Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

baclofen 10 mg Tab [VDMC]

Facility

$2.53

Service Code	HCPCS A9270
Hospital Charge Code	10369331
Hospital Revenue Code	259
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna of IA Commercial	$2.27
Rate for Payer: Aetna of IA Medical Rental Products	$2.27
Rate for Payer: Aetna of IA Medicare	$1.44
Rate for Payer: Amerigroup Medicaid	$1.46
Rate for Payer: Amerigroup Medicare	$1.15
Rate for Payer: Cash Price	$2.02
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.14
Rate for Payer: Iowa Total Care Managed Medicaid	$1.44
Rate for Payer: Medical Associates Commercial	$1.90
Rate for Payer: Medical Associates Managed Medicare	$1.14
Rate for Payer: Midlands Choice Commercial	$1.77
Rate for Payer: Molina Healthcare Managed Medicaid	$1.46
Rate for Payer: Partners Health Alliance Commercial	$1.31
Rate for Payer: United Healthcare Commercial	$2.27
Rate for Payer: United Healthcare Managed Medicare	$1.49

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	297662
Hospital Revenue Code	306
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: United Healthcare Commercial	$53.10

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	297662
Hospital Revenue Code	306
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Aetna of IA Medicare	$33.63
Rate for Payer: Amerigroup Medicaid	$34.03
Rate for Payer: Amerigroup Medicare	$26.82
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.55
Rate for Payer: Iowa Total Care Managed Medicaid	$33.70
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Medical Associates Managed Medicare	$26.55
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: Molina Healthcare Managed Medicaid	$34.20
Rate for Payer: Partners Health Alliance Commercial	$30.53
Rate for Payer: United Healthcare Commercial	$53.10
Rate for Payer: United Healthcare Managed Medicare	$34.81

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	7734008
Hospital Revenue Code	306
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Aetna of IA Medicare	$33.63
Rate for Payer: Amerigroup Medicaid	$34.03
Rate for Payer: Amerigroup Medicare	$26.82
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.55
Rate for Payer: Iowa Total Care Managed Medicaid	$33.70
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Medical Associates Managed Medicare	$26.55
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: Molina Healthcare Managed Medicaid	$34.20
Rate for Payer: Partners Health Alliance Commercial	$30.53
Rate for Payer: United Healthcare Commercial	$53.10
Rate for Payer: United Healthcare Managed Medicare	$34.81

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	297663
Hospital Revenue Code	306
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: United Healthcare Commercial	$53.10

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	7734008
Hospital Revenue Code	306
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: United Healthcare Commercial	$53.10

BACTERIAL IDENTIFICATION

Facility

$59.00

Service Code	CPT 87077
Hospital Charge Code	297663
Hospital Revenue Code	306
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of IA Commercial	$53.10
Rate for Payer: Aetna of IA Medical Rental Products	$53.10
Rate for Payer: Aetna of IA Medicare	$33.63
Rate for Payer: Amerigroup Medicaid	$34.03
Rate for Payer: Amerigroup Medicare	$26.82
Rate for Payer: Cash Price	$47.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.55
Rate for Payer: Iowa Total Care Managed Medicaid	$33.70
Rate for Payer: Medical Associates Commercial	$44.25
Rate for Payer: Medical Associates Managed Medicare	$26.55
Rate for Payer: Midlands Choice Commercial	$41.30
Rate for Payer: Molina Healthcare Managed Medicaid	$34.20
Rate for Payer: Partners Health Alliance Commercial	$30.53
Rate for Payer: United Healthcare Commercial	$53.10
Rate for Payer: United Healthcare Managed Medicare	$34.81

balanced Salt irrig Opth 15 ml [VDMC]

Facility

$25.71

Service Code	HCPCS A9270
Hospital Charge Code	10410623
Hospital Revenue Code	259
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$23.14
Rate for Payer: Aetna of IA Commercial	$23.14
Rate for Payer: Aetna of IA Medical Rental Products	$23.14
Rate for Payer: Aetna of IA Medicare	$14.65
Rate for Payer: Amerigroup Medicaid	$14.83
Rate for Payer: Amerigroup Medicare	$11.68
Rate for Payer: Cash Price	$20.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.57
Rate for Payer: Iowa Total Care Managed Medicaid	$14.68
Rate for Payer: Medical Associates Commercial	$19.28
Rate for Payer: Medical Associates Managed Medicare	$11.57
Rate for Payer: Midlands Choice Commercial	$18.00
Rate for Payer: Molina Healthcare Managed Medicaid	$14.90
Rate for Payer: Partners Health Alliance Commercial	$13.30
Rate for Payer: United Healthcare Commercial	$23.14
Rate for Payer: United Healthcare Managed Medicare	$15.17

balanced Salt irrig Opth 15 ml [VDMC]

Facility

$25.71

Service Code	HCPCS A9270
Hospital Charge Code	10410623
Hospital Revenue Code	259
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$23.14
Rate for Payer: Aetna of IA Commercial	$23.14
Rate for Payer: Aetna of IA Medical Rental Products	$23.14
Rate for Payer: Cash Price	$20.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.28
Rate for Payer: Medical Associates Commercial	$19.28
Rate for Payer: Midlands Choice Commercial	$18.00
Rate for Payer: United Healthcare Commercial	$23.14

balsalazide 750 mg Cap [VDMC]

Facility

$5.10

Service Code	HCPCS A9270
Hospital Charge Code	10369471
Hospital Revenue Code	259
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna of IA Commercial	$4.59
Rate for Payer: Aetna of IA Medical Rental Products	$4.59
Rate for Payer: Cash Price	$4.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.82
Rate for Payer: Medical Associates Commercial	$3.82
Rate for Payer: Midlands Choice Commercial	$3.57
Rate for Payer: United Healthcare Commercial	$4.59

balsalazide 750 mg Cap [VDMC]

Facility

$5.10

Service Code	HCPCS A9270
Hospital Charge Code	10369471
Hospital Revenue Code	259
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna of IA Commercial	$4.59
Rate for Payer: Aetna of IA Medical Rental Products	$4.59
Rate for Payer: Aetna of IA Medicare	$2.91
Rate for Payer: Amerigroup Medicaid	$2.94
Rate for Payer: Amerigroup Medicare	$2.32
Rate for Payer: Cash Price	$4.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.29
Rate for Payer: Iowa Total Care Managed Medicaid	$2.91
Rate for Payer: Medical Associates Commercial	$3.82
Rate for Payer: Medical Associates Managed Medicare	$2.29
Rate for Payer: Midlands Choice Commercial	$3.57
Rate for Payer: Molina Healthcare Managed Medicaid	$2.96
Rate for Payer: Partners Health Alliance Commercial	$2.64
Rate for Payer: United Healthcare Commercial	$4.59
Rate for Payer: United Healthcare Managed Medicare	$3.01

balsam Peru-castor oil topical 87 mg-788 mg/g Oin

Facility

$9.22

Service Code	HCPCS A9270
Hospital Charge Code	23072734
Hospital Revenue Code	259
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$8.30
Rate for Payer: Aetna of IA Commercial	$8.30
Rate for Payer: Aetna of IA Medical Rental Products	$8.30
Rate for Payer: Aetna of IA Medicare	$5.26
Rate for Payer: Amerigroup Medicaid	$5.32
Rate for Payer: Amerigroup Medicare	$4.19
Rate for Payer: Cash Price	$7.38
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.92
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.15
Rate for Payer: Iowa Total Care Managed Medicaid	$5.27
Rate for Payer: Medical Associates Commercial	$6.92
Rate for Payer: Medical Associates Managed Medicare	$4.15
Rate for Payer: Midlands Choice Commercial	$6.46
Rate for Payer: Molina Healthcare Managed Medicaid	$5.35
Rate for Payer: Partners Health Alliance Commercial	$4.77
Rate for Payer: United Healthcare Commercial	$8.30
Rate for Payer: United Healthcare Managed Medicare	$5.44

balsam Peru-castor oil topical 87 mg-788 mg/g Oin

Facility

$9.22

Service Code	HCPCS A9270
Hospital Charge Code	23072734
Hospital Revenue Code	259
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$8.30
Rate for Payer: Aetna of IA Commercial	$8.30
Rate for Payer: Aetna of IA Medical Rental Products	$8.30
Rate for Payer: Cash Price	$7.38
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.92
Rate for Payer: Medical Associates Commercial	$6.92
Rate for Payer: Midlands Choice Commercial	$6.46
Rate for Payer: United Healthcare Commercial	$8.30

bamlanivimab

Facility

$579.00

Service Code	CPT M0239
Hospital Charge Code	8814037
Hospital Revenue Code	260
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: United Healthcare Commercial	$521.10

bamlanivimab

Facility

$579.00

Service Code	CPT M0239
Hospital Charge Code	8814037
Hospital Revenue Code	260
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61

Bamlanivimab Infusion

Facility

$579.00

Service Code	HCPCS M0239
Hospital Charge Code	8819966
Hospital Revenue Code	771
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61

Bamlanivimab Infusion

Facility

$579.00

Service Code	HCPCS M0239
Hospital Charge Code	8819966
Hospital Revenue Code	771
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: United Healthcare Commercial	$521.10

BARD PERMESH LARGE

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Charge Code	8999689
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$990.00
Rate for Payer: Aetna of IA Commercial	$990.00
Rate for Payer: Aetna of IA Medical Rental Products	$990.00
Rate for Payer: Aetna of IA Medicare	$627.00
Rate for Payer: Amerigroup Medicaid	$634.48
Rate for Payer: Amerigroup Medicare	$499.95
Rate for Payer: Cash Price	$880.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$825.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$495.00
Rate for Payer: Iowa Total Care Managed Medicaid	$628.32
Rate for Payer: Medical Associates Commercial	$825.00
Rate for Payer: Medical Associates Managed Medicare	$495.00
Rate for Payer: Midlands Choice Commercial	$770.00
Rate for Payer: Molina Healthcare Managed Medicaid	$637.56
Rate for Payer: Partners Health Alliance Commercial	$569.25
Rate for Payer: United Healthcare Commercial	$990.00
Rate for Payer: United Healthcare Managed Medicare	$649.00

BARD PERMESH LARGE

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Charge Code	8999689
Hospital Revenue Code	278
Min. Negotiated Rate	$770.00
Max. Negotiated Rate	$990.00
Rate for Payer: Aetna of IA Commercial	$990.00
Rate for Payer: Aetna of IA Medical Rental Products	$990.00
Rate for Payer: Cash Price	$880.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$825.00
Rate for Payer: Medical Associates Commercial	$825.00
Rate for Payer: Midlands Choice Commercial	$770.00
Rate for Payer: United Healthcare Commercial	$990.00

BARD SOFT MESH 3X6

Facility

$81.00

Service Code	HCPCS C1787
Hospital Charge Code	8026288
Hospital Revenue Code	278
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of IA Commercial	$72.90
Rate for Payer: Aetna of IA Medical Rental Products	$72.90
Rate for Payer: Aetna of IA Medicare	$46.17
Rate for Payer: Amerigroup Medicaid	$46.72
Rate for Payer: Amerigroup Medicare	$36.81
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$60.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.45
Rate for Payer: Iowa Total Care Managed Medicaid	$46.27
Rate for Payer: Medical Associates Commercial	$60.75
Rate for Payer: Medical Associates Managed Medicare	$36.45
Rate for Payer: Midlands Choice Commercial	$56.70
Rate for Payer: Molina Healthcare Managed Medicaid	$46.95
Rate for Payer: Partners Health Alliance Commercial	$41.92
Rate for Payer: United Healthcare Commercial	$72.90
Rate for Payer: United Healthcare Managed Medicare	$47.79

BARD SOFT MESH 3X6

Facility

$81.00

Service Code	HCPCS C1787
Hospital Charge Code	8026288
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of IA Commercial	$72.90
Rate for Payer: Aetna of IA Medical Rental Products	$72.90
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$60.75
Rate for Payer: Medical Associates Commercial	$60.75
Rate for Payer: Midlands Choice Commercial	$56.70
Rate for Payer: United Healthcare Commercial	$72.90

BARD SOFT MESH 6X6

Facility

$133.00

Service Code	HCPCS C1781
Hospital Charge Code	8026132
Hospital Revenue Code	278
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Aetna of IA Medicare	$75.81
Rate for Payer: Amerigroup Medicaid	$76.71
Rate for Payer: Amerigroup Medicare	$60.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.85
Rate for Payer: Iowa Total Care Managed Medicaid	$75.97
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Medical Associates Managed Medicare	$59.85
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: Molina Healthcare Managed Medicaid	$77.09
Rate for Payer: Partners Health Alliance Commercial	$68.83
Rate for Payer: United Healthcare Commercial	$119.70
Rate for Payer: United Healthcare Managed Medicare	$78.47

BARD SOFT MESH 6X6

Facility

$133.00

Service Code	HCPCS C1781
Hospital Charge Code	8026132
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: United Healthcare Commercial	$119.70

BASIC METABOLIC PROFILE

Facility

$141.00

Service Code	CPT 80048
Hospital Charge Code	633628
Hospital Revenue Code	301
Min. Negotiated Rate	$63.45
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: Aetna of IA Medicare	$80.37
Rate for Payer: Amerigroup Medicaid	$81.33
Rate for Payer: Amerigroup Medicare	$64.08
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	$63.45
Rate for Payer: Iowa Total Care Managed Medicaid	$80.54
Rate for Payer: Medical Associates Commercial	$105.75
Rate for Payer: Medical Associates Managed Medicare	$63.45
Rate for Payer: Midlands Choice Commercial	$98.70
Rate for Payer: Molina Healthcare Managed Medicaid	$81.72
Rate for Payer: Partners Health Alliance Commercial	$72.97
Rate for Payer: United Healthcare Commercial	$126.90
Rate for Payer: United Healthcare Managed Medicare	$83.19

BASIC METABOLIC PROFILE

Facility

$141.00

Service Code	CPT 80048
Hospital Charge Code	633628
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges