Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

TREAT KNEECAP DISLOCATION

Facility

$818.00

Service Code	CPT 27562
Hospital Charge Code	7983030
Hospital Revenue Code	450
Min. Negotiated Rate	$368.10
Max. Negotiated Rate	$2,696.01
Rate for Payer: Aetna of IA Commercial	$736.20
Rate for Payer: Aetna of IA Medical Rental Products	$736.20
Rate for Payer: Aetna of IA Medicare	$466.26
Rate for Payer: Amerigroup Medicaid	$471.82
Rate for Payer: Amerigroup Medicare	$371.78
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$654.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$613.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$368.10
Rate for Payer: Iowa Total Care Managed Medicaid	$467.24
Rate for Payer: Medical Associates Commercial	$613.50
Rate for Payer: Medical Associates Managed Medicare	$368.10
Rate for Payer: Midlands Choice Commercial	$572.60
Rate for Payer: Molina Healthcare Managed Medicaid	$474.11
Rate for Payer: Partners Health Alliance Commercial	$423.32
Rate for Payer: United Healthcare Commercial	$736.20
Rate for Payer: United Healthcare Managed Medicare	$482.62
Rate for Payer: Wellmark IA HMO WHPI	$2,447.47
Rate for Payer: Wellmark IA PPO	$2,696.01

TREAT KNEECAP DISLOCATION

Facility

$879.00

Service Code	CPT 27560
Hospital Charge Code	4864799
Hospital Revenue Code	450
Min. Negotiated Rate	$615.30
Max. Negotiated Rate	$791.10
Rate for Payer: Aetna of IA Commercial	$791.10
Rate for Payer: Aetna of IA Medical Rental Products	$791.10
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$659.25
Rate for Payer: Medical Associates Commercial	$659.25
Rate for Payer: Midlands Choice Commercial	$615.30
Rate for Payer: United Healthcare Commercial	$791.10

TREAT KNEECAP DISLOCATION

Facility

$818.00

Service Code	CPT 27562
Hospital Charge Code	7983030
Hospital Revenue Code	450
Min. Negotiated Rate	$572.60
Max. Negotiated Rate	$736.20
Rate for Payer: Aetna of IA Commercial	$736.20
Rate for Payer: Aetna of IA Medical Rental Products	$736.20
Rate for Payer: Cash Price	$654.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$613.50
Rate for Payer: Medical Associates Commercial	$613.50
Rate for Payer: Midlands Choice Commercial	$572.60
Rate for Payer: United Healthcare Commercial	$736.20

TREAT KNEECAP DISLOCATION

Professional

Both

$1,194.00

Service Code	CPT 27560
Hospital Charge Code	7982794
Hospital Revenue Code	981
Min. Negotiated Rate	$294.45
Max. Negotiated Rate	$895.50
Rate for Payer: Amerigroup Medicaid	$297.34
Rate for Payer: Cash Price	$955.20
Rate for Payer: Cash Price	$955.20
Rate for Payer: Iowa Total Care Managed Medicaid	$294.45
Rate for Payer: Medical Associates Commercial	$895.50
Rate for Payer: Midlands Choice Commercial	$835.80
Rate for Payer: Molina Healthcare Managed Medicaid	$295.90
Rate for Payer: Partners Health Alliance Commercial	$895.50
Rate for Payer: United Healthcare Commercial	$561.89
Rate for Payer: Wellmark IA HMO WHPI	$734.00
Rate for Payer: Wellmark IA PPO	$863.60

TREAT KNEECAP DISLOCATION

Facility

$879.00

Service Code	CPT 27560
Hospital Charge Code	4864799
Hospital Revenue Code	450
Min. Negotiated Rate	$395.55
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$791.10
Rate for Payer: Aetna of IA Medical Rental Products	$791.10
Rate for Payer: Aetna of IA Medicare	$501.03
Rate for Payer: Amerigroup Medicaid	$507.01
Rate for Payer: Amerigroup Medicare	$399.51
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$659.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$395.55
Rate for Payer: Iowa Total Care Managed Medicaid	$502.08
Rate for Payer: Medical Associates Commercial	$659.25
Rate for Payer: Medical Associates Managed Medicare	$395.55
Rate for Payer: Midlands Choice Commercial	$615.30
Rate for Payer: Molina Healthcare Managed Medicaid	$509.47
Rate for Payer: Partners Health Alliance Commercial	$454.88
Rate for Payer: United Healthcare Commercial	$791.10
Rate for Payer: United Healthcare Managed Medicare	$518.61
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREAT KNEECAP DISLOCATION

Professional

Both

$1,586.00

Service Code	CPT 27562
Hospital Charge Code	7982866
Hospital Revenue Code	981
Min. Negotiated Rate	$394.92
Max. Negotiated Rate	$1,189.50
Rate for Payer: Amerigroup Medicaid	$398.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Iowa Total Care Managed Medicaid	$394.92
Rate for Payer: Medical Associates Commercial	$1,189.50
Rate for Payer: Midlands Choice Commercial	$1,110.20
Rate for Payer: Molina Healthcare Managed Medicaid	$396.86
Rate for Payer: Partners Health Alliance Commercial	$1,189.50
Rate for Payer: United Healthcare Commercial	$732.96
Rate for Payer: Wellmark IA HMO WHPI	$949.80
Rate for Payer: Wellmark IA PPO	$1,117.40

TREAT KNEECAP FRACTURE

Facility

$879.00

Service Code	CPT 27520
Hospital Charge Code	7983026
Hospital Revenue Code	450
Min. Negotiated Rate	$615.30
Max. Negotiated Rate	$791.10
Rate for Payer: Aetna of IA Commercial	$791.10
Rate for Payer: Aetna of IA Medical Rental Products	$791.10
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$659.25
Rate for Payer: Medical Associates Commercial	$659.25
Rate for Payer: Midlands Choice Commercial	$615.30
Rate for Payer: United Healthcare Commercial	$791.10

TREAT KNEECAP FRACTURE

Facility

$879.00

Service Code	CPT 27520
Hospital Charge Code	7983026
Hospital Revenue Code	450
Min. Negotiated Rate	$395.55
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$791.10
Rate for Payer: Aetna of IA Medical Rental Products	$791.10
Rate for Payer: Aetna of IA Medicare	$501.03
Rate for Payer: Amerigroup Medicaid	$507.01
Rate for Payer: Amerigroup Medicare	$399.51
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$659.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$395.55
Rate for Payer: Iowa Total Care Managed Medicaid	$502.08
Rate for Payer: Medical Associates Commercial	$659.25
Rate for Payer: Medical Associates Managed Medicare	$395.55
Rate for Payer: Midlands Choice Commercial	$615.30
Rate for Payer: Molina Healthcare Managed Medicaid	$509.47
Rate for Payer: Partners Health Alliance Commercial	$454.88
Rate for Payer: United Healthcare Commercial	$791.10
Rate for Payer: United Healthcare Managed Medicare	$518.61
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREAT KNEE DISLOCATION

Facility

$754.00

Service Code	CPT 27550
Hospital Charge Code	4864797
Hospital Revenue Code	450
Min. Negotiated Rate	$527.80
Max. Negotiated Rate	$678.60
Rate for Payer: Aetna of IA Commercial	$678.60
Rate for Payer: Aetna of IA Medical Rental Products	$678.60
Rate for Payer: Cash Price	$603.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$565.50
Rate for Payer: Medical Associates Commercial	$565.50
Rate for Payer: Midlands Choice Commercial	$527.80
Rate for Payer: United Healthcare Commercial	$678.60

TREAT KNEE DISLOCATION

Facility

$754.00

Service Code	CPT 27550
Hospital Charge Code	4864797
Hospital Revenue Code	450
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$678.60
Rate for Payer: Aetna of IA Medical Rental Products	$678.60
Rate for Payer: Aetna of IA Medicare	$429.78
Rate for Payer: Amerigroup Medicaid	$434.91
Rate for Payer: Amerigroup Medicare	$342.69
Rate for Payer: Cash Price	$603.20
Rate for Payer: Cash Price	$603.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$565.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$339.30
Rate for Payer: Iowa Total Care Managed Medicaid	$430.68
Rate for Payer: Medical Associates Commercial	$565.50
Rate for Payer: Medical Associates Managed Medicare	$339.30
Rate for Payer: Midlands Choice Commercial	$527.80
Rate for Payer: Molina Healthcare Managed Medicaid	$437.02
Rate for Payer: Partners Health Alliance Commercial	$390.20
Rate for Payer: United Healthcare Commercial	$678.60
Rate for Payer: United Healthcare Managed Medicare	$444.86
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREAT KNEE DISLOCATION

Professional

Both

$1,493.00

Service Code	CPT 27550
Hospital Charge Code	7982795
Hospital Revenue Code	981
Min. Negotiated Rate	$409.14
Max. Negotiated Rate	$1,170.70
Rate for Payer: Amerigroup Medicaid	$413.15
Rate for Payer: Cash Price	$1,194.40
Rate for Payer: Cash Price	$1,194.40
Rate for Payer: Iowa Total Care Managed Medicaid	$409.14
Rate for Payer: Medical Associates Commercial	$1,119.75
Rate for Payer: Midlands Choice Commercial	$1,045.10
Rate for Payer: Molina Healthcare Managed Medicaid	$411.15
Rate for Payer: Partners Health Alliance Commercial	$1,119.75
Rate for Payer: United Healthcare Commercial	$787.42
Rate for Payer: Wellmark IA HMO WHPI	$995.10
Rate for Payer: Wellmark IA PPO	$1,170.70

TREAT KNUCKLE DISLOCATION

Professional

Both

$1,071.00

Service Code	CPT 26700
Hospital Charge Code	7982801
Hospital Revenue Code	981
Min. Negotiated Rate	$224.85
Max. Negotiated Rate	$803.25
Rate for Payer: Amerigroup Medicaid	$227.05
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Iowa Total Care Managed Medicaid	$224.85
Rate for Payer: Medical Associates Commercial	$803.25
Rate for Payer: Midlands Choice Commercial	$749.70
Rate for Payer: Molina Healthcare Managed Medicaid	$225.95
Rate for Payer: Partners Health Alliance Commercial	$803.25
Rate for Payer: United Healthcare Commercial	$500.37
Rate for Payer: Wellmark IA HMO WHPI	$669.30
Rate for Payer: Wellmark IA PPO	$787.40

TREAT KNUCKLE DISLOCATION

Facility

$686.00

Service Code	CPT 26700
Hospital Charge Code	4862814
Hospital Revenue Code	450
Min. Negotiated Rate	$480.20
Max. Negotiated Rate	$617.40
Rate for Payer: Aetna of IA Commercial	$617.40
Rate for Payer: Aetna of IA Medical Rental Products	$617.40
Rate for Payer: Cash Price	$548.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$514.50
Rate for Payer: Medical Associates Commercial	$514.50
Rate for Payer: Midlands Choice Commercial	$480.20
Rate for Payer: United Healthcare Commercial	$617.40

TREAT KNUCKLE DISLOCATION

Facility

$686.00

Service Code	CPT 26700
Hospital Charge Code	4862814
Hospital Revenue Code	450
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$617.40
Rate for Payer: Aetna of IA Medical Rental Products	$617.40
Rate for Payer: Aetna of IA Medicare	$391.02
Rate for Payer: Amerigroup Medicaid	$395.68
Rate for Payer: Amerigroup Medicare	$311.79
Rate for Payer: Cash Price	$548.80
Rate for Payer: Cash Price	$548.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$514.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$308.70
Rate for Payer: Iowa Total Care Managed Medicaid	$391.84
Rate for Payer: Medical Associates Commercial	$514.50
Rate for Payer: Medical Associates Managed Medicare	$308.70
Rate for Payer: Midlands Choice Commercial	$480.20
Rate for Payer: Molina Healthcare Managed Medicaid	$397.61
Rate for Payer: Partners Health Alliance Commercial	$355.00
Rate for Payer: United Healthcare Commercial	$617.40
Rate for Payer: United Healthcare Managed Medicare	$404.74
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREAT LOWER LEG FRACTURE

Facility

$1,256.00

Service Code	CPT 27824
Hospital Charge Code	7983034
Hospital Revenue Code	450
Min. Negotiated Rate	$565.20
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Aetna of IA Medicare	$715.92
Rate for Payer: Amerigroup Medicaid	$724.46
Rate for Payer: Amerigroup Medicare	$570.85
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$565.20
Rate for Payer: Iowa Total Care Managed Medicaid	$717.43
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Medical Associates Managed Medicare	$565.20
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: Molina Healthcare Managed Medicaid	$727.98
Rate for Payer: Partners Health Alliance Commercial	$649.98
Rate for Payer: United Healthcare Commercial	$1,130.40
Rate for Payer: United Healthcare Managed Medicare	$741.04
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREAT LOWER LEG FRACTURE

Facility

$1,256.00

Service Code	CPT 27824
Hospital Charge Code	7983034
Hospital Revenue Code	450
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,130.40
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: United Healthcare Commercial	$1,130.40

TREATMEN CLOSED ELBOW DISLOCATION W/O ANESTH

Professional

Both

$1,289.00

Service Code	CPT 24600
Hospital Charge Code	8822635
Hospital Revenue Code	981
Min. Negotiated Rate	$331.53
Max. Negotiated Rate	$966.75
Rate for Payer: Amerigroup Medicaid	$334.78
Rate for Payer: Cash Price	$1,031.20
Rate for Payer: Cash Price	$1,031.20
Rate for Payer: Iowa Total Care Managed Medicaid	$331.53
Rate for Payer: Medical Associates Commercial	$966.75
Rate for Payer: Midlands Choice Commercial	$902.30
Rate for Payer: Molina Healthcare Managed Medicaid	$333.16
Rate for Payer: Partners Health Alliance Commercial	$966.75
Rate for Payer: United Healthcare Commercial	$558.06
Rate for Payer: Wellmark IA HMO WHPI	$741.00
Rate for Payer: Wellmark IA PPO	$871.70

TREATMENT OF ANKLE FRACTURE

Facility

$1,256.00

Service Code	CPT 27818
Hospital Charge Code	4864824
Hospital Revenue Code	450
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,130.40
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: United Healthcare Commercial	$1,130.40

TREATMENT OF ANKLE FRACTURE

Facility

$502.00

Service Code	CPT 27786
Hospital Charge Code	4864808
Hospital Revenue Code	450
Min. Negotiated Rate	$225.90
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$451.80
Rate for Payer: Aetna of IA Medical Rental Products	$451.80
Rate for Payer: Aetna of IA Medicare	$286.14
Rate for Payer: Amerigroup Medicaid	$289.55
Rate for Payer: Amerigroup Medicare	$228.16
Rate for Payer: Cash Price	$401.60
Rate for Payer: Cash Price	$401.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$376.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$225.90
Rate for Payer: Iowa Total Care Managed Medicaid	$286.74
Rate for Payer: Medical Associates Commercial	$376.50
Rate for Payer: Medical Associates Managed Medicare	$225.90
Rate for Payer: Midlands Choice Commercial	$351.40
Rate for Payer: Molina Healthcare Managed Medicaid	$290.96
Rate for Payer: Partners Health Alliance Commercial	$259.78
Rate for Payer: United Healthcare Commercial	$451.80
Rate for Payer: United Healthcare Managed Medicare	$296.18
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREATMENT OF ANKLE FRACTURE

Facility

$1,256.00

Service Code	CPT 27788
Hospital Charge Code	4864811
Hospital Revenue Code	450
Min. Negotiated Rate	$565.20
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Aetna of IA Medicare	$715.92
Rate for Payer: Amerigroup Medicaid	$724.46
Rate for Payer: Amerigroup Medicare	$570.85
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$565.20
Rate for Payer: Iowa Total Care Managed Medicaid	$717.43
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Medical Associates Managed Medicare	$565.20
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: Molina Healthcare Managed Medicaid	$727.98
Rate for Payer: Partners Health Alliance Commercial	$649.98
Rate for Payer: United Healthcare Commercial	$1,130.40
Rate for Payer: United Healthcare Managed Medicare	$741.04
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREATMENT OF ANKLE FRACTURE

Facility

$1,256.00

Service Code	CPT 27818
Hospital Charge Code	4864824
Hospital Revenue Code	450
Min. Negotiated Rate	$565.20
Max. Negotiated Rate	$2,009.51
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Aetna of IA Medicare	$715.92
Rate for Payer: Amerigroup Medicaid	$724.46
Rate for Payer: Amerigroup Medicare	$570.85
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$565.20
Rate for Payer: Iowa Total Care Managed Medicaid	$717.43
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Medical Associates Managed Medicare	$565.20
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: Molina Healthcare Managed Medicaid	$727.98
Rate for Payer: Partners Health Alliance Commercial	$649.98
Rate for Payer: United Healthcare Commercial	$1,130.40
Rate for Payer: United Healthcare Managed Medicare	$741.04
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

TREATMENT OF ANKLE FRACTURE

Facility

$502.00

Service Code	CPT 27786
Hospital Charge Code	4864808
Hospital Revenue Code	450
Min. Negotiated Rate	$351.40
Max. Negotiated Rate	$451.80
Rate for Payer: Aetna of IA Commercial	$451.80
Rate for Payer: Aetna of IA Medical Rental Products	$451.80
Rate for Payer: Cash Price	$401.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$376.50
Rate for Payer: Medical Associates Commercial	$376.50
Rate for Payer: Midlands Choice Commercial	$351.40
Rate for Payer: United Healthcare Commercial	$451.80

TREATMENT OF ANKLE FRACTURE

Facility

$1,256.00

Service Code	CPT 27788
Hospital Charge Code	4864811
Hospital Revenue Code	450
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,130.40
Rate for Payer: Aetna of IA Commercial	$1,130.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,130.40
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$942.00
Rate for Payer: Medical Associates Commercial	$942.00
Rate for Payer: Midlands Choice Commercial	$879.20
Rate for Payer: United Healthcare Commercial	$1,130.40

TREATMENT OF BLADDER LESION

Facility

$996.00

Service Code	CPT 51720
Hospital Charge Code	7983039
Hospital Revenue Code	450
Min. Negotiated Rate	$448.20
Max. Negotiated Rate	$896.40
Rate for Payer: Aetna of IA Commercial	$896.40
Rate for Payer: Aetna of IA Medical Rental Products	$896.40
Rate for Payer: Aetna of IA Medicare	$567.72
Rate for Payer: Amerigroup Medicaid	$574.49
Rate for Payer: Amerigroup Medicare	$452.68
Rate for Payer: Cash Price	$796.80
Rate for Payer: Cash Price	$796.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$747.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$448.20
Rate for Payer: Iowa Total Care Managed Medicaid	$568.92
Rate for Payer: Medical Associates Commercial	$747.00
Rate for Payer: Medical Associates Managed Medicare	$448.20
Rate for Payer: Midlands Choice Commercial	$697.20
Rate for Payer: Molina Healthcare Managed Medicaid	$577.28
Rate for Payer: Partners Health Alliance Commercial	$515.43
Rate for Payer: United Healthcare Commercial	$896.40
Rate for Payer: United Healthcare Managed Medicare	$587.64
Rate for Payer: Wellmark IA HMO WHPI	$684.89
Rate for Payer: Wellmark IA PPO	$754.45

TREATMENT OF BLADDER LESION

Facility

$996.00

Service Code	CPT 51720
Hospital Charge Code	7983039
Hospital Revenue Code	450
Min. Negotiated Rate	$697.20
Max. Negotiated Rate	$896.40
Rate for Payer: Aetna of IA Commercial	$896.40
Rate for Payer: Aetna of IA Medical Rental Products	$896.40
Rate for Payer: Cash Price	$796.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$747.00
Rate for Payer: Medical Associates Commercial	$747.00
Rate for Payer: Midlands Choice Commercial	$697.20
Rate for Payer: United Healthcare Commercial	$896.40

Know your out-of-pocket cost for care.

All Charges