Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

belimumab 400 mg Pow [VDMC]

Facility

$4,187.14

Service Code	HCPCS J0490
Hospital Charge Code	27276990
Hospital Revenue Code	259
Min. Negotiated Rate	$2,931.00
Max. Negotiated Rate	$3,768.43
Rate for Payer: Aetna of IA Commercial	$3,768.43
Rate for Payer: Aetna of IA Medical Rental Products	$3,768.43
Rate for Payer: Cash Price	$3,349.71
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,140.36
Rate for Payer: Medical Associates Commercial	$3,140.36
Rate for Payer: Midlands Choice Commercial	$2,931.00
Rate for Payer: United Healthcare Commercial	$3,768.43

benazepril 10 mg Tab [VDMC]

Facility

$2.51

Service Code	HCPCS A9270
Hospital Charge Code	10369735
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.26
Rate for Payer: Aetna of IA Commercial	$2.26
Rate for Payer: Aetna of IA Medical Rental Products	$2.26
Rate for Payer: Aetna of IA Medicare	$1.43
Rate for Payer: Amerigroup Medicaid	$1.45
Rate for Payer: Amerigroup Medicare	$1.14
Rate for Payer: Cash Price	$2.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.13
Rate for Payer: Iowa Total Care Managed Medicaid	$1.43
Rate for Payer: Medical Associates Commercial	$1.88
Rate for Payer: Medical Associates Managed Medicare	$1.13
Rate for Payer: Midlands Choice Commercial	$1.76
Rate for Payer: Molina Healthcare Managed Medicaid	$1.46
Rate for Payer: Partners Health Alliance Commercial	$1.30
Rate for Payer: United Healthcare Commercial	$2.26
Rate for Payer: United Healthcare Managed Medicare	$1.48

benazepril 10 mg Tab [VDMC]

Facility

$2.51

Service Code	HCPCS A9270
Hospital Charge Code	10369735
Hospital Revenue Code	259
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.26
Rate for Payer: Aetna of IA Commercial	$2.26
Rate for Payer: Aetna of IA Medical Rental Products	$2.26
Rate for Payer: Cash Price	$2.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.88
Rate for Payer: Medical Associates Commercial	$1.88
Rate for Payer: Midlands Choice Commercial	$1.76
Rate for Payer: United Healthcare Commercial	$2.26

benzocaine-menthol topical 15 mg-3.6 mg Loz [VDMC]

Facility

$1.70

Service Code	HCPCS A9270
Hospital Charge Code	10369942
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.53
Rate for Payer: Aetna of IA Commercial	$1.53
Rate for Payer: Aetna of IA Medical Rental Products	$1.53
Rate for Payer: Aetna of IA Medicare	$0.97
Rate for Payer: Amerigroup Medicaid	$0.98
Rate for Payer: Amerigroup Medicare	$0.77
Rate for Payer: Cash Price	$1.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.77
Rate for Payer: Iowa Total Care Managed Medicaid	$0.97
Rate for Payer: Medical Associates Commercial	$1.28
Rate for Payer: Medical Associates Managed Medicare	$0.77
Rate for Payer: Midlands Choice Commercial	$1.19
Rate for Payer: Molina Healthcare Managed Medicaid	$0.99
Rate for Payer: Partners Health Alliance Commercial	$0.88
Rate for Payer: United Healthcare Commercial	$1.53
Rate for Payer: United Healthcare Managed Medicare	$1.00

benzocaine-menthol topical 15 mg-3.6 mg Loz [VDMC]

Facility

$1.70

Service Code	HCPCS A9270
Hospital Charge Code	10369942
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.53
Rate for Payer: Aetna of IA Commercial	$1.53
Rate for Payer: Aetna of IA Medical Rental Products	$1.53
Rate for Payer: Cash Price	$1.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.28
Rate for Payer: Medical Associates Commercial	$1.28
Rate for Payer: Midlands Choice Commercial	$1.19
Rate for Payer: United Healthcare Commercial	$1.53

benzocaine Top 20% mucous membrane spray [VDMC]

Facility

$9.79

Service Code	NDC 00283-0679-02
Hospital Charge Code	10433282
Hospital Revenue Code	259
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna of IA Commercial	$8.81
Rate for Payer: Aetna of IA Medical Rental Products	$8.81
Rate for Payer: Cash Price	$7.83
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.34
Rate for Payer: Medical Associates Commercial	$7.34
Rate for Payer: Midlands Choice Commercial	$6.85
Rate for Payer: United Healthcare Commercial	$8.81

benzocaine Top 20% mucous membrane spray [VDMC]

Facility

$9.79

Service Code	NDC 00283-0679-02
Hospital Charge Code	10433282
Hospital Revenue Code	259
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna of IA Commercial	$8.81
Rate for Payer: Aetna of IA Medical Rental Products	$8.81
Rate for Payer: Aetna of IA Medicare	$5.58
Rate for Payer: Amerigroup Medicaid	$5.65
Rate for Payer: Amerigroup Medicare	$4.45
Rate for Payer: Cash Price	$7.83
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.34
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.40
Rate for Payer: Iowa Total Care Managed Medicaid	$5.59
Rate for Payer: Medical Associates Commercial	$7.34
Rate for Payer: Medical Associates Managed Medicare	$4.40
Rate for Payer: Midlands Choice Commercial	$6.85
Rate for Payer: Molina Healthcare Managed Medicaid	$5.67
Rate for Payer: Partners Health Alliance Commercial	$5.07
Rate for Payer: United Healthcare Commercial	$8.81
Rate for Payer: United Healthcare Managed Medicare	$5.78

benzocaine topical 20% Spray Unit Dose [VDMC]

Facility

$48.49

Service Code	NDC 00283-0610-26
Hospital Charge Code	15281292
Hospital Revenue Code	259
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$43.64
Rate for Payer: Aetna of IA Commercial	$43.64
Rate for Payer: Aetna of IA Medical Rental Products	$43.64
Rate for Payer: Aetna of IA Medicare	$27.64
Rate for Payer: Amerigroup Medicaid	$27.97
Rate for Payer: Amerigroup Medicare	$22.04
Rate for Payer: Cash Price	$38.79
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.37
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.82
Rate for Payer: Iowa Total Care Managed Medicaid	$27.70
Rate for Payer: Medical Associates Commercial	$36.37
Rate for Payer: Medical Associates Managed Medicare	$21.82
Rate for Payer: Midlands Choice Commercial	$33.94
Rate for Payer: Molina Healthcare Managed Medicaid	$28.11
Rate for Payer: Partners Health Alliance Commercial	$25.09
Rate for Payer: United Healthcare Commercial	$43.64
Rate for Payer: United Healthcare Managed Medicare	$28.61

benzocaine topical 20% Spray Unit Dose [VDMC]

Facility

$48.49

Service Code	NDC 00283-0610-26
Hospital Charge Code	15281292
Hospital Revenue Code	259
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$43.64
Rate for Payer: Aetna of IA Commercial	$43.64
Rate for Payer: Aetna of IA Medical Rental Products	$43.64
Rate for Payer: Cash Price	$38.79
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.37
Rate for Payer: Medical Associates Commercial	$36.37
Rate for Payer: Midlands Choice Commercial	$33.94
Rate for Payer: United Healthcare Commercial	$43.64

Benzoin Topical compound Tincture [VDMC]

Facility

$21.56

Service Code	HCPCS A9270
Hospital Charge Code	11222680
Hospital Revenue Code	259
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$19.40
Rate for Payer: Aetna of IA Commercial	$19.40
Rate for Payer: Aetna of IA Medical Rental Products	$19.40
Rate for Payer: Aetna of IA Medicare	$12.29
Rate for Payer: Amerigroup Medicaid	$12.44
Rate for Payer: Amerigroup Medicare	$9.80
Rate for Payer: Cash Price	$17.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.17
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.70
Rate for Payer: Iowa Total Care Managed Medicaid	$12.32
Rate for Payer: Medical Associates Commercial	$16.17
Rate for Payer: Medical Associates Managed Medicare	$9.70
Rate for Payer: Midlands Choice Commercial	$15.09
Rate for Payer: Molina Healthcare Managed Medicaid	$12.50
Rate for Payer: Partners Health Alliance Commercial	$11.16
Rate for Payer: United Healthcare Commercial	$19.40
Rate for Payer: United Healthcare Managed Medicare	$12.72

Benzoin Topical compound Tincture [VDMC]

Facility

$21.56

Service Code	HCPCS A9270
Hospital Charge Code	11222680
Hospital Revenue Code	259
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$19.40
Rate for Payer: Aetna of IA Commercial	$19.40
Rate for Payer: Aetna of IA Medical Rental Products	$19.40
Rate for Payer: Cash Price	$17.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.17
Rate for Payer: Medical Associates Commercial	$16.17
Rate for Payer: Midlands Choice Commercial	$15.09
Rate for Payer: United Healthcare Commercial	$19.40

benzonatate 100 mg Cap [VDMC]

Facility

$2.82

Service Code	HCPCS A9270
Hospital Charge Code	10370011
Hospital Revenue Code	259
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna of IA Commercial	$2.54
Rate for Payer: Aetna of IA Medical Rental Products	$2.54
Rate for Payer: Aetna of IA Medicare	$1.61
Rate for Payer: Amerigroup Medicaid	$1.63
Rate for Payer: Amerigroup Medicare	$1.28
Rate for Payer: Cash Price	$2.26
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.27
Rate for Payer: Iowa Total Care Managed Medicaid	$1.61
Rate for Payer: Medical Associates Commercial	$2.11
Rate for Payer: Medical Associates Managed Medicare	$1.27
Rate for Payer: Midlands Choice Commercial	$1.97
Rate for Payer: Molina Healthcare Managed Medicaid	$1.63
Rate for Payer: Partners Health Alliance Commercial	$1.46
Rate for Payer: United Healthcare Commercial	$2.54
Rate for Payer: United Healthcare Managed Medicare	$1.66

benzonatate 100 mg Cap [VDMC]

Facility

$2.82

Service Code	HCPCS A9270
Hospital Charge Code	10370011
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna of IA Commercial	$2.54
Rate for Payer: Aetna of IA Medical Rental Products	$2.54
Rate for Payer: Cash Price	$2.26
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.11
Rate for Payer: Medical Associates Commercial	$2.11
Rate for Payer: Midlands Choice Commercial	$1.97
Rate for Payer: United Healthcare Commercial	$2.54

benztropine 1 mg/mL 2ml Inj SDV Sol [VDMC]

Facility

$188.74

Service Code	HCPCS J0515
Hospital Charge Code	10370151
Hospital Revenue Code	259
Min. Negotiated Rate	$84.93
Max. Negotiated Rate	$169.87
Rate for Payer: Aetna of IA Commercial	$169.87
Rate for Payer: Aetna of IA Medical Rental Products	$169.87
Rate for Payer: Aetna of IA Medicare	$107.58
Rate for Payer: Amerigroup Medicaid	$108.87
Rate for Payer: Amerigroup Medicare	$85.78
Rate for Payer: Cash Price	$151.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$84.93
Rate for Payer: Iowa Total Care Managed Medicaid	$107.81
Rate for Payer: Medical Associates Commercial	$141.56
Rate for Payer: Medical Associates Managed Medicare	$84.93
Rate for Payer: Midlands Choice Commercial	$132.12
Rate for Payer: Molina Healthcare Managed Medicaid	$109.40
Rate for Payer: Partners Health Alliance Commercial	$97.68
Rate for Payer: United Healthcare Commercial	$169.87
Rate for Payer: United Healthcare Managed Medicare	$111.36

benztropine 1 mg/mL 2ml Inj SDV Sol [VDMC]

Facility

$188.74

Service Code	HCPCS J0515
Hospital Charge Code	10370151
Hospital Revenue Code	259
Min. Negotiated Rate	$132.12
Max. Negotiated Rate	$169.87
Rate for Payer: Aetna of IA Commercial	$169.87
Rate for Payer: Aetna of IA Medical Rental Products	$169.87
Rate for Payer: Cash Price	$151.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.56
Rate for Payer: Medical Associates Commercial	$141.56
Rate for Payer: Midlands Choice Commercial	$132.12
Rate for Payer: United Healthcare Commercial	$169.87

benztropine mesylate 1 mg Tab [VDMC]

Facility

$2.09

Service Code	HCPCS A9270
Hospital Charge Code	10370080
Hospital Revenue Code	259
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of IA Commercial	$1.88
Rate for Payer: Aetna of IA Medical Rental Products	$1.88
Rate for Payer: Cash Price	$1.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.56
Rate for Payer: Medical Associates Commercial	$1.56
Rate for Payer: Midlands Choice Commercial	$1.46
Rate for Payer: United Healthcare Commercial	$1.88

benztropine mesylate 1 mg Tab [VDMC]

Facility

$2.09

Service Code	HCPCS A9270
Hospital Charge Code	10370080
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of IA Commercial	$1.88
Rate for Payer: Aetna of IA Medical Rental Products	$1.88
Rate for Payer: Aetna of IA Medicare	$1.19
Rate for Payer: Amerigroup Medicaid	$1.20
Rate for Payer: Amerigroup Medicare	$0.95
Rate for Payer: Cash Price	$1.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.56
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.94
Rate for Payer: Iowa Total Care Managed Medicaid	$1.19
Rate for Payer: Medical Associates Commercial	$1.56
Rate for Payer: Medical Associates Managed Medicare	$0.94
Rate for Payer: Midlands Choice Commercial	$1.46
Rate for Payer: Molina Healthcare Managed Medicaid	$1.21
Rate for Payer: Partners Health Alliance Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.88
Rate for Payer: United Healthcare Managed Medicare	$1.23

Beta 2 Glyco Cardio Ab DMCL

Facility

$157.00

Service Code	CPT 86146
Hospital Charge Code	8037501
Hospital Revenue Code	302
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Aetna of IA Medicare	$89.49
Rate for Payer: Amerigroup Medicaid	$90.56
Rate for Payer: Amerigroup Medicare	$71.36
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$70.65
Rate for Payer: Iowa Total Care Managed Medicaid	$89.68
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Medical Associates Managed Medicare	$70.65
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: Molina Healthcare Managed Medicaid	$91.00
Rate for Payer: Partners Health Alliance Commercial	$81.25
Rate for Payer: United Healthcare Commercial	$141.30
Rate for Payer: United Healthcare Managed Medicare	$92.63

Beta 2 Glyco Cardio Ab DMCL

Facility

$157.00

Service Code	CPT 86146
Hospital Charge Code	8037501
Hospital Revenue Code	302
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: United Healthcare Commercial	$141.30

BETA 2 GLYCOPROTIEN

Facility

$157.00

Service Code	CPT 86146
Hospital Charge Code	8093927
Hospital Revenue Code	302
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Aetna of IA Medicare	$89.49
Rate for Payer: Amerigroup Medicaid	$90.56
Rate for Payer: Amerigroup Medicare	$71.36
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$70.65
Rate for Payer: Iowa Total Care Managed Medicaid	$89.68
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Medical Associates Managed Medicare	$70.65
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: Molina Healthcare Managed Medicaid	$91.00
Rate for Payer: Partners Health Alliance Commercial	$81.25
Rate for Payer: United Healthcare Commercial	$141.30
Rate for Payer: United Healthcare Managed Medicare	$92.63

BETA 2 GLYCOPROTIEN

Facility

$157.00

Service Code	CPT 86146
Hospital Charge Code	8093927
Hospital Revenue Code	302
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$141.30
Rate for Payer: Aetna of IA Commercial	$141.30
Rate for Payer: Aetna of IA Medical Rental Products	$141.30
Rate for Payer: Cash Price	$125.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$117.75
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: United Healthcare Commercial	$141.30

Beta 2 Microglobulin DMCL

Facility

$135.00

Service Code	CPT 82232
Hospital Charge Code	8037502
Hospital Revenue Code	301
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Beta 2 Microglobulin DMCL

Facility

$135.00

Service Code	CPT 82232
Hospital Charge Code	8037502
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

BETA HCG

Facility

$143.00

Service Code	CPT 84702
Hospital Charge Code	4017122
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of IA Commercial	$128.70
Rate for Payer: Aetna of IA Medical Rental Products	$128.70
Rate for Payer: Aetna of IA Medicare	$81.51
Rate for Payer: Amerigroup Medicaid	$82.48
Rate for Payer: Amerigroup Medicare	$64.99
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$107.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$64.35
Rate for Payer: Iowa Total Care Managed Medicaid	$81.68
Rate for Payer: Medical Associates Commercial	$107.25
Rate for Payer: Medical Associates Managed Medicare	$64.35
Rate for Payer: Midlands Choice Commercial	$100.10
Rate for Payer: Molina Healthcare Managed Medicaid	$82.88
Rate for Payer: Partners Health Alliance Commercial	$74.00
Rate for Payer: United Healthcare Commercial	$128.70
Rate for Payer: United Healthcare Managed Medicare	$84.37

BETA HCG

Facility

$143.00

Service Code	CPT 84702
Hospital Charge Code	4017122
Hospital Revenue Code	301
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of IA Commercial	$128.70
Rate for Payer: Aetna of IA Medical Rental Products	$128.70
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$107.25
Rate for Payer: Medical Associates Commercial	$107.25
Rate for Payer: Midlands Choice Commercial	$100.10
Rate for Payer: United Healthcare Commercial	$128.70

Know your out-of-pocket cost for care.

All Charges