Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

PTT SUBSTITUTION, PLASMA FRACTIONS

Facility

$64.00

Service Code	CPT 85732
Hospital Charge Code	8093944
Hospital Revenue Code	305
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: United Healthcare Commercial	$57.60

PT Unattended E-Stim Units

Facility

$85.00

Service Code	CPT G0283 GP
Hospital Charge Code	1374022
Hospital Revenue Code	420
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: United Healthcare Commercial	$76.50

PT Unattended E-Stim Units

Facility

$85.00

Service Code	CPT G0283 GP
Hospital Charge Code	1374022
Hospital Revenue Code	420
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Aetna of IA Medicare	$48.45
Rate for Payer: Amerigroup Medicaid	$42.90
Rate for Payer: Amerigroup Medicare	$42.92
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.50
Rate for Payer: Iowa Total Care Managed Medicaid	$42.48
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Medical Associates Managed Medicare	$42.50
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: Molina Healthcare Managed Medicaid	$43.14
Rate for Payer: Molina Healthcare Managed Medicare	$43.11
Rate for Payer: Oscar Health of IA Commercial	$63.75
Rate for Payer: Partners Health Alliance Commercial	$63.75
Rate for Payer: United Healthcare Commercial	$76.50
Rate for Payer: United Healthcare Managed Medicare	$50.15

PULM FUNCTION TEST VOLUMES BY GAS

Facility

$260.00

Service Code	CPT 94727
Hospital Charge Code	5338938
Hospital Revenue Code	460
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: United Healthcare Commercial	$234.00

PULM FUNCTION TEST VOLUMES BY GAS

Facility

$260.00

Service Code	CPT 94727
Hospital Charge Code	5338938
Hospital Revenue Code	460
Min. Negotiated Rate	$129.95
Max. Negotiated Rate	$282.35
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Aetna of IA Medicare	$148.20
Rate for Payer: Amerigroup Medicaid	$131.22
Rate for Payer: Amerigroup Medicare	$131.30
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.00
Rate for Payer: Iowa Total Care Managed Medicaid	$129.95
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Medical Associates Managed Medicare	$130.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: Molina Healthcare Managed Medicaid	$131.95
Rate for Payer: Molina Healthcare Managed Medicare	$131.87
Rate for Payer: Oscar Health of IA Commercial	$195.00
Rate for Payer: Partners Health Alliance Commercial	$195.00
Rate for Payer: United Healthcare Commercial	$234.00
Rate for Payer: United Healthcare Managed Medicare	$153.40
Rate for Payer: Wellmark IA HMO	$256.68
Rate for Payer: Wellmark IA PPO	$282.35

Pulmonary Edema and Respiratory Failure

Facility

$10,865.05

Service Code	MS-DRG 189
Hospital Charge Code	60
Min. Negotiated Rate	$10,707.58
Max. Negotiated Rate	$10,865.05
Rate for Payer: Amerigroup Medicaid	$10,812.56
Rate for Payer: Iowa Total Care Managed Medicaid	$10,707.58
Rate for Payer: Molina Healthcare Managed Medicaid	$10,865.05

Pulmonary Embolism With MCC or Acute Cor Pulmonale

Facility

$11,792.20

Service Code	MS-DRG 175
Hospital Charge Code	46
Min. Negotiated Rate	$11,621.30
Max. Negotiated Rate	$11,792.20
Rate for Payer: Amerigroup Medicaid	$11,735.23
Rate for Payer: Iowa Total Care Managed Medicaid	$11,621.30
Rate for Payer: Molina Healthcare Managed Medicaid	$11,792.20

Pulmonary Embolism Without MCC

Facility

$7,528.47

Service Code	MS-DRG 176
Hospital Charge Code	47
Min. Negotiated Rate	$7,419.36
Max. Negotiated Rate	$7,528.47
Rate for Payer: Amerigroup Medicaid	$7,492.10
Rate for Payer: Iowa Total Care Managed Medicaid	$7,419.36
Rate for Payer: Molina Healthcare Managed Medicaid	$7,528.47

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059082
Hospital Revenue Code	948
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$360.78
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Aetna of IA Medicare	$88.92
Rate for Payer: Amerigroup Medicaid	$78.73
Rate for Payer: Amerigroup Medicare	$78.78
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$78.00
Rate for Payer: Iowa Total Care Managed Medicaid	$77.97
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Medical Associates Managed Medicare	$78.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: Molina Healthcare Managed Medicaid	$79.17
Rate for Payer: Molina Healthcare Managed Medicare	$79.12
Rate for Payer: Oscar Health of IA Commercial	$117.00
Rate for Payer: Partners Health Alliance Commercial	$117.00
Rate for Payer: United Healthcare Commercial	$140.40
Rate for Payer: United Healthcare Managed Medicare	$92.04
Rate for Payer: Wellmark IA HMO	$327.98
Rate for Payer: Wellmark IA PPO	$360.78

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059084
Hospital Revenue Code	948
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: United Healthcare Commercial	$140.40

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059082
Hospital Revenue Code	948
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: United Healthcare Commercial	$140.40

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059081
Hospital Revenue Code	948
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$360.78
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Aetna of IA Medicare	$88.92
Rate for Payer: Amerigroup Medicaid	$78.73
Rate for Payer: Amerigroup Medicare	$78.78
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$78.00
Rate for Payer: Iowa Total Care Managed Medicaid	$77.97
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Medical Associates Managed Medicare	$78.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: Molina Healthcare Managed Medicaid	$79.17
Rate for Payer: Molina Healthcare Managed Medicare	$79.12
Rate for Payer: Oscar Health of IA Commercial	$117.00
Rate for Payer: Partners Health Alliance Commercial	$117.00
Rate for Payer: United Healthcare Commercial	$140.40
Rate for Payer: United Healthcare Managed Medicare	$92.04
Rate for Payer: Wellmark IA HMO	$327.98
Rate for Payer: Wellmark IA PPO	$360.78

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238 KX
Hospital Charge Code	8059083
Hospital Revenue Code	948
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Aetna of IA Medicare	$88.92
Rate for Payer: Amerigroup Medicaid	$78.73
Rate for Payer: Amerigroup Medicare	$78.78
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$78.00
Rate for Payer: Iowa Total Care Managed Medicaid	$77.97
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Medical Associates Managed Medicare	$78.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: Molina Healthcare Managed Medicaid	$79.17
Rate for Payer: Molina Healthcare Managed Medicare	$79.12
Rate for Payer: Oscar Health of IA Commercial	$117.00
Rate for Payer: Partners Health Alliance Commercial	$117.00
Rate for Payer: United Healthcare Commercial	$140.40
Rate for Payer: United Healthcare Managed Medicare	$92.04

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059081
Hospital Revenue Code	948
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: United Healthcare Commercial	$140.40

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238 KX
Hospital Charge Code	8059083
Hospital Revenue Code	948
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: United Healthcare Commercial	$140.40

Pulmonary Rehab Non COPD Charge

Facility

$156.00

Service Code	CPT G0238
Hospital Charge Code	8059084
Hospital Revenue Code	948
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$360.78
Rate for Payer: Aetna of IA Commercial	$140.40
Rate for Payer: Aetna of IA Medical Rental Products	$140.40
Rate for Payer: Aetna of IA Medicare	$88.92
Rate for Payer: Amerigroup Medicaid	$78.73
Rate for Payer: Amerigroup Medicare	$78.78
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$78.00
Rate for Payer: Iowa Total Care Managed Medicaid	$77.97
Rate for Payer: Medical Associates Commercial	$117.00
Rate for Payer: Medical Associates Managed Medicare	$78.00
Rate for Payer: Midlands Choice Commercial	$109.20
Rate for Payer: Molina Healthcare Managed Medicaid	$79.17
Rate for Payer: Molina Healthcare Managed Medicare	$79.12
Rate for Payer: Oscar Health of IA Commercial	$117.00
Rate for Payer: Partners Health Alliance Commercial	$117.00
Rate for Payer: United Healthcare Commercial	$140.40
Rate for Payer: United Healthcare Managed Medicare	$92.04
Rate for Payer: Wellmark IA HMO	$327.98
Rate for Payer: Wellmark IA PPO	$360.78

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424
Hospital Charge Code	7827005
Hospital Revenue Code	948
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424
Hospital Charge Code	7827004
Hospital Revenue Code	948
Min. Negotiated Rate	$119.45
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Aetna of IA Medicare	$136.23
Rate for Payer: Amerigroup Medicaid	$120.62
Rate for Payer: Amerigroup Medicare	$120.70
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$119.50
Rate for Payer: Iowa Total Care Managed Medicaid	$119.45
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Medical Associates Managed Medicare	$119.50
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: Molina Healthcare Managed Medicaid	$121.29
Rate for Payer: Molina Healthcare Managed Medicare	$121.22
Rate for Payer: Oscar Health of IA Commercial	$179.25
Rate for Payer: Partners Health Alliance Commercial	$179.25
Rate for Payer: United Healthcare Commercial	$215.10
Rate for Payer: United Healthcare Managed Medicare	$141.01
Rate for Payer: Wellmark IA HMO	$189.10
Rate for Payer: Wellmark IA PPO	$208.01

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424
Hospital Charge Code	7827004
Hospital Revenue Code	948
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424
Hospital Charge Code	7827005
Hospital Revenue Code	948
Min. Negotiated Rate	$119.45
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Aetna of IA Medicare	$136.23
Rate for Payer: Amerigroup Medicaid	$120.62
Rate for Payer: Amerigroup Medicare	$120.70
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$119.50
Rate for Payer: Iowa Total Care Managed Medicaid	$119.45
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Medical Associates Managed Medicare	$119.50
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: Molina Healthcare Managed Medicaid	$121.29
Rate for Payer: Molina Healthcare Managed Medicare	$121.22
Rate for Payer: Oscar Health of IA Commercial	$179.25
Rate for Payer: Partners Health Alliance Commercial	$179.25
Rate for Payer: United Healthcare Commercial	$215.10
Rate for Payer: United Healthcare Managed Medicare	$141.01
Rate for Payer: Wellmark IA HMO	$189.10
Rate for Payer: Wellmark IA PPO	$208.01

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424 KX
Hospital Charge Code	7702164
Hospital Revenue Code	948
Min. Negotiated Rate	$119.45
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Aetna of IA Medicare	$136.23
Rate for Payer: Amerigroup Medicaid	$120.62
Rate for Payer: Amerigroup Medicare	$120.70
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$119.50
Rate for Payer: Iowa Total Care Managed Medicaid	$119.45
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Medical Associates Managed Medicare	$119.50
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: Molina Healthcare Managed Medicaid	$121.29
Rate for Payer: Molina Healthcare Managed Medicare	$121.22
Rate for Payer: Oscar Health of IA Commercial	$179.25
Rate for Payer: Partners Health Alliance Commercial	$179.25
Rate for Payer: United Healthcare Commercial	$215.10
Rate for Payer: United Healthcare Managed Medicare	$141.01

PULMONARY REHAB PHASE II

Facility

$239.00

Service Code	CPT G0424 KX
Hospital Charge Code	7702164
Hospital Revenue Code	948
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

Pulmonary Rehab TherEx Charge

Facility

$99.00

Service Code	CPT G0237
Hospital Charge Code	8058999
Hospital Revenue Code	410
Min. Negotiated Rate	$49.48
Max. Negotiated Rate	$360.78
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Aetna of IA Medicare	$56.43
Rate for Payer: Amerigroup Medicaid	$49.97
Rate for Payer: Amerigroup Medicare	$50.00
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
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	$49.48
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Medical Associates Managed Medicare	$49.50
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: Molina Healthcare Managed Medicaid	$50.24
Rate for Payer: Molina Healthcare Managed Medicare	$50.21
Rate for Payer: Oscar Health of IA Commercial	$74.25
Rate for Payer: Partners Health Alliance Commercial	$74.25
Rate for Payer: United Healthcare Commercial	$89.10
Rate for Payer: United Healthcare Managed Medicare	$58.41
Rate for Payer: Wellmark IA HMO	$327.98
Rate for Payer: Wellmark IA PPO	$360.78

Pulmonary Rehab TherEx Charge

Facility

$99.00

Service Code	CPT G0237
Hospital Charge Code	8058999
Hospital Revenue Code	410
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: United Healthcare Commercial	$89.10

PUNCH FOR 3.5MM PUNCHLOCK

Facility

$358.00

Service Code	CPT C1713
Hospital Charge Code	8026412
Hospital Revenue Code	278
Min. Negotiated Rate	$250.60
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of IA Commercial	$322.20
Rate for Payer: Aetna of IA Medical Rental Products	$322.20
Rate for Payer: Cash Price	$286.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$268.50
Rate for Payer: Medical Associates Commercial	$268.50
Rate for Payer: Midlands Choice Commercial	$250.60
Rate for Payer: United Healthcare Commercial	$322.20

Know your out-of-pocket cost for care.

All Charges