed Medicaid	$58.89
Rate for Payer: Partners Health Alliance Commercial	$113.25
Rate for Payer: United Healthcare Commercial	$84.30
Rate for Payer: Wellmark IA HMO WHPI	$99.40
Rate for Payer: Wellmark IA PPO	$116.90

INR PROTIME PROTHROMBIN TIME

Facility

$43.00

Service Code	CPT 85610
Hospital Charge Code	633793
Hospital Revenue Code	305
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of IA Commercial	$38.70
Rate for Payer: Aetna of IA Medical Rental Products	$38.70
Rate for Payer: Cash Price	$34.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.25
Rate for Payer: Medical Associates Commercial	$32.25
Rate for Payer: Midlands Choice Commercial	$30.10
Rate for Payer: United Healthcare Commercial	$38.70

INR PROTIME PROTHROMBIN TIME

Facility

$43.00

Service Code	CPT 85610
Hospital Charge Code	8093940
Hospital Revenue Code	305
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of IA Commercial	$38.70
Rate for Payer: Aetna of IA Medical Rental Products	$38.70
Rate for Payer: Aetna of IA Medicare	$24.51
Rate for Payer: Amerigroup Medicaid	$24.80
Rate for Payer: Amerigroup Medicare	$19.54
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$19.35
Rate for Payer: Iowa Total Care Managed Medicaid	$24.56
Rate for Payer: Medical Associates Commercial	$32.25
Rate for Payer: Medical Associates Managed Medicare	$19.35
Rate for Payer: Midlands Choice Commercial	$30.10
Rate for Payer: Molina Healthcare Managed Medicaid	$24.92
Rate for Payer: Partners Health Alliance Commercial	$22.25
Rate for Payer: United Healthcare Commercial	$38.70
Rate for Payer: United Healthcare Managed Medicare	$25.37
Rate for Payer: Wellmark IA HMO WHPI	$29.07
Rate for Payer: Wellmark IA PPO	$32.02

INR PROTIME PROTHROMBIN TIME

Facility

$43.00

Service Code	CPT 85610
Hospital Charge Code	633793
Hospital Revenue Code	305
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of IA Commercial	$38.70
Rate for Payer: Aetna of IA Medical Rental Products	$38.70
Rate for Payer: Aetna of IA Medicare	$24.51
Rate for Payer: Amerigroup Medicaid	$24.80
Rate for Payer: Amerigroup Medicare	$19.54
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$19.35
Rate for Payer: Iowa Total Care Managed Medicaid	$24.56
Rate for Payer: Medical Associates Commercial	$32.25
Rate for Payer: Medical Associates Managed Medicare	$19.35
Rate for Payer: Midlands Choice Commercial	$30.10
Rate for Payer: Molina Healthcare Managed Medicaid	$24.92
Rate for Payer: Partners Health Alliance Commercial	$22.25
Rate for Payer: United Healthcare Commercial	$38.70
Rate for Payer: United Healthcare Managed Medicare	$25.37
Rate for Payer: Wellmark IA HMO WHPI	$29.07
Rate for Payer: Wellmark IA PPO	$32.02

INR PROTIME PROTHROMBIN TIME

Facility

$43.00

Service Code	CPT 85610
Hospital Charge Code	8093940
Hospital Revenue Code	305
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of IA Commercial	$38.70
Rate for Payer: Aetna of IA Medical Rental Products	$38.70
Rate for Payer: Cash Price	$34.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$32.25
Rate for Payer: Medical Associates Commercial	$32.25
Rate for Payer: Midlands Choice Commercial	$30.10
Rate for Payer: United Healthcare Commercial	$38.70

INSERT BLADDER CATHETER

Facility

$235.00

Service Code	CPT 51701
Hospital Charge Code	4863314
Hospital Revenue Code	450
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna of IA Commercial	$211.50
Rate for Payer: Aetna of IA Medical Rental Products	$211.50
Rate for Payer: Cash Price	$188.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$176.25
Rate for Payer: Medical Associates Commercial	$176.25
Rate for Payer: Midlands Choice Commercial	$164.50
Rate for Payer: United Healthcare Commercial	$211.50

INSERT BLADDER CATHETER

Facility

$235.00

Service Code	CPT 51701
Hospital Charge Code	4863314
Hospital Revenue Code	450
Min. Negotiated Rate	$105.75
Max. Negotiated Rate	$267.88
Rate for Payer: Aetna of IA Commercial	$211.50
Rate for Payer: Aetna of IA Medical Rental Products	$211.50
Rate for Payer: Aetna of IA Medicare	$133.95
Rate for Payer: Amerigroup Medicaid	$135.55
Rate for Payer: Amerigroup Medicare	$106.81
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$176.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$105.75
Rate for Payer: Iowa Total Care Managed Medicaid	$134.23
Rate for Payer: Medical Associates Commercial	$176.25
Rate for Payer: Medical Associates Managed Medicare	$105.75
Rate for Payer: Midlands Choice Commercial	$164.50
Rate for Payer: Molina Healthcare Managed Medicaid	$136.21
Rate for Payer: Partners Health Alliance Commercial	$121.61
Rate for Payer: United Healthcare Commercial	$211.50
Rate for Payer: United Healthcare Managed Medicare	$138.65
Rate for Payer: Wellmark IA HMO WHPI	$243.19
Rate for Payer: Wellmark IA PPO	$267.88

INSERT CATH PLEURA W/O IMAGE

Facility

$783.00

Service Code	CPT 32556
Hospital Charge Code	7982926
Hospital Revenue Code	450
Min. Negotiated Rate	$352.35
Max. Negotiated Rate	$1,640.88
Rate for Payer: Aetna of IA Commercial	$704.70
Rate for Payer: Aetna of IA Medical Rental Products	$704.70
Rate for Payer: Aetna of IA Medicare	$446.31
Rate for Payer: Amerigroup Medicaid	$451.63
Rate for Payer: Amerigroup Medicare	$355.87
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$587.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$352.35
Rate for Payer: Iowa Total Care Managed Medicaid	$447.25
Rate for Payer: Medical Associates Commercial	$587.25
Rate for Payer: Medical Associates Managed Medicare	$352.35
Rate for Payer: Midlands Choice Commercial	$548.10
Rate for Payer: Molina Healthcare Managed Medicaid	$453.83
Rate for Payer: Partners Health Alliance Commercial	$405.20
Rate for Payer: United Healthcare Commercial	$704.70
Rate for Payer: United Healthcare Managed Medicare	$461.97
Rate for Payer: Wellmark IA HMO WHPI	$1,489.61
Rate for Payer: Wellmark IA PPO	$1,640.88

INSERT CATH PLEURA W/O IMAGE

Facility

$783.00

Service Code	CPT 32556
Hospital Charge Code	7982926
Hospital Revenue Code	450
Min. Negotiated Rate	$548.10
Max. Negotiated Rate	$704.70
Rate for Payer: Aetna of IA Commercial	$704.70
Rate for Payer: Aetna of IA Medical Rental Products	$704.70
Rate for Payer: Cash Price	$626.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$587.25
Rate for Payer: Medical Associates Commercial	$587.25
Rate for Payer: Midlands Choice Commercial	$548.10
Rate for Payer: United Healthcare Commercial	$704.70

Insert Chest Tube Procedure

Facility

$1,299.00

Service Code	CPT 32551
Hospital Charge Code	8069122
Hospital Revenue Code	761
Min. Negotiated Rate	$909.30
Max. Negotiated Rate	$1,169.10
Rate for Payer: Aetna of IA Commercial	$1,169.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,169.10
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$974.25
Rate for Payer: Medical Associates Commercial	$974.25
Rate for Payer: Midlands Choice Commercial	$909.30
Rate for Payer: United Healthcare Commercial	$1,169.10

Insert Chest Tube Procedure

Facility

$1,299.00

Service Code	CPT 32551
Hospital Charge Code	8069122
Hospital Revenue Code	761
Min. Negotiated Rate	$584.55
Max. Negotiated Rate	$1,640.88
Rate for Payer: Aetna of IA Commercial	$1,169.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,169.10
Rate for Payer: Aetna of IA Medicare	$740.43
Rate for Payer: Amerigroup Medicaid	$749.26
Rate for Payer: Amerigroup Medicare	$590.40
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$974.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$584.55
Rate for Payer: Iowa Total Care Managed Medicaid	$741.99
Rate for Payer: Medical Associates Commercial	$974.25
Rate for Payer: Medical Associates Managed Medicare	$584.55
Rate for Payer: Midlands Choice Commercial	$909.30
Rate for Payer: Molina Healthcare Managed Medicaid	$752.90
Rate for Payer: Partners Health Alliance Commercial	$672.23
Rate for Payer: United Healthcare Commercial	$1,169.10
Rate for Payer: United Healthcare Managed Medicare	$766.41
Rate for Payer: Wellmark IA HMO WHPI	$1,489.61
Rate for Payer: Wellmark IA PPO	$1,640.88

INSERT EMERGENCY AIRWAY

Professional

Both

$440.00

Service Code	CPT 31500
Hospital Charge Code	7822790
Hospital Revenue Code	981
Min. Negotiated Rate	$116.79
Max. Negotiated Rate	$330.00
Rate for Payer: Amerigroup Medicaid	$117.94
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Iowa Total Care Managed Medicaid	$116.79
Rate for Payer: Medical Associates Commercial	$330.00
Rate for Payer: Midlands Choice Commercial	$308.00
Rate for Payer: Molina Healthcare Managed Medicaid	$117.36
Rate for Payer: Partners Health Alliance Commercial	$330.00
Rate for Payer: United Healthcare Commercial	$220.94
Rate for Payer: Wellmark IA HMO WHPI	$262.30
Rate for Payer: Wellmark IA PPO	$308.60

INSERT EMERGENCY AIRWAY

Facility

$525.00

Service Code	CPT 31500
Hospital Charge Code	4864908
Hospital Revenue Code	450
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of IA Commercial	$472.50
Rate for Payer: Aetna of IA Medical Rental Products	$472.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$393.75
Rate for Payer: Medical Associates Commercial	$393.75
Rate for Payer: Midlands Choice Commercial	$367.50
Rate for Payer: United Healthcare Commercial	$472.50

INSERT EMERGENCY AIRWAY

Facility

$525.00

Service Code	CPT 31500
Hospital Charge Code	4864908
Hospital Revenue Code	450
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$2,116.51
Rate for Payer: Aetna of IA Commercial	$472.50
Rate for Payer: Aetna of IA Medical Rental Products	$472.50
Rate for Payer: Aetna of IA Medicare	$299.25
Rate for Payer: Amerigroup Medicaid	$302.82
Rate for Payer: Amerigroup Medicare	$238.61
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$393.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$236.25
Rate for Payer: Iowa Total Care Managed Medicaid	$299.88
Rate for Payer: Medical Associates Commercial	$393.75
Rate for Payer: Medical Associates Managed Medicare	$236.25
Rate for Payer: Midlands Choice Commercial	$367.50
Rate for Payer: Molina Healthcare Managed Medicaid	$304.29
Rate for Payer: Partners Health Alliance Commercial	$271.69
Rate for Payer: United Healthcare Commercial	$472.50
Rate for Payer: United Healthcare Managed Medicare	$309.75
Rate for Payer: Wellmark IA HMO WHPI	$1,921.39
Rate for Payer: Wellmark IA PPO	$2,116.51

INSERTION OF CHEST TUBE

Facility

$783.00

Service Code	CPT 32551
Hospital Charge Code	4864922
Hospital Revenue Code	450
Min. Negotiated Rate	$352.35
Max. Negotiated Rate	$1,640.88
Rate for Payer: Aetna of IA Commercial	$704.70
Rate for Payer: Aetna of IA Medical Rental Products	$704.70
Rate for Payer: Aetna of IA Medicare	$446.31
Rate for Payer: Amerigroup Medicaid	$451.63
Rate for Payer: Amerigroup Medicare	$355.87
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$587.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$352.35
Rate for Payer: Iowa Total Care Managed Medicaid	$447.25
Rate for Payer: Medical Associates Commercial	$587.25
Rate for Payer: Medical Associates Managed Medicare	$352.35
Rate for Payer: Midlands Choice Commercial	$548.10
Rate for Payer: Molina Healthcare Managed Medicaid	$453.83
Rate for Payer: Partners Health Alliance Commercial	$405.20
Rate for Payer: United Healthcare Commercial	$704.70
Rate for Payer: United Healthcare Managed Medicare	$461.97
Rate for Payer: Wellmark IA HMO WHPI	$1,489.61
Rate for Payer: Wellmark IA PPO	$1,640.88

INSERTION OF CHEST TUBE

Facility

$783.00

Service Code	CPT 32551
Hospital Charge Code	4864922
Hospital Revenue Code	450
Min. Negotiated Rate	$548.10
Max. Negotiated Rate	$704.70
Rate for Payer: Aetna of IA Commercial	$704.70
Rate for Payer: Aetna of IA Medical Rental Products	$704.70
Rate for Payer: Cash Price	$626.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$587.25
Rate for Payer: Medical Associates Commercial	$587.25
Rate for Payer: Midlands Choice Commercial	$548.10
Rate for Payer: United Healthcare Commercial	$704.70

INSERTION OF CHEST TUBE

Professional

Both

$490.00

Service Code	CPT 32551
Hospital Charge Code	7982779
Hospital Revenue Code	981
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$367.50
Rate for Payer: Amerigroup Medicaid	$140.87
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Iowa Total Care Managed Medicaid	$139.51
Rate for Payer: Medical Associates Commercial	$367.50
Rate for Payer: Midlands Choice Commercial	$343.00
Rate for Payer: Molina Healthcare Managed Medicaid	$140.19
Rate for Payer: Partners Health Alliance Commercial	$367.50
Rate for Payer: United Healthcare Commercial	$240.37
Rate for Payer: Wellmark IA HMO WHPI	$288.70
Rate for Payer: Wellmark IA PPO	$339.70

INSERTION OF INTRAUTERINE DEVICE (IUD)

Facility

$301.47

Service Code	CPT 58300
Hospital Revenue Code	360
Min. Negotiated Rate	$273.67
Max. Negotiated Rate	$301.47
Rate for Payer: Wellmark IA HMO WHPI	$273.67
Rate for Payer: Wellmark IA PPO	$301.47

Insertion of PICC venous access device with subcutaneous port; over 5 yr old

Professional

Both

$4,023.00

Service Code	CPT 36571
Hospital Charge Code	8069111
Hospital Revenue Code	975
Min. Negotiated Rate	$345.26
Max. Negotiated Rate	$3,017.25
Rate for Payer: Amerigroup Medicaid	$348.64
Rate for Payer: Cash Price	$3,218.40
Rate for Payer: Cash Price	$3,218.40
Rate for Payer: Iowa Total Care Managed Medicaid	$345.26
Rate for Payer: Medical Associates Commercial	$3,017.25
Rate for Payer: Midlands Choice Commercial	$2,816.10
Rate for Payer: Molina Healthcare Managed Medicaid	$346.95
Rate for Payer: Partners Health Alliance Commercial	$3,017.25
Rate for Payer: United Healthcare Commercial	$1,940.70
Rate for Payer: Wellmark IA HMO WHPI	$2,400.70
Rate for Payer: Wellmark IA PPO	$2,824.40

Insertion of PICC w/o port w/o imaging ages 5+

Professional

Both

$828.00

Service Code	CPT 36569
Hospital Charge Code	8068991
Hospital Revenue Code	975
Min. Negotiated Rate	$89.95
Max. Negotiated Rate	$621.00
Rate for Payer: Amerigroup Medicaid	$90.84
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Iowa Total Care Managed Medicaid	$89.95
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: Molina Healthcare Managed Medicaid	$90.39
Rate for Payer: Partners Health Alliance Commercial	$621.00
Rate for Payer: United Healthcare Commercial	$148.16
Rate for Payer: Wellmark IA HMO WHPI	$181.40
Rate for Payer: Wellmark IA PPO	$213.40

INSERT LOCKING AXSOS 3.0MM

Facility

$57.00

Service Code	HCPCS C1713
Hospital Charge Code	8046628
Hospital Revenue Code	278
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Aetna of IA Medicare	$32.49
Rate for Payer: Amerigroup Medicaid	$32.88
Rate for Payer: Amerigroup Medicare	$25.91
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.65
Rate for Payer: Iowa Total Care Managed Medicaid	$32.56
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Medical Associates Managed Medicare	$25.65
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: Molina Healthcare Managed Medicaid	$33.04
Rate for Payer: Partners Health Alliance Commercial	$29.50
Rate for Payer: United Healthcare Commercial	$51.30
Rate for Payer: United Healthcare Managed Medicare	$33.63

INSERT LOCKING AXSOS 3.0MM

Facility

$57.00

Service Code	HCPCS C1713
Hospital Charge Code	8046628
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: United Healthcare Commercial	$51.30

INSERT LOCKING AXSOS 4.0MM

Facility

$57.00

Service Code	HCPCS C1713
Hospital Charge Code	8046629
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: United Healthcare Commercial	$51.30

INSERT LOCKING AXSOS 4.0MM

Facility

$57.00

Service Code	HCPCS C1713
Hospital Charge Code	8046629
Hospital Revenue Code	278
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Aetna of IA Medicare	$32.49
Rate for Payer: Amerigroup Medicaid	$32.88
Rate for Payer: Amerigroup Medicare	$25.91
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.65
Rate for Payer: Iowa Total Care Managed Medicaid	$32.56
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Medical Associates Managed Medicare	$25.65
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: Molina Healthcare Managed Medicaid	$33.04
Rate for Payer: Partners Health Alliance Commercial	$29.50
Rate for Payer: United Healthcare Commercial	$51.30
Rate for Payer: United Healthcare Managed Medicare	$33.63

INSERT NEEDLE BONE CAVITY

Facility

$378.00

Service Code	CPT 36680
Hospital Charge Code	4864946
Hospital Revenue Code	450
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$340.20
Rate for Payer: Aetna of IA Commercial	$340.20
Rate for Payer: Aetna of IA Medical Rental Products	$340.20
Rate for Payer: Cash Price	$302.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$283.50
Rate for Payer: Medical Associates Commercial	$283.50
Rate for Payer: Midlands Choice Commercial	$264.60
Rate for Payer: United Healthcare Commercial	$340.20

Know your out-of-pocket cost for care.

All Charges