Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

BILIRUBIN TOTAL

Facility

$61.00

Service Code	CPT 82247
Hospital Charge Code	633672
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
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	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
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	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

BILL ABO

Facility

$52.00

Service Code	CPT 86900
Hospital Charge Code	8015152
Hospital Revenue Code	302
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

BILL ABO

Facility

$52.00

Service Code	CPT 86900
Hospital Charge Code	8015152
Hospital Revenue Code	302
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$107.07
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$26.24
Rate for Payer: Amerigroup Medicare	$26.26
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.00
Rate for Payer: Iowa Total Care Managed Medicaid	$25.99
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$26.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$26.39
Rate for Payer: Molina Healthcare Managed Medicare	$26.37
Rate for Payer: Oscar Health of IA Commercial	$39.00
Rate for Payer: Partners Health Alliance Commercial	$39.00
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

Bill Alcohol Saliva 82055

Facility

$61.00

Service Code	CPT 80320
Hospital Charge Code	8100912
Hospital Revenue Code	300
Min. Negotiated Rate	$30.49
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	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
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	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Bill Alcohol Saliva 82055

Facility

$61.00

Service Code	CPT 80320
Hospital Charge Code	8100912
Hospital Revenue Code	300
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

BILL ANTIBODY ELUTION

Facility

$125.00

Service Code	CPT 86860
Hospital Charge Code	7829178
Hospital Revenue Code	302
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of IA Commercial	$112.50
Rate for Payer: Aetna of IA Medical Rental Products	$112.50
Rate for Payer: Aetna of IA Medicare	$71.25
Rate for Payer: Amerigroup Medicaid	$63.09
Rate for Payer: Amerigroup Medicare	$63.12
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$93.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.50
Rate for Payer: Iowa Total Care Managed Medicaid	$62.48
Rate for Payer: Medical Associates Commercial	$93.75
Rate for Payer: Medical Associates Managed Medicare	$62.50
Rate for Payer: Midlands Choice Commercial	$87.50
Rate for Payer: Molina Healthcare Managed Medicaid	$63.44
Rate for Payer: Molina Healthcare Managed Medicare	$63.40
Rate for Payer: Oscar Health of IA Commercial	$93.75
Rate for Payer: Partners Health Alliance Commercial	$93.75
Rate for Payer: United Healthcare Commercial	$112.50
Rate for Payer: United Healthcare Managed Medicare	$73.75
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

BILL ANTIBODY ELUTION

Facility

$125.00

Service Code	CPT 86860
Hospital Charge Code	7829178
Hospital Revenue Code	302
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of IA Commercial	$112.50
Rate for Payer: Aetna of IA Medical Rental Products	$112.50
Rate for Payer: Cash Price	$100.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$93.75
Rate for Payer: Medical Associates Commercial	$93.75
Rate for Payer: Midlands Choice Commercial	$87.50
Rate for Payer: United Healthcare Commercial	$112.50

BILL ANTIBODY ID

Facility

$141.00

Service Code	CPT 86870
Hospital Charge Code	7829179
Hospital Revenue Code	302
Min. Negotiated Rate	$70.47
Max. Negotiated Rate	$126.90
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Aetna of IA Commercial	$126.90
Rate for Payer: Aetna of IA Medical Rental Products	$126.90
Rate for Payer: Aetna of IA Medicare	$80.37
Rate for Payer: Amerigroup Medicaid	$71.16
Rate for Payer: Amerigroup Medicare	$71.20
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$70.50
Rate for Payer: Iowa Total Care Managed Medicaid	$70.47
Rate for Payer: Medical Associates Commercial	$105.75
Rate for Payer: Medical Associates Managed Medicare	$70.50
Rate for Payer: Midlands Choice Commercial	$98.70
Rate for Payer: Molina Healthcare Managed Medicaid	$71.56
Rate for Payer: Molina Healthcare Managed Medicare	$71.52
Rate for Payer: Oscar Health of IA Commercial	$105.75
Rate for Payer: Partners Health Alliance Commercial	$105.75
Rate for Payer: United Healthcare Commercial	$126.90
Rate for Payer: United Healthcare Managed Medicare	$83.19
Rate for Payer: Wellmark IA PPO	$107.07

BILL ANTIBODY ID

Facility

$141.00

Service Code	CPT 86870
Hospital Charge Code	7829179
Hospital Revenue Code	302
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of IA Commercial	$126.90
Rate for Payer: Aetna of IA Medical Rental Products	$126.90
Rate for Payer: Cash Price	$112.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$105.75
Rate for Payer: Medical Associates Commercial	$105.75
Rate for Payer: Midlands Choice Commercial	$98.70
Rate for Payer: United Healthcare Commercial	$126.90

BILL ANTIBODY SCREEN

Facility

$73.00

Service Code	CPT 86850
Hospital Charge Code	7862116
Hospital Revenue Code	302
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: United Healthcare Commercial	$65.70

BILL ANTIBODY SCREEN

Facility

$73.00

Service Code	CPT 86850
Hospital Charge Code	7862116
Hospital Revenue Code	302
Min. Negotiated Rate	$36.49
Max. Negotiated Rate	$107.07
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Aetna of IA Medicare	$41.61
Rate for Payer: Amerigroup Medicaid	$36.84
Rate for Payer: Amerigroup Medicare	$36.86
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.50
Rate for Payer: Iowa Total Care Managed Medicaid	$36.49
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Medical Associates Managed Medicare	$36.50
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: Molina Healthcare Managed Medicaid	$37.05
Rate for Payer: Molina Healthcare Managed Medicare	$37.03
Rate for Payer: Oscar Health of IA Commercial	$54.75
Rate for Payer: Partners Health Alliance Commercial	$54.75
Rate for Payer: United Healthcare Commercial	$65.70
Rate for Payer: United Healthcare Managed Medicare	$43.07
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

BILL ANTIBODY TITER

Facility

$78.00

Service Code	CPT 86886
Hospital Charge Code	7829181
Hospital Revenue Code	302
Min. Negotiated Rate	$38.98
Max. Negotiated Rate	$107.07
Rate for Payer: Aetna of IA Commercial	$70.20
Rate for Payer: Aetna of IA Medical Rental Products	$70.20
Rate for Payer: Aetna of IA Medicare	$44.46
Rate for Payer: Amerigroup Medicaid	$39.37
Rate for Payer: Amerigroup Medicare	$39.39
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$58.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$39.00
Rate for Payer: Iowa Total Care Managed Medicaid	$38.98
Rate for Payer: Medical Associates Commercial	$58.50
Rate for Payer: Medical Associates Managed Medicare	$39.00
Rate for Payer: Midlands Choice Commercial	$54.60
Rate for Payer: Molina Healthcare Managed Medicaid	$39.58
Rate for Payer: Molina Healthcare Managed Medicare	$39.56
Rate for Payer: Oscar Health of IA Commercial	$58.50
Rate for Payer: Partners Health Alliance Commercial	$58.50
Rate for Payer: United Healthcare Commercial	$70.20
Rate for Payer: United Healthcare Managed Medicare	$46.02
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

BILL ANTIBODY TITER

Facility

$78.00

Service Code	CPT 86886
Hospital Charge Code	7829181
Hospital Revenue Code	302
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of IA Commercial	$70.20
Rate for Payer: Aetna of IA Medical Rental Products	$70.20
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$58.50
Rate for Payer: Medical Associates Commercial	$58.50
Rate for Payer: Midlands Choice Commercial	$54.60
Rate for Payer: United Healthcare Commercial	$70.20

BILL ANTIGEN SCREEN EACH UNIT

Facility

$56.00

Service Code	CPT 86902
Hospital Charge Code	7829177
Hospital Revenue Code	302
Min. Negotiated Rate	$27.99
Max. Negotiated Rate	$107.07
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$28.26
Rate for Payer: Amerigroup Medicare	$28.28
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.00
Rate for Payer: Iowa Total Care Managed Medicaid	$27.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$28.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$28.42
Rate for Payer: Molina Healthcare Managed Medicare	$28.40
Rate for Payer: Oscar Health of IA Commercial	$42.00
Rate for Payer: Partners Health Alliance Commercial	$42.00
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

BILL ANTIGEN SCREEN EACH UNIT

Facility

$56.00

Service Code	CPT 86902
Hospital Charge Code	7829177
Hospital Revenue Code	302
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

BILL ANTIGEN SCREEN W/ PT. PLASMA

Facility

$51.00

Service Code	CPT 86904
Hospital Charge Code	7841884
Hospital Revenue Code	302
Min. Negotiated Rate	$25.49
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of IA Commercial	$45.90
Rate for Payer: Aetna of IA Medical Rental Products	$45.90
Rate for Payer: Aetna of IA Medicare	$29.07
Rate for Payer: Amerigroup Medicaid	$25.74
Rate for Payer: Amerigroup Medicare	$25.76
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.50
Rate for Payer: Iowa Total Care Managed Medicaid	$25.49
Rate for Payer: Medical Associates Commercial	$38.25
Rate for Payer: Medical Associates Managed Medicare	$25.50
Rate for Payer: Midlands Choice Commercial	$35.70
Rate for Payer: Molina Healthcare Managed Medicaid	$25.88
Rate for Payer: Molina Healthcare Managed Medicare	$25.87
Rate for Payer: Oscar Health of IA Commercial	$38.25
Rate for Payer: Partners Health Alliance Commercial	$38.25
Rate for Payer: United Healthcare Commercial	$45.90
Rate for Payer: United Healthcare Managed Medicare	$30.09
Rate for Payer: Wellmark IA HMO	$31.00
Rate for Payer: Wellmark IA PPO	$34.10

BILL ANTIGEN SCREEN W/ PT. PLASMA

Facility

$51.00

Service Code	CPT 86904
Hospital Charge Code	7841884
Hospital Revenue Code	302
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of IA Commercial	$45.90
Rate for Payer: Aetna of IA Medical Rental Products	$45.90
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.25
Rate for Payer: Medical Associates Commercial	$38.25
Rate for Payer: Midlands Choice Commercial	$35.70
Rate for Payer: United Healthcare Commercial	$45.90

BILL AUTOLOGOUS BLOOD EA

Facility

$113.00

Service Code	CPT 86890
Hospital Charge Code	8015151
Hospital Revenue Code	390
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of IA Commercial	$101.70
Rate for Payer: Aetna of IA Medical Rental Products	$101.70
Rate for Payer: Aetna of IA Medicare	$64.41
Rate for Payer: Amerigroup Medicaid	$57.03
Rate for Payer: Amerigroup Medicare	$57.06
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$84.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$56.50
Rate for Payer: Iowa Total Care Managed Medicaid	$56.48
Rate for Payer: Medical Associates Commercial	$84.75
Rate for Payer: Medical Associates Managed Medicare	$56.50
Rate for Payer: Midlands Choice Commercial	$79.10
Rate for Payer: Molina Healthcare Managed Medicaid	$57.35
Rate for Payer: Molina Healthcare Managed Medicare	$57.31
Rate for Payer: Oscar Health of IA Commercial	$84.75
Rate for Payer: Partners Health Alliance Commercial	$84.75
Rate for Payer: United Healthcare Commercial	$101.70
Rate for Payer: United Healthcare Managed Medicare	$66.67
Rate for Payer: Wellmark IA HMO	$55.18
Rate for Payer: Wellmark IA PPO	$60.70

BILL AUTOLOGOUS BLOOD EA

Facility

$113.00

Service Code	CPT 86890
Hospital Charge Code	8015151
Hospital Revenue Code	390
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of IA Commercial	$101.70
Rate for Payer: Aetna of IA Medical Rental Products	$101.70
Rate for Payer: Cash Price	$90.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$84.75
Rate for Payer: Medical Associates Commercial	$84.75
Rate for Payer: Midlands Choice Commercial	$79.10
Rate for Payer: United Healthcare Commercial	$101.70

Bill Body Fluid Cell Count 89051

Facility

$74.00

Service Code	CPT 89051
Hospital Charge Code	8098792
Hospital Revenue Code	309
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: United Healthcare Commercial	$66.60

Bill Body Fluid Cell Count 89051

Facility

$74.00

Service Code	CPT 89051
Hospital Charge Code	8098792
Hospital Revenue Code	309
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$67.52
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Aetna of IA Medicare	$42.18
Rate for Payer: Amerigroup Medicaid	$37.35
Rate for Payer: Amerigroup Medicare	$37.37
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.00
Rate for Payer: Iowa Total Care Managed Medicaid	$36.99
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Medical Associates Managed Medicare	$37.00
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: Molina Healthcare Managed Medicaid	$37.56
Rate for Payer: Molina Healthcare Managed Medicare	$37.53
Rate for Payer: Oscar Health of IA Commercial	$55.50
Rate for Payer: Partners Health Alliance Commercial	$55.50
Rate for Payer: United Healthcare Commercial	$66.60
Rate for Payer: United Healthcare Managed Medicare	$43.66
Rate for Payer: Wellmark IA HMO	$61.38
Rate for Payer: Wellmark IA PPO	$67.52

Bill Body Fluid Crystals 89060

Facility

$74.00

Service Code	CPT 89060
Hospital Charge Code	8098794
Hospital Revenue Code	309
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: United Healthcare Commercial	$66.60

Bill Body Fluid Crystals 89060

Facility

$74.00

Service Code	CPT 89060
Hospital Charge Code	8098794
Hospital Revenue Code	309
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$67.52
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Aetna of IA Medicare	$42.18
Rate for Payer: Amerigroup Medicaid	$37.35
Rate for Payer: Amerigroup Medicare	$37.37
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.00
Rate for Payer: Iowa Total Care Managed Medicaid	$36.99
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Medical Associates Managed Medicare	$37.00
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: Molina Healthcare Managed Medicaid	$37.56
Rate for Payer: Molina Healthcare Managed Medicare	$37.53
Rate for Payer: Oscar Health of IA Commercial	$55.50
Rate for Payer: Partners Health Alliance Commercial	$55.50
Rate for Payer: United Healthcare Commercial	$66.60
Rate for Payer: United Healthcare Managed Medicare	$43.66
Rate for Payer: Wellmark IA HMO	$61.38
Rate for Payer: Wellmark IA PPO	$67.52

Bill Chromosome Analysis 88262

Facility

$278.00

Service Code	CPT 88262
Hospital Charge Code	8099069
Hospital Revenue Code	310
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$250.20
Rate for Payer: Aetna of IA Commercial	$250.20
Rate for Payer: Aetna of IA Medical Rental Products	$250.20
Rate for Payer: Aetna of IA Medicare	$158.46
Rate for Payer: Amerigroup Medicaid	$140.31
Rate for Payer: Amerigroup Medicare	$140.39
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$208.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$139.00
Rate for Payer: Iowa Total Care Managed Medicaid	$138.94
Rate for Payer: Medical Associates Commercial	$208.50
Rate for Payer: Medical Associates Managed Medicare	$139.00
Rate for Payer: Midlands Choice Commercial	$194.60
Rate for Payer: Molina Healthcare Managed Medicaid	$141.08
Rate for Payer: Molina Healthcare Managed Medicare	$141.00
Rate for Payer: Oscar Health of IA Commercial	$208.50
Rate for Payer: Partners Health Alliance Commercial	$208.50
Rate for Payer: United Healthcare Commercial	$250.20
Rate for Payer: United Healthcare Managed Medicare	$164.02
Rate for Payer: Wellmark IA HMO	$149.42
Rate for Payer: Wellmark IA PPO	$164.36

Bill Chromosome Analysis 88262

Facility

$278.00

Service Code	CPT 88262
Hospital Charge Code	8099069
Hospital Revenue Code	310
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$250.20
Rate for Payer: Aetna of IA Commercial	$250.20
Rate for Payer: Aetna of IA Medical Rental Products	$250.20
Rate for Payer: Cash Price	$222.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$208.50
Rate for Payer: Medical Associates Commercial	$208.50
Rate for Payer: Midlands Choice Commercial	$194.60
Rate for Payer: United Healthcare Commercial	$250.20

Know your out-of-pocket cost for care.

All Charges