Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

US Breast Left.

Facility

$360.00

Service Code	CPT 76641 LT
Hospital Charge Code	1169623
Hospital Revenue Code	402
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Aetna of IA Medicare	$205.20
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$181.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$180.00
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Medical Associates Managed Medicare	$180.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: Molina Healthcare Managed Medicaid	$182.70
Rate for Payer: Molina Healthcare Managed Medicare	$182.59
Rate for Payer: Oscar Health of IA Commercial	$270.00
Rate for Payer: Partners Health Alliance Commercial	$270.00
Rate for Payer: United Healthcare Commercial	$324.00
Rate for Payer: United Healthcare Managed Medicare	$212.40

US Breast Left.

Facility

$360.00

Service Code	CPT 76641 LT
Hospital Charge Code	1169623
Hospital Revenue Code	402
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: United Healthcare Commercial	$324.00

US Breast Limited Left

Facility

$252.00

Service Code	CPT 76642 LT
Hospital Charge Code	6800933
Hospital Revenue Code	402
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Aetna of IA Medicare	$143.64
Rate for Payer: Amerigroup Medicaid	$127.18
Rate for Payer: Amerigroup Medicare	$127.26
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.00
Rate for Payer: Iowa Total Care Managed Medicaid	$125.95
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Medical Associates Managed Medicare	$126.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: Molina Healthcare Managed Medicaid	$127.89
Rate for Payer: Molina Healthcare Managed Medicare	$127.81
Rate for Payer: Oscar Health of IA Commercial	$189.00
Rate for Payer: Partners Health Alliance Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$226.80
Rate for Payer: United Healthcare Managed Medicare	$148.68

US Breast Limited Left

Facility

$252.00

Service Code	CPT 76642 LT
Hospital Charge Code	6800933
Hospital Revenue Code	402
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: United Healthcare Commercial	$226.80

US Breast Limited Left.

Facility

$252.00

Service Code	CPT 76642 LT
Hospital Charge Code	5052788
Hospital Revenue Code	402
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: United Healthcare Commercial	$226.80

US Breast Limited Left.

Facility

$252.00

Service Code	CPT 76642 LT
Hospital Charge Code	5052788
Hospital Revenue Code	402
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Aetna of IA Medicare	$143.64
Rate for Payer: Amerigroup Medicaid	$127.18
Rate for Payer: Amerigroup Medicare	$127.26
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.00
Rate for Payer: Iowa Total Care Managed Medicaid	$125.95
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Medical Associates Managed Medicare	$126.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: Molina Healthcare Managed Medicaid	$127.89
Rate for Payer: Molina Healthcare Managed Medicare	$127.81
Rate for Payer: Oscar Health of IA Commercial	$189.00
Rate for Payer: Partners Health Alliance Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$226.80
Rate for Payer: United Healthcare Managed Medicare	$148.68

US Breast Limited Right

Facility

$252.00

Service Code	CPT 76642 RT
Hospital Charge Code	6800936
Hospital Revenue Code	402
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: United Healthcare Commercial	$226.80

US Breast Limited Right

Facility

$252.00

Service Code	CPT 76642 RT
Hospital Charge Code	6800936
Hospital Revenue Code	402
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Aetna of IA Medicare	$143.64
Rate for Payer: Amerigroup Medicaid	$127.18
Rate for Payer: Amerigroup Medicare	$127.26
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.00
Rate for Payer: Iowa Total Care Managed Medicaid	$125.95
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Medical Associates Managed Medicare	$126.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: Molina Healthcare Managed Medicaid	$127.89
Rate for Payer: Molina Healthcare Managed Medicare	$127.81
Rate for Payer: Oscar Health of IA Commercial	$189.00
Rate for Payer: Partners Health Alliance Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$226.80
Rate for Payer: United Healthcare Managed Medicare	$148.68

US Breast Limited Right.

Facility

$252.00

Service Code	CPT 76642 RT
Hospital Charge Code	5052791
Hospital Revenue Code	402
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Aetna of IA Medicare	$143.64
Rate for Payer: Amerigroup Medicaid	$127.18
Rate for Payer: Amerigroup Medicare	$127.26
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.00
Rate for Payer: Iowa Total Care Managed Medicaid	$125.95
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Medical Associates Managed Medicare	$126.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: Molina Healthcare Managed Medicaid	$127.89
Rate for Payer: Molina Healthcare Managed Medicare	$127.81
Rate for Payer: Oscar Health of IA Commercial	$189.00
Rate for Payer: Partners Health Alliance Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$226.80
Rate for Payer: United Healthcare Managed Medicare	$148.68

US Breast Limited Right.

Facility

$252.00

Service Code	CPT 76642 RT
Hospital Charge Code	5052791
Hospital Revenue Code	402
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of IA Commercial	$226.80
Rate for Payer: Aetna of IA Medical Rental Products	$226.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.00
Rate for Payer: Medical Associates Commercial	$189.00
Rate for Payer: Midlands Choice Commercial	$176.40
Rate for Payer: United Healthcare Commercial	$226.80

US Breast Right

Facility

$360.00

Service Code	CPT 76641 RT
Hospital Charge Code	6800939
Hospital Revenue Code	402
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Aetna of IA Medicare	$205.20
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$181.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$180.00
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Medical Associates Managed Medicare	$180.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: Molina Healthcare Managed Medicaid	$182.70
Rate for Payer: Molina Healthcare Managed Medicare	$182.59
Rate for Payer: Oscar Health of IA Commercial	$270.00
Rate for Payer: Partners Health Alliance Commercial	$270.00
Rate for Payer: United Healthcare Commercial	$324.00
Rate for Payer: United Healthcare Managed Medicare	$212.40

US Breast Right

Facility

$360.00

Service Code	CPT 76641 RT
Hospital Charge Code	6800939
Hospital Revenue Code	402
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: United Healthcare Commercial	$324.00

US Breast Right.

Facility

$360.00

Service Code	CPT 76641 RT
Hospital Charge Code	1169625
Hospital Revenue Code	402
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Aetna of IA Medicare	$205.20
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$181.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$180.00
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Medical Associates Managed Medicare	$180.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: Molina Healthcare Managed Medicaid	$182.70
Rate for Payer: Molina Healthcare Managed Medicare	$182.59
Rate for Payer: Oscar Health of IA Commercial	$270.00
Rate for Payer: Partners Health Alliance Commercial	$270.00
Rate for Payer: United Healthcare Commercial	$324.00
Rate for Payer: United Healthcare Managed Medicare	$212.40

US Breast Right.

Facility

$360.00

Service Code	CPT 76641 RT
Hospital Charge Code	1169625
Hospital Revenue Code	402
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: United Healthcare Commercial	$324.00

US Carotid Doppler Bilateral

Facility

$716.00

Service Code	CPT 93880
Hospital Charge Code	1169627
Hospital Revenue Code	921
Min. Negotiated Rate	$501.20
Max. Negotiated Rate	$644.40
Rate for Payer: Aetna of IA Commercial	$644.40
Rate for Payer: Aetna of IA Medical Rental Products	$644.40
Rate for Payer: Cash Price	$572.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$537.00
Rate for Payer: Medical Associates Commercial	$537.00
Rate for Payer: Midlands Choice Commercial	$501.20
Rate for Payer: United Healthcare Commercial	$644.40

US Carotid Doppler Bilateral

Facility

$716.00

Service Code	CPT 93880
Hospital Charge Code	1169627
Hospital Revenue Code	921
Min. Negotiated Rate	$191.58
Max. Negotiated Rate	$644.40
Rate for Payer: Aetna of IA Commercial	$644.40
Rate for Payer: Aetna of IA Medical Rental Products	$644.40
Rate for Payer: Aetna of IA Medicare	$408.12
Rate for Payer: Amerigroup Medicaid	$361.37
Rate for Payer: Amerigroup Medicare	$361.58
Rate for Payer: Cash Price	$572.80
Rate for Payer: Cash Price	$572.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$537.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$358.00
Rate for Payer: Iowa Total Care Managed Medicaid	$357.86
Rate for Payer: Medical Associates Commercial	$537.00
Rate for Payer: Medical Associates Managed Medicare	$358.00
Rate for Payer: Midlands Choice Commercial	$501.20
Rate for Payer: Molina Healthcare Managed Medicaid	$363.37
Rate for Payer: Molina Healthcare Managed Medicare	$363.16
Rate for Payer: Oscar Health of IA Commercial	$537.00
Rate for Payer: Partners Health Alliance Commercial	$537.00
Rate for Payer: United Healthcare Commercial	$644.40
Rate for Payer: United Healthcare Managed Medicare	$422.44
Rate for Payer: Wellmark IA HMO	$191.58
Rate for Payer: Wellmark IA PPO	$210.74

US Carotid Duplex Bilateral

Facility

$716.00

Service Code	CPT 93880
Hospital Charge Code	1169629
Hospital Revenue Code	921
Min. Negotiated Rate	$191.58
Max. Negotiated Rate	$644.40
Rate for Payer: Aetna of IA Commercial	$644.40
Rate for Payer: Aetna of IA Medical Rental Products	$644.40
Rate for Payer: Aetna of IA Medicare	$408.12
Rate for Payer: Amerigroup Medicaid	$361.37
Rate for Payer: Amerigroup Medicare	$361.58
Rate for Payer: Cash Price	$572.80
Rate for Payer: Cash Price	$572.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$537.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$358.00
Rate for Payer: Iowa Total Care Managed Medicaid	$357.86
Rate for Payer: Medical Associates Commercial	$537.00
Rate for Payer: Medical Associates Managed Medicare	$358.00
Rate for Payer: Midlands Choice Commercial	$501.20
Rate for Payer: Molina Healthcare Managed Medicaid	$363.37
Rate for Payer: Molina Healthcare Managed Medicare	$363.16
Rate for Payer: Oscar Health of IA Commercial	$537.00
Rate for Payer: Partners Health Alliance Commercial	$537.00
Rate for Payer: United Healthcare Commercial	$644.40
Rate for Payer: United Healthcare Managed Medicare	$422.44
Rate for Payer: Wellmark IA HMO	$191.58
Rate for Payer: Wellmark IA PPO	$210.74

US Carotid Duplex Bilateral

Facility

$716.00

Service Code	CPT 93880
Hospital Charge Code	1169629
Hospital Revenue Code	921
Min. Negotiated Rate	$501.20
Max. Negotiated Rate	$644.40
Rate for Payer: Aetna of IA Commercial	$644.40
Rate for Payer: Aetna of IA Medical Rental Products	$644.40
Rate for Payer: Cash Price	$572.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$537.00
Rate for Payer: Medical Associates Commercial	$537.00
Rate for Payer: Midlands Choice Commercial	$501.20
Rate for Payer: United Healthcare Commercial	$644.40

US CHEST

Facility

$360.00

Service Code	CPT 76604
Hospital Charge Code	1169635
Hospital Revenue Code	402
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: United Healthcare Commercial	$324.00

US CHEST

Facility

$360.00

Service Code	CPT 76604
Hospital Charge Code	1169635
Hospital Revenue Code	402
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of IA Commercial	$324.00
Rate for Payer: Aetna of IA Medical Rental Products	$324.00
Rate for Payer: Aetna of IA Medicare	$205.20
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$181.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$270.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$180.00
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$270.00
Rate for Payer: Medical Associates Managed Medicare	$180.00
Rate for Payer: Midlands Choice Commercial	$252.00
Rate for Payer: Molina Healthcare Managed Medicaid	$182.70
Rate for Payer: Molina Healthcare Managed Medicare	$182.59
Rate for Payer: Oscar Health of IA Commercial	$270.00
Rate for Payer: Partners Health Alliance Commercial	$270.00
Rate for Payer: United Healthcare Commercial	$324.00
Rate for Payer: United Healthcare Managed Medicare	$212.40
Rate for Payer: Wellmark IA HMO	$191.58
Rate for Payer: Wellmark IA PPO	$210.74

US Drainage Abscess or Cyst

Facility

$897.00

Service Code	CPT 75989
Hospital Charge Code	1169645
Hospital Revenue Code	320
Min. Negotiated Rate	$448.32
Max. Negotiated Rate	$807.30
Rate for Payer: Aetna of IA Commercial	$807.30
Rate for Payer: Aetna of IA Medical Rental Products	$807.30
Rate for Payer: Aetna of IA Medicare	$511.29
Rate for Payer: Amerigroup Medicaid	$452.72
Rate for Payer: Amerigroup Medicare	$452.98
Rate for Payer: Cash Price	$717.60
Rate for Payer: Cash Price	$717.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$672.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$448.50
Rate for Payer: Iowa Total Care Managed Medicaid	$448.32
Rate for Payer: Medical Associates Commercial	$672.75
Rate for Payer: Medical Associates Managed Medicare	$448.50
Rate for Payer: Midlands Choice Commercial	$627.90
Rate for Payer: Molina Healthcare Managed Medicaid	$455.23
Rate for Payer: Molina Healthcare Managed Medicare	$454.96
Rate for Payer: Oscar Health of IA Commercial	$672.75
Rate for Payer: Partners Health Alliance Commercial	$672.75
Rate for Payer: United Healthcare Commercial	$807.30
Rate for Payer: United Healthcare Managed Medicare	$529.23
Rate for Payer: Wellmark IA HMO	$655.34
Rate for Payer: Wellmark IA PPO	$720.87

US Drainage Abscess or Cyst

Facility

$897.00

Service Code	CPT 75989
Hospital Charge Code	1169645
Hospital Revenue Code	320
Min. Negotiated Rate	$627.90
Max. Negotiated Rate	$807.30
Rate for Payer: Aetna of IA Commercial	$807.30
Rate for Payer: Aetna of IA Medical Rental Products	$807.30
Rate for Payer: Cash Price	$717.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$672.75
Rate for Payer: Medical Associates Commercial	$672.75
Rate for Payer: Midlands Choice Commercial	$627.90
Rate for Payer: United Healthcare Commercial	$807.30

US Echocardiogram

Facility

$1,338.00

Service Code	CPT 93306 TC
Hospital Charge Code	1844784
Hospital Revenue Code	480
Min. Negotiated Rate	$668.73
Max. Negotiated Rate	$1,204.20
Rate for Payer: Aetna of IA Commercial	$1,204.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,204.20
Rate for Payer: Aetna of IA Medicare	$762.66
Rate for Payer: Amerigroup Medicaid	$675.29
Rate for Payer: Amerigroup Medicare	$675.69
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,003.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$669.00
Rate for Payer: Iowa Total Care Managed Medicaid	$668.73
Rate for Payer: Medical Associates Commercial	$1,003.50
Rate for Payer: Medical Associates Managed Medicare	$669.00
Rate for Payer: Midlands Choice Commercial	$936.60
Rate for Payer: Molina Healthcare Managed Medicaid	$679.04
Rate for Payer: Molina Healthcare Managed Medicare	$678.63
Rate for Payer: Oscar Health of IA Commercial	$1,003.50
Rate for Payer: Partners Health Alliance Commercial	$1,003.50
Rate for Payer: United Healthcare Commercial	$1,204.20
Rate for Payer: United Healthcare Managed Medicare	$789.42

US Echocardiogram

Facility

$1,338.00

Service Code	CPT 93306 TC
Hospital Charge Code	1844784
Hospital Revenue Code	480
Min. Negotiated Rate	$936.60
Max. Negotiated Rate	$1,204.20
Rate for Payer: Aetna of IA Commercial	$1,204.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,204.20
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,003.50
Rate for Payer: Medical Associates Commercial	$1,003.50
Rate for Payer: Midlands Choice Commercial	$936.60
Rate for Payer: United Healthcare Commercial	$1,204.20

US Echocardiogram Limited

Facility

$518.00

Service Code	CPT 93308
Hospital Charge Code	7960820
Hospital Revenue Code	480
Min. Negotiated Rate	$362.60
Max. Negotiated Rate	$466.20
Rate for Payer: Aetna of IA Commercial	$466.20
Rate for Payer: Aetna of IA Medical Rental Products	$466.20
Rate for Payer: Cash Price	$414.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$388.50
Rate for Payer: Medical Associates Commercial	$388.50
Rate for Payer: Midlands Choice Commercial	$362.60
Rate for Payer: United Healthcare Commercial	$466.20

Know your out-of-pocket cost for care.

All Charges