Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006795
Hospital Revenue Code	307
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$28.12
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$17.88
Rate for Payer: Amerigroup Medicare	$14.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.95
Rate for Payer: Iowa Total Care Managed Medicaid	$17.71
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$13.95
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$17.97
Rate for Payer: Partners Health Alliance Commercial	$16.04
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29
Rate for Payer: Wellmark IA HMO WHPI	$25.52
Rate for Payer: Wellmark IA PPO	$28.12

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006797
Hospital Revenue Code	307
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

URINARY STONES WITH MCC

Facility

$9,698.04

Service Code	MSDRG 693
Min. Negotiated Rate	$9,557.48
Max. Negotiated Rate	$9,698.04
Rate for Payer: Amerigroup Medicaid	$9,651.19
Rate for Payer: Iowa Total Care Managed Medicaid	$9,557.48
Rate for Payer: Molina Healthcare Managed Medicaid	$9,698.04

URINARY STONES WITHOUT MCC

Facility

$6,457.48

Service Code	MSDRG 694
Min. Negotiated Rate	$6,363.89
Max. Negotiated Rate	$6,457.48
Rate for Payer: Amerigroup Medicaid	$6,426.28
Rate for Payer: Iowa Total Care Managed Medicaid	$6,363.89
Rate for Payer: Molina Healthcare Managed Medicaid	$6,457.48

URINE CHLORIDE

Facility

$48.00

Service Code	CPT 82436
Hospital Charge Code	4006802
Hospital Revenue Code	301
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of IA Commercial	$43.20
Rate for Payer: Aetna of IA Medical Rental Products	$43.20
Rate for Payer: Cash Price	$38.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.00
Rate for Payer: Medical Associates Commercial	$36.00
Rate for Payer: Midlands Choice Commercial	$33.60
Rate for Payer: United Healthcare Commercial	$43.20

URINE CHLORIDE

Facility

$48.00

Service Code	CPT 82436
Hospital Charge Code	4006802
Hospital Revenue Code	301
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of IA Commercial	$43.20
Rate for Payer: Aetna of IA Medical Rental Products	$43.20
Rate for Payer: Aetna of IA Medicare	$27.36
Rate for Payer: Amerigroup Medicaid	$27.69
Rate for Payer: Amerigroup Medicare	$21.82
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.60
Rate for Payer: Iowa Total Care Managed Medicaid	$27.42
Rate for Payer: Medical Associates Commercial	$36.00
Rate for Payer: Medical Associates Managed Medicare	$21.60
Rate for Payer: Midlands Choice Commercial	$33.60
Rate for Payer: Molina Healthcare Managed Medicaid	$27.82
Rate for Payer: Partners Health Alliance Commercial	$24.84
Rate for Payer: United Healthcare Commercial	$43.20
Rate for Payer: United Healthcare Managed Medicare	$28.32
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	1930782
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	8419061
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	1930782
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	8419061
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE CULTURE ID

Facility

$66.00

Service Code	CPT 87088
Hospital Charge Code	7836071
Hospital Revenue Code	306
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Aetna of IA Medicare	$37.62
Rate for Payer: Amerigroup Medicaid	$38.07
Rate for Payer: Amerigroup Medicare	$30.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.70
Rate for Payer: Iowa Total Care Managed Medicaid	$37.70
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Medical Associates Managed Medicare	$29.70
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: Molina Healthcare Managed Medicaid	$38.25
Rate for Payer: Partners Health Alliance Commercial	$34.16
Rate for Payer: United Healthcare Commercial	$59.40
Rate for Payer: United Healthcare Managed Medicare	$38.94
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

URINE CULTURE ID

Facility

$66.00

Service Code	CPT 87088
Hospital Charge Code	7836071
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: United Healthcare Commercial	$59.40

URINE K (POTASSIUM)

Facility

$61.00

Service Code	CPT 84133
Hospital Charge Code	4021240
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE K (POTASSIUM)

Facility

$61.00

Service Code	CPT 84133
Hospital Charge Code	4021240
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	4019304
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	4019304
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Aetna of IA Medicare	$31.35
Rate for Payer: Amerigroup Medicaid	$31.72
Rate for Payer: Amerigroup Medicare	$25.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.75
Rate for Payer: Iowa Total Care Managed Medicaid	$31.42
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Medical Associates Managed Medicare	$24.75
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: Molina Healthcare Managed Medicaid	$31.88
Rate for Payer: Partners Health Alliance Commercial	$28.46
Rate for Payer: United Healthcare Commercial	$49.50
Rate for Payer: United Healthcare Managed Medicare	$32.45
Rate for Payer: Wellmark IA HMO WHPI	$25.52
Rate for Payer: Wellmark IA PPO	$28.12

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	8093947
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Aetna of IA Medicare	$31.35
Rate for Payer: Amerigroup Medicaid	$31.72
Rate for Payer: Amerigroup Medicare	$25.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.75
Rate for Payer: Iowa Total Care Managed Medicaid	$31.42
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Medical Associates Managed Medicare	$24.75
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: Molina Healthcare Managed Medicaid	$31.88
Rate for Payer: Partners Health Alliance Commercial	$28.46
Rate for Payer: United Healthcare Commercial	$49.50
Rate for Payer: United Healthcare Managed Medicare	$32.45
Rate for Payer: Wellmark IA HMO WHPI	$25.52
Rate for Payer: Wellmark IA PPO	$28.12

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	8093947
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

Urine Protein

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	7942974
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

Urine Protein

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	7942974
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE PROTEIN

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	4006798
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE PROTEIN

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	4006798
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE PROTEIN

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	8094266
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE PROTEIN

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	8094266
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

URINE PROTEIN

Facility

$61.00

Service Code	CPT 84156
Hospital Charge Code	8419063
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

Know your out-of-pocket cost for care.

All Charges