Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

palonosetron 0.25 mg/5 mL SDV [VDMC]

Facility

$65.84

Service Code	HCPCS J2469
Hospital Charge Code	13339269
Hospital Revenue Code	259
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$59.26
Rate for Payer: Aetna of IA Commercial	$59.26
Rate for Payer: Aetna of IA Medical Rental Products	$59.26
Rate for Payer: Cash Price	$52.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.38
Rate for Payer: Medical Associates Commercial	$49.38
Rate for Payer: Midlands Choice Commercial	$46.09
Rate for Payer: United Healthcare Commercial	$59.26

palonosetron 0.25 mg/5 mL SDV [VDMC]

Facility

$65.84

Service Code	HCPCS J2469
Hospital Charge Code	13339269
Hospital Revenue Code	259
Min. Negotiated Rate	$29.63
Max. Negotiated Rate	$59.26
Rate for Payer: Aetna of IA Commercial	$59.26
Rate for Payer: Aetna of IA Medical Rental Products	$59.26
Rate for Payer: Aetna of IA Medicare	$37.53
Rate for Payer: Amerigroup Medicaid	$37.98
Rate for Payer: Amerigroup Medicare	$29.92
Rate for Payer: Cash Price	$52.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.63
Rate for Payer: Iowa Total Care Managed Medicaid	$37.61
Rate for Payer: Medical Associates Commercial	$49.38
Rate for Payer: Medical Associates Managed Medicare	$29.63
Rate for Payer: Midlands Choice Commercial	$46.09
Rate for Payer: Molina Healthcare Managed Medicaid	$38.16
Rate for Payer: Partners Health Alliance Commercial	$34.07
Rate for Payer: United Healthcare Commercial	$59.26
Rate for Payer: United Healthcare Managed Medicare	$38.85

pamidronate 3 mg/mL 10 ml SDV [VDMC]

Facility

$54.24

Service Code	HCPCS J2430
Hospital Charge Code	10411386
Hospital Revenue Code	259
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna of IA Commercial	$48.82
Rate for Payer: Aetna of IA Medical Rental Products	$48.82
Rate for Payer: Cash Price	$43.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.68
Rate for Payer: Medical Associates Commercial	$40.68
Rate for Payer: Midlands Choice Commercial	$37.97
Rate for Payer: United Healthcare Commercial	$48.82

pamidronate 3 mg/mL 10 ml SDV [VDMC]

Facility

$54.24

Service Code	HCPCS J2430
Hospital Charge Code	10411386
Hospital Revenue Code	259
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna of IA Commercial	$48.82
Rate for Payer: Aetna of IA Medical Rental Products	$48.82
Rate for Payer: Aetna of IA Medicare	$30.92
Rate for Payer: Amerigroup Medicaid	$31.29
Rate for Payer: Amerigroup Medicare	$24.65
Rate for Payer: Cash Price	$43.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.68
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.41
Rate for Payer: Iowa Total Care Managed Medicaid	$30.98
Rate for Payer: Medical Associates Commercial	$40.68
Rate for Payer: Medical Associates Managed Medicare	$24.41
Rate for Payer: Midlands Choice Commercial	$37.97
Rate for Payer: Molina Healthcare Managed Medicaid	$31.44
Rate for Payer: Partners Health Alliance Commercial	$28.07
Rate for Payer: United Healthcare Commercial	$48.82
Rate for Payer: United Healthcare Managed Medicare	$32.00

pantoprazole 20 mg Oral DR Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10411658
Hospital Revenue Code	259
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Aetna of IA Medicare	$0.93
Rate for Payer: Amerigroup Medicaid	$0.94
Rate for Payer: Amerigroup Medicare	$0.74
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.22
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.73
Rate for Payer: Iowa Total Care Managed Medicaid	$0.93
Rate for Payer: Medical Associates Commercial	$1.22
Rate for Payer: Medical Associates Managed Medicare	$0.73
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: Molina Healthcare Managed Medicaid	$0.94
Rate for Payer: Partners Health Alliance Commercial	$0.84
Rate for Payer: United Healthcare Commercial	$1.47
Rate for Payer: United Healthcare Managed Medicare	$0.96

pantoprazole 20 mg Oral DR Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10411658
Hospital Revenue Code	259
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.22
Rate for Payer: Medical Associates Commercial	$1.22
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: United Healthcare Commercial	$1.47

pantoprazole 40 mg IV Inj [VDMC]

Facility

$38.67

Service Code	HCPCS J2470
Hospital Charge Code	10411727
Hospital Revenue Code	259
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$34.80
Rate for Payer: Aetna of IA Commercial	$34.80
Rate for Payer: Aetna of IA Medical Rental Products	$34.80
Rate for Payer: Aetna of IA Medicare	$22.04
Rate for Payer: Amerigroup Medicaid	$22.31
Rate for Payer: Amerigroup Medicare	$17.58
Rate for Payer: Cash Price	$30.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$17.40
Rate for Payer: Iowa Total Care Managed Medicaid	$22.09
Rate for Payer: Medical Associates Commercial	$29.00
Rate for Payer: Medical Associates Managed Medicare	$17.40
Rate for Payer: Midlands Choice Commercial	$27.07
Rate for Payer: Molina Healthcare Managed Medicaid	$22.41
Rate for Payer: Partners Health Alliance Commercial	$20.01
Rate for Payer: United Healthcare Commercial	$34.80
Rate for Payer: United Healthcare Managed Medicare	$22.82

pantoprazole 40 mg IV Inj [VDMC]

Facility

$38.67

Service Code	HCPCS J2470
Hospital Charge Code	10411727
Hospital Revenue Code	259
Min. Negotiated Rate	$27.07
Max. Negotiated Rate	$34.80
Rate for Payer: Aetna of IA Commercial	$34.80
Rate for Payer: Aetna of IA Medical Rental Products	$34.80
Rate for Payer: Cash Price	$30.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.00
Rate for Payer: Medical Associates Commercial	$29.00
Rate for Payer: Midlands Choice Commercial	$27.07
Rate for Payer: United Healthcare Commercial	$34.80

pantoprazole 40 mg Oral DR Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	10411794
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Aetna of IA Medicare	$0.80
Rate for Payer: Amerigroup Medicaid	$0.81
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.63
Rate for Payer: Iowa Total Care Managed Medicaid	$0.80
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Medical Associates Managed Medicare	$0.63
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: Molina Healthcare Managed Medicaid	$0.81
Rate for Payer: Partners Health Alliance Commercial	$0.72
Rate for Payer: United Healthcare Commercial	$1.26
Rate for Payer: United Healthcare Managed Medicare	$0.82

pantoprazole 40 mg Oral DR Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	10411794
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.26

PAP THIN PREP

Facility

$110.00

Service Code	HCPCS G0123
Hospital Charge Code	8089044
Hospital Revenue Code	309
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of IA Commercial	$99.00
Rate for Payer: Aetna of IA Medical Rental Products	$99.00
Rate for Payer: Aetna of IA Medicare	$62.70
Rate for Payer: Amerigroup Medicaid	$63.45
Rate for Payer: Amerigroup Medicare	$49.99
Rate for Payer: Cash Price	$88.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$82.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$49.50
Rate for Payer: Iowa Total Care Managed Medicaid	$62.83
Rate for Payer: Medical Associates Commercial	$82.50
Rate for Payer: Medical Associates Managed Medicare	$49.50
Rate for Payer: Midlands Choice Commercial	$77.00
Rate for Payer: Molina Healthcare Managed Medicaid	$63.76
Rate for Payer: Partners Health Alliance Commercial	$56.92
Rate for Payer: United Healthcare Commercial	$99.00
Rate for Payer: United Healthcare Managed Medicare	$64.90

PAP THIN PREP

Facility

$110.00

Service Code	HCPCS G0123
Hospital Charge Code	8089044
Hospital Revenue Code	309
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of IA Commercial	$99.00
Rate for Payer: Aetna of IA Medical Rental Products	$99.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$82.50
Rate for Payer: Medical Associates Commercial	$82.50
Rate for Payer: Midlands Choice Commercial	$77.00
Rate for Payer: United Healthcare Commercial	$99.00

Paracentesis Procedure

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	8060784
Hospital Revenue Code	761
Min. Negotiated Rate	$481.60
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: United Healthcare Commercial	$619.20

Paracentesis Procedure

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	8060784
Hospital Revenue Code	761
Min. Negotiated Rate	$309.60
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Aetna of IA Medicare	$392.16
Rate for Payer: Amerigroup Medicaid	$396.84
Rate for Payer: Amerigroup Medicare	$312.70
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$309.60
Rate for Payer: Iowa Total Care Managed Medicaid	$392.99
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Medical Associates Managed Medicare	$309.60
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: Molina Healthcare Managed Medicaid	$398.76
Rate for Payer: Partners Health Alliance Commercial	$356.04
Rate for Payer: United Healthcare Commercial	$619.20
Rate for Payer: United Healthcare Managed Medicare	$405.92

PARAFFIN BATH

Facility

$73.00

Service Code	CPT 97018 GO
Hospital Charge Code	1373447
Hospital Revenue Code	430
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: United Healthcare Commercial	$65.70

PARAFFIN BATH

Facility

$73.00

Service Code	CPT 97018 GO
Hospital Charge Code	1373447
Hospital Revenue Code	430
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Aetna of IA Medicare	$41.61
Rate for Payer: Amerigroup Medicaid	$42.11
Rate for Payer: Amerigroup Medicare	$33.18
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.85
Rate for Payer: Iowa Total Care Managed Medicaid	$41.70
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Medical Associates Managed Medicare	$32.85
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: Molina Healthcare Managed Medicaid	$42.31
Rate for Payer: Partners Health Alliance Commercial	$37.78
Rate for Payer: United Healthcare Commercial	$65.70
Rate for Payer: United Healthcare Managed Medicare	$43.07

PARAFFIN BATH APPLICATION

Facility

$73.00

Service Code	CPT 97018 GP
Hospital Charge Code	1373914
Hospital Revenue Code	420
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: United Healthcare Commercial	$65.70

PARAFFIN BATH APPLICATION

Facility

$73.00

Service Code	CPT 97018 GP
Hospital Charge Code	1373914
Hospital Revenue Code	420
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Aetna of IA Medicare	$41.61
Rate for Payer: Amerigroup Medicaid	$42.11
Rate for Payer: Amerigroup Medicare	$33.18
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.85
Rate for Payer: Iowa Total Care Managed Medicaid	$41.70
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Medical Associates Managed Medicare	$32.85
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: Molina Healthcare Managed Medicaid	$42.31
Rate for Payer: Partners Health Alliance Commercial	$37.78
Rate for Payer: United Healthcare Commercial	$65.70
Rate for Payer: United Healthcare Managed Medicare	$43.07

Parathyroid Hormone Intact DMCL

Facility

$281.00

Service Code	CPT 83970
Hospital Charge Code	8037747
Hospital Revenue Code	301
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of IA Commercial	$252.90
Rate for Payer: Aetna of IA Medical Rental Products	$252.90
Rate for Payer: Aetna of IA Medicare	$160.17
Rate for Payer: Amerigroup Medicaid	$162.08
Rate for Payer: Amerigroup Medicare	$127.71
Rate for Payer: Cash Price	$224.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$210.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.45
Rate for Payer: Iowa Total Care Managed Medicaid	$160.51
Rate for Payer: Medical Associates Commercial	$210.75
Rate for Payer: Medical Associates Managed Medicare	$126.45
Rate for Payer: Midlands Choice Commercial	$196.70
Rate for Payer: Molina Healthcare Managed Medicaid	$162.87
Rate for Payer: Partners Health Alliance Commercial	$145.42
Rate for Payer: United Healthcare Commercial	$252.90
Rate for Payer: United Healthcare Managed Medicare	$165.79

Parathyroid Hormone Intact DMCL

Facility

$281.00

Service Code	CPT 83970
Hospital Charge Code	8037747
Hospital Revenue Code	301
Min. Negotiated Rate	$196.70
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of IA Commercial	$252.90
Rate for Payer: Aetna of IA Medical Rental Products	$252.90
Rate for Payer: Cash Price	$224.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$210.75
Rate for Payer: Medical Associates Commercial	$210.75
Rate for Payer: Midlands Choice Commercial	$196.70
Rate for Payer: United Healthcare Commercial	$252.90

paricalcitol 5 mcg/mL Sol SDV Inj Sol [VDMC]

Facility

$30.10

Service Code	HCPCS J2501
Hospital Charge Code	23689427
Hospital Revenue Code	259
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$27.09
Rate for Payer: Aetna of IA Commercial	$27.09
Rate for Payer: Aetna of IA Medical Rental Products	$27.09
Rate for Payer: Cash Price	$24.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.58
Rate for Payer: Medical Associates Commercial	$22.58
Rate for Payer: Midlands Choice Commercial	$21.07
Rate for Payer: United Healthcare Commercial	$27.09

paricalcitol 5 mcg/mL Sol SDV Inj Sol [VDMC]

Facility

$30.10

Service Code	HCPCS J2501
Hospital Charge Code	23689427
Hospital Revenue Code	259
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$27.09
Rate for Payer: Aetna of IA Commercial	$27.09
Rate for Payer: Aetna of IA Medical Rental Products	$27.09
Rate for Payer: Aetna of IA Medicare	$17.16
Rate for Payer: Amerigroup Medicaid	$17.36
Rate for Payer: Amerigroup Medicare	$13.68
Rate for Payer: Cash Price	$24.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.55
Rate for Payer: Iowa Total Care Managed Medicaid	$17.20
Rate for Payer: Medical Associates Commercial	$22.58
Rate for Payer: Medical Associates Managed Medicare	$13.55
Rate for Payer: Midlands Choice Commercial	$21.07
Rate for Payer: Molina Healthcare Managed Medicaid	$17.45
Rate for Payer: Partners Health Alliance Commercial	$15.58
Rate for Payer: United Healthcare Commercial	$27.09
Rate for Payer: United Healthcare Managed Medicare	$17.76

Parietal Cell Antibody DMCL

Facility

$114.00

Service Code	CPT 86256
Hospital Charge Code	8037748
Hospital Revenue Code	301
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$58.99
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26

Parietal Cell Antibody DMCL

Facility

$114.00

Service Code	CPT 86256
Hospital Charge Code	8037748
Hospital Revenue Code	301
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

PARING OF CORN/CALLUS 2-4

Facility

$144.00

Service Code	CPT 11056
Hospital Charge Code	7438806
Hospital Revenue Code	510
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

Know your out-of-pocket cost for care.

All Charges