Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

VDMC CT Abdomen + Pelvis w/ + w/o Contrast

Facility

$3,176.00

Service Code	CPT 74178
Hospital Charge Code	8027195
Hospital Revenue Code	352
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$2,858.40
Rate for Payer: Aetna of IA Commercial	$2,858.40
Rate for Payer: Aetna of IA Medical Rental Products	$2,858.40
Rate for Payer: Cash Price	$2,540.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,382.00
Rate for Payer: Medical Associates Commercial	$2,382.00
Rate for Payer: Midlands Choice Commercial	$2,223.20
Rate for Payer: United Healthcare Commercial	$2,858.40

VDMC CT Angio Chest w/ Cont

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8208787
Hospital Revenue Code	352
Min. Negotiated Rate	$847.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: United Healthcare Commercial	$1,089.00

VDMC CT Angio Chest w/ Cont

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8208787
Hospital Revenue Code	352
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Aetna of IA Medicare	$689.70
Rate for Payer: Amerigroup Medicaid	$697.93
Rate for Payer: Amerigroup Medicare	$549.95
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$544.50
Rate for Payer: Iowa Total Care Managed Medicaid	$691.15
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Medical Associates Managed Medicare	$544.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: Molina Healthcare Managed Medicaid	$701.32
Rate for Payer: Partners Health Alliance Commercial	$626.17
Rate for Payer: United Healthcare Commercial	$1,089.00
Rate for Payer: United Healthcare Managed Medicare	$713.90

VDMC CT Angiography Abdomen + Pelvis

Facility

$2,420.00

Service Code	CPT 74174
Hospital Charge Code	8027198
Hospital Revenue Code	352
Min. Negotiated Rate	$1,089.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Aetna of IA Commercial	$2,178.00
Rate for Payer: Aetna of IA Medical Rental Products	$2,178.00
Rate for Payer: Aetna of IA Medicare	$1,379.40
Rate for Payer: Amerigroup Medicaid	$1,395.86
Rate for Payer: Amerigroup Medicare	$1,099.89
Rate for Payer: Cash Price	$1,936.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,815.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,089.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,382.30
Rate for Payer: Medical Associates Commercial	$1,815.00
Rate for Payer: Medical Associates Managed Medicare	$1,089.00
Rate for Payer: Midlands Choice Commercial	$1,694.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,402.63
Rate for Payer: Partners Health Alliance Commercial	$1,252.35
Rate for Payer: United Healthcare Commercial	$2,178.00
Rate for Payer: United Healthcare Managed Medicare	$1,427.80

VDMC CT Angiography Abdomen + Pelvis

Facility

$2,420.00

Service Code	CPT 74174
Hospital Charge Code	8027198
Hospital Revenue Code	352
Min. Negotiated Rate	$1,694.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Aetna of IA Commercial	$2,178.00
Rate for Payer: Aetna of IA Medical Rental Products	$2,178.00
Rate for Payer: Cash Price	$1,936.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,815.00
Rate for Payer: Medical Associates Commercial	$1,815.00
Rate for Payer: Midlands Choice Commercial	$1,694.00
Rate for Payer: United Healthcare Commercial	$2,178.00

VDMC CT Angiography Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8027199
Hospital Revenue Code	352
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Aetna of IA Medicare	$689.70
Rate for Payer: Amerigroup Medicaid	$697.93
Rate for Payer: Amerigroup Medicare	$549.95
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$544.50
Rate for Payer: Iowa Total Care Managed Medicaid	$691.15
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Medical Associates Managed Medicare	$544.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: Molina Healthcare Managed Medicaid	$701.32
Rate for Payer: Partners Health Alliance Commercial	$626.17
Rate for Payer: United Healthcare Commercial	$1,089.00
Rate for Payer: United Healthcare Managed Medicare	$713.90

VDMC CT Angiography Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8027199
Hospital Revenue Code	352
Min. Negotiated Rate	$847.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: United Healthcare Commercial	$1,089.00

VDMC CT Angiography Head w/ Contrast

Facility

$1,445.00

Service Code	CPT 70496
Hospital Charge Code	8027200
Hospital Revenue Code	352
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,300.50
Rate for Payer: Aetna of IA Commercial	$1,300.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,300.50
Rate for Payer: Cash Price	$1,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,083.75
Rate for Payer: Medical Associates Commercial	$1,083.75
Rate for Payer: Midlands Choice Commercial	$1,011.50
Rate for Payer: United Healthcare Commercial	$1,300.50

VDMC CT Angiography Head w/ Contrast

Facility

$1,445.00

Service Code	CPT 70496
Hospital Charge Code	8027200
Hospital Revenue Code	352
Min. Negotiated Rate	$650.25
Max. Negotiated Rate	$1,300.50
Rate for Payer: Aetna of IA Commercial	$1,300.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,300.50
Rate for Payer: Aetna of IA Medicare	$823.65
Rate for Payer: Amerigroup Medicaid	$833.48
Rate for Payer: Amerigroup Medicare	$656.75
Rate for Payer: Cash Price	$1,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,083.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$650.25
Rate for Payer: Iowa Total Care Managed Medicaid	$825.38
Rate for Payer: Medical Associates Commercial	$1,083.75
Rate for Payer: Medical Associates Managed Medicare	$650.25
Rate for Payer: Midlands Choice Commercial	$1,011.50
Rate for Payer: Molina Healthcare Managed Medicaid	$837.52
Rate for Payer: Partners Health Alliance Commercial	$747.79
Rate for Payer: United Healthcare Commercial	$1,300.50
Rate for Payer: United Healthcare Managed Medicare	$852.55

VDMC CT Angiography Neck w/ Contrast

Facility

$1,445.00

Service Code	CPT 70498
Hospital Charge Code	8027201
Hospital Revenue Code	352
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,300.50
Rate for Payer: Aetna of IA Commercial	$1,300.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,300.50
Rate for Payer: Cash Price	$1,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,083.75
Rate for Payer: Medical Associates Commercial	$1,083.75
Rate for Payer: Midlands Choice Commercial	$1,011.50
Rate for Payer: United Healthcare Commercial	$1,300.50

VDMC CT Angiography Neck w/ Contrast

Facility

$1,445.00

Service Code	CPT 70498
Hospital Charge Code	8027201
Hospital Revenue Code	352
Min. Negotiated Rate	$650.25
Max. Negotiated Rate	$1,300.50
Rate for Payer: Aetna of IA Commercial	$1,300.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,300.50
Rate for Payer: Aetna of IA Medicare	$823.65
Rate for Payer: Amerigroup Medicaid	$833.48
Rate for Payer: Amerigroup Medicare	$656.75
Rate for Payer: Cash Price	$1,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,083.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$650.25
Rate for Payer: Iowa Total Care Managed Medicaid	$825.38
Rate for Payer: Medical Associates Commercial	$1,083.75
Rate for Payer: Medical Associates Managed Medicare	$650.25
Rate for Payer: Midlands Choice Commercial	$1,011.50
Rate for Payer: Molina Healthcare Managed Medicaid	$837.52
Rate for Payer: Partners Health Alliance Commercial	$747.79
Rate for Payer: United Healthcare Commercial	$1,300.50
Rate for Payer: United Healthcare Managed Medicare	$852.55

VDMC CT Anigo Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8148971
Hospital Revenue Code	352
Min. Negotiated Rate	$847.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: United Healthcare Commercial	$1,089.00

VDMC CT Anigo Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71275
Hospital Charge Code	8148971
Hospital Revenue Code	352
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Aetna of IA Medicare	$689.70
Rate for Payer: Amerigroup Medicaid	$697.93
Rate for Payer: Amerigroup Medicare	$549.95
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$544.50
Rate for Payer: Iowa Total Care Managed Medicaid	$691.15
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Medical Associates Managed Medicare	$544.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: Molina Healthcare Managed Medicaid	$701.32
Rate for Payer: Partners Health Alliance Commercial	$626.17
Rate for Payer: United Healthcare Commercial	$1,089.00
Rate for Payer: United Healthcare Managed Medicare	$713.90

VDMC CT Chest w/ Cont

Facility

$1,210.00

Service Code	CPT 71260
Hospital Charge Code	8148972
Hospital Revenue Code	352
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Aetna of IA Medicare	$689.70
Rate for Payer: Amerigroup Medicaid	$697.93
Rate for Payer: Amerigroup Medicare	$549.95
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$544.50
Rate for Payer: Iowa Total Care Managed Medicaid	$691.15
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Medical Associates Managed Medicare	$544.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: Molina Healthcare Managed Medicaid	$701.32
Rate for Payer: Partners Health Alliance Commercial	$626.17
Rate for Payer: United Healthcare Commercial	$1,089.00
Rate for Payer: United Healthcare Managed Medicare	$713.90

VDMC CT Chest w/ Cont

Facility

$1,210.00

Service Code	CPT 71260
Hospital Charge Code	8148972
Hospital Revenue Code	352
Min. Negotiated Rate	$847.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: United Healthcare Commercial	$1,089.00

VDMC CT Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71260
Hospital Charge Code	8027203
Hospital Revenue Code	352
Min. Negotiated Rate	$847.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: United Healthcare Commercial	$1,089.00

VDMC CT Chest w/ Contrast

Facility

$1,210.00

Service Code	CPT 71260
Hospital Charge Code	8027203
Hospital Revenue Code	352
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna of IA Commercial	$1,089.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,089.00
Rate for Payer: Aetna of IA Medicare	$689.70
Rate for Payer: Amerigroup Medicaid	$697.93
Rate for Payer: Amerigroup Medicare	$549.95
Rate for Payer: Cash Price	$968.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$907.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$544.50
Rate for Payer: Iowa Total Care Managed Medicaid	$691.15
Rate for Payer: Medical Associates Commercial	$907.50
Rate for Payer: Medical Associates Managed Medicare	$544.50
Rate for Payer: Midlands Choice Commercial	$847.00
Rate for Payer: Molina Healthcare Managed Medicaid	$701.32
Rate for Payer: Partners Health Alliance Commercial	$626.17
Rate for Payer: United Healthcare Commercial	$1,089.00
Rate for Payer: United Healthcare Managed Medicare	$713.90

VDMC CT Chest w/o Cont

Facility

$1,137.00

Service Code	CPT 71250
Hospital Charge Code	8148973
Hospital Revenue Code	352
Min. Negotiated Rate	$795.90
Max. Negotiated Rate	$1,023.30
Rate for Payer: Aetna of IA Commercial	$1,023.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,023.30
Rate for Payer: Cash Price	$909.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$852.75
Rate for Payer: Medical Associates Commercial	$852.75
Rate for Payer: Midlands Choice Commercial	$795.90
Rate for Payer: United Healthcare Commercial	$1,023.30

VDMC CT Chest w/o Cont

Facility

$1,137.00

Service Code	CPT 71250
Hospital Charge Code	8148973
Hospital Revenue Code	352
Min. Negotiated Rate	$511.65
Max. Negotiated Rate	$1,023.30
Rate for Payer: Aetna of IA Commercial	$1,023.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,023.30
Rate for Payer: Aetna of IA Medicare	$648.09
Rate for Payer: Amerigroup Medicaid	$655.82
Rate for Payer: Amerigroup Medicare	$516.77
Rate for Payer: Cash Price	$909.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$852.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$511.65
Rate for Payer: Iowa Total Care Managed Medicaid	$649.45
Rate for Payer: Medical Associates Commercial	$852.75
Rate for Payer: Medical Associates Managed Medicare	$511.65
Rate for Payer: Midlands Choice Commercial	$795.90
Rate for Payer: Molina Healthcare Managed Medicaid	$659.01
Rate for Payer: Partners Health Alliance Commercial	$588.40
Rate for Payer: United Healthcare Commercial	$1,023.30
Rate for Payer: United Healthcare Managed Medicare	$670.83

VDMC CT Chest w/o Contrast

Facility

$1,137.00

Service Code	CPT 71250
Hospital Charge Code	8027204
Hospital Revenue Code	352
Min. Negotiated Rate	$511.65
Max. Negotiated Rate	$1,023.30
Rate for Payer: Aetna of IA Commercial	$1,023.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,023.30
Rate for Payer: Aetna of IA Medicare	$648.09
Rate for Payer: Amerigroup Medicaid	$655.82
Rate for Payer: Amerigroup Medicare	$516.77
Rate for Payer: Cash Price	$909.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$852.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$511.65
Rate for Payer: Iowa Total Care Managed Medicaid	$649.45
Rate for Payer: Medical Associates Commercial	$852.75
Rate for Payer: Medical Associates Managed Medicare	$511.65
Rate for Payer: Midlands Choice Commercial	$795.90
Rate for Payer: Molina Healthcare Managed Medicaid	$659.01
Rate for Payer: Partners Health Alliance Commercial	$588.40
Rate for Payer: United Healthcare Commercial	$1,023.30
Rate for Payer: United Healthcare Managed Medicare	$670.83

VDMC CT Chest w/o Contrast

Facility

$1,137.00

Service Code	CPT 71250
Hospital Charge Code	8027204
Hospital Revenue Code	352
Min. Negotiated Rate	$795.90
Max. Negotiated Rate	$1,023.30
Rate for Payer: Aetna of IA Commercial	$1,023.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,023.30
Rate for Payer: Cash Price	$909.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$852.75
Rate for Payer: Medical Associates Commercial	$852.75
Rate for Payer: Midlands Choice Commercial	$795.90
Rate for Payer: United Healthcare Commercial	$1,023.30

VDMC CT Chest w/ + w/o Cont

Facility

$1,672.00

Service Code	CPT 71270
Hospital Charge Code	8148970
Hospital Revenue Code	352
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$1,504.80
Rate for Payer: Aetna of IA Commercial	$1,504.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,504.80
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,254.00
Rate for Payer: Medical Associates Commercial	$1,254.00
Rate for Payer: Midlands Choice Commercial	$1,170.40
Rate for Payer: United Healthcare Commercial	$1,504.80

VDMC CT Chest w/ + w/o Cont

Facility

$1,672.00

Service Code	CPT 71270
Hospital Charge Code	8148970
Hospital Revenue Code	352
Min. Negotiated Rate	$752.40
Max. Negotiated Rate	$1,504.80
Rate for Payer: Aetna of IA Commercial	$1,504.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,504.80
Rate for Payer: Aetna of IA Medicare	$953.04
Rate for Payer: Amerigroup Medicaid	$964.41
Rate for Payer: Amerigroup Medicare	$759.92
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,254.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$752.40
Rate for Payer: Iowa Total Care Managed Medicaid	$955.05
Rate for Payer: Medical Associates Commercial	$1,254.00
Rate for Payer: Medical Associates Managed Medicare	$752.40
Rate for Payer: Midlands Choice Commercial	$1,170.40
Rate for Payer: Molina Healthcare Managed Medicaid	$969.09
Rate for Payer: Partners Health Alliance Commercial	$865.26
Rate for Payer: United Healthcare Commercial	$1,504.80
Rate for Payer: United Healthcare Managed Medicare	$986.48

VDMC CT Chest w/ + w/o Contrast

Facility

$1,672.00

Service Code	CPT 71270
Hospital Charge Code	8027202
Hospital Revenue Code	352
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$1,504.80
Rate for Payer: Aetna of IA Commercial	$1,504.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,504.80
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,254.00
Rate for Payer: Medical Associates Commercial	$1,254.00
Rate for Payer: Midlands Choice Commercial	$1,170.40
Rate for Payer: United Healthcare Commercial	$1,504.80

VDMC CT Chest w/ + w/o Contrast

Facility

$1,672.00

Service Code	CPT 71270
Hospital Charge Code	8027202
Hospital Revenue Code	352
Min. Negotiated Rate	$752.40
Max. Negotiated Rate	$1,504.80
Rate for Payer: Aetna of IA Commercial	$1,504.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,504.80
Rate for Payer: Aetna of IA Medicare	$953.04
Rate for Payer: Amerigroup Medicaid	$964.41
Rate for Payer: Amerigroup Medicare	$759.92
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,254.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$752.40
Rate for Payer: Iowa Total Care Managed Medicaid	$955.05
Rate for Payer: Medical Associates Commercial	$1,254.00
Rate for Payer: Medical Associates Managed Medicare	$752.40
Rate for Payer: Midlands Choice Commercial	$1,170.40
Rate for Payer: Molina Healthcare Managed Medicaid	$969.09
Rate for Payer: Partners Health Alliance Commercial	$865.26
Rate for Payer: United Healthcare Commercial	$1,504.80
Rate for Payer: United Healthcare Managed Medicare	$986.48

Know your out-of-pocket cost for care.

All Charges