Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Carbamazepine Level DMCL

Facility

$99.00

Service Code	CPT 80156
Hospital Charge Code	8037508
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: United Healthcare Commercial	$89.10

Carbamazepine Level DMCL

Facility

$99.00

Service Code	CPT 80156
Hospital Charge Code	8037508
Hospital Revenue Code	301
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Aetna of IA Medicare	$56.43
Rate for Payer: Amerigroup Medicaid	$57.10
Rate for Payer: Amerigroup Medicare	$45.00
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$44.55
Rate for Payer: Iowa Total Care Managed Medicaid	$56.55
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Medical Associates Managed Medicare	$44.55
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: Molina Healthcare Managed Medicaid	$57.38
Rate for Payer: Partners Health Alliance Commercial	$51.23
Rate for Payer: United Healthcare Commercial	$89.10
Rate for Payer: United Healthcare Managed Medicare	$58.41

carbamide peroxide Otic 6.5% Sol [VDMC]

Facility

$19.64

Service Code	HCPCS A9270
Hospital Charge Code	10433737
Hospital Revenue Code	259
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$17.68
Rate for Payer: Aetna of IA Commercial	$17.68
Rate for Payer: Aetna of IA Medical Rental Products	$17.68
Rate for Payer: Aetna of IA Medicare	$11.19
Rate for Payer: Amerigroup Medicaid	$11.33
Rate for Payer: Amerigroup Medicare	$8.93
Rate for Payer: Cash Price	$15.71
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.84
Rate for Payer: Iowa Total Care Managed Medicaid	$11.22
Rate for Payer: Medical Associates Commercial	$14.73
Rate for Payer: Medical Associates Managed Medicare	$8.84
Rate for Payer: Midlands Choice Commercial	$13.75
Rate for Payer: Molina Healthcare Managed Medicaid	$11.38
Rate for Payer: Partners Health Alliance Commercial	$10.16
Rate for Payer: United Healthcare Commercial	$17.68
Rate for Payer: United Healthcare Managed Medicare	$11.59

carbamide peroxide Otic 6.5% Sol [VDMC]

Facility

$19.64

Service Code	HCPCS A9270
Hospital Charge Code	10433737
Hospital Revenue Code	259
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$17.68
Rate for Payer: Aetna of IA Commercial	$17.68
Rate for Payer: Aetna of IA Medical Rental Products	$17.68
Rate for Payer: Cash Price	$15.71
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.73
Rate for Payer: Medical Associates Commercial	$14.73
Rate for Payer: Midlands Choice Commercial	$13.75
Rate for Payer: United Healthcare Commercial	$17.68

carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [VDMC]

Facility

$3.76

Service Code	HCPCS A9270
Hospital Charge Code	10374064
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna of IA Commercial	$3.38
Rate for Payer: Aetna of IA Medical Rental Products	$3.38
Rate for Payer: Aetna of IA Medicare	$2.14
Rate for Payer: Amerigroup Medicaid	$2.17
Rate for Payer: Amerigroup Medicare	$1.71
Rate for Payer: Cash Price	$3.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.82
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.69
Rate for Payer: Iowa Total Care Managed Medicaid	$2.15
Rate for Payer: Medical Associates Commercial	$2.82
Rate for Payer: Medical Associates Managed Medicare	$1.69
Rate for Payer: Midlands Choice Commercial	$2.63
Rate for Payer: Molina Healthcare Managed Medicaid	$2.18
Rate for Payer: Partners Health Alliance Commercial	$1.95
Rate for Payer: United Healthcare Commercial	$3.38
Rate for Payer: United Healthcare Managed Medicare	$2.22

carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [VDMC]

Facility

$3.76

Service Code	HCPCS A9270
Hospital Charge Code	10374064
Hospital Revenue Code	259
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna of IA Commercial	$3.38
Rate for Payer: Aetna of IA Medical Rental Products	$3.38
Rate for Payer: Cash Price	$3.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.82
Rate for Payer: Medical Associates Commercial	$2.82
Rate for Payer: Midlands Choice Commercial	$2.63
Rate for Payer: United Healthcare Commercial	$3.38

carbidopa-levodopa 10 mg-100 mg Tab [VDMC]

Facility

$1.58

Service Code	HCPCS A9270
Hospital Charge Code	10374133
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of IA Commercial	$1.42
Rate for Payer: Aetna of IA Medical Rental Products	$1.42
Rate for Payer: Aetna of IA Medicare	$0.90
Rate for Payer: Amerigroup Medicaid	$0.91
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.71
Rate for Payer: Iowa Total Care Managed Medicaid	$0.90
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Medical Associates Managed Medicare	$0.71
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: Molina Healthcare Managed Medicaid	$0.92
Rate for Payer: Partners Health Alliance Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$1.42
Rate for Payer: United Healthcare Managed Medicare	$0.93

carbidopa-levodopa 10 mg-100 mg Tab [VDMC]

Facility

$1.58

Service Code	HCPCS A9270
Hospital Charge Code	10374133
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of IA Commercial	$1.42
Rate for Payer: Aetna of IA Medical Rental Products	$1.42
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.19
Rate for Payer: Medical Associates Commercial	$1.19
Rate for Payer: Midlands Choice Commercial	$1.11
Rate for Payer: United Healthcare Commercial	$1.42

carbidopa-levodopa 25 mg-100 mg ER Tab [VDMC]

Facility

$2.02

Service Code	HCPCS A9270
Hospital Charge Code	10374202
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.81
Rate for Payer: Aetna of IA Commercial	$1.81
Rate for Payer: Aetna of IA Medical Rental Products	$1.81
Rate for Payer: Cash Price	$1.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.51
Rate for Payer: Medical Associates Commercial	$1.51
Rate for Payer: Midlands Choice Commercial	$1.41
Rate for Payer: United Healthcare Commercial	$1.81

carbidopa-levodopa 25 mg-100 mg ER Tab [VDMC]

Facility

$2.02

Service Code	HCPCS A9270
Hospital Charge Code	10374202
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.81
Rate for Payer: Aetna of IA Commercial	$1.81
Rate for Payer: Aetna of IA Medical Rental Products	$1.81
Rate for Payer: Aetna of IA Medicare	$1.15
Rate for Payer: Amerigroup Medicaid	$1.16
Rate for Payer: Amerigroup Medicare	$0.92
Rate for Payer: Cash Price	$1.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.51
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.91
Rate for Payer: Iowa Total Care Managed Medicaid	$1.15
Rate for Payer: Medical Associates Commercial	$1.51
Rate for Payer: Medical Associates Managed Medicare	$0.91
Rate for Payer: Midlands Choice Commercial	$1.41
Rate for Payer: Molina Healthcare Managed Medicaid	$1.17
Rate for Payer: Partners Health Alliance Commercial	$1.04
Rate for Payer: United Healthcare Commercial	$1.81
Rate for Payer: United Healthcare Managed Medicare	$1.19

carbidopa-levodopa 25 mg-100 mg Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10374273
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Aetna of IA Medicare	$0.93
Rate for Payer: Amerigroup Medicaid	$0.94
Rate for Payer: Amerigroup Medicare	$0.74
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.23
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.74
Rate for Payer: Iowa Total Care Managed Medicaid	$0.93
Rate for Payer: Medical Associates Commercial	$1.23
Rate for Payer: Medical Associates Managed Medicare	$0.74
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: Molina Healthcare Managed Medicaid	$0.95
Rate for Payer: Partners Health Alliance Commercial	$0.85
Rate for Payer: United Healthcare Commercial	$1.47
Rate for Payer: United Healthcare Managed Medicare	$0.96

carbidopa-levodopa 25 mg-100 mg Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10374273
Hospital Revenue Code	259
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.23
Rate for Payer: Medical Associates Commercial	$1.23
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: United Healthcare Commercial	$1.47

carbidopa-levodopa 25 mg-250 mg Tab [VDMC]

Facility

$1.80

Service Code	HCPCS A9270
Hospital Charge Code	10374344
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna of IA Commercial	$1.62
Rate for Payer: Aetna of IA Medical Rental Products	$1.62
Rate for Payer: Cash Price	$1.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.35
Rate for Payer: Medical Associates Commercial	$1.35
Rate for Payer: Midlands Choice Commercial	$1.26
Rate for Payer: United Healthcare Commercial	$1.62

carbidopa-levodopa 25 mg-250 mg Tab [VDMC]

Facility

$1.80

Service Code	HCPCS A9270
Hospital Charge Code	10374344
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna of IA Commercial	$1.62
Rate for Payer: Aetna of IA Medical Rental Products	$1.62
Rate for Payer: Aetna of IA Medicare	$1.03
Rate for Payer: Amerigroup Medicaid	$1.04
Rate for Payer: Amerigroup Medicare	$0.82
Rate for Payer: Cash Price	$1.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.35
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.81
Rate for Payer: Iowa Total Care Managed Medicaid	$1.03
Rate for Payer: Medical Associates Commercial	$1.35
Rate for Payer: Medical Associates Managed Medicare	$0.81
Rate for Payer: Midlands Choice Commercial	$1.26
Rate for Payer: Molina Healthcare Managed Medicaid	$1.04
Rate for Payer: Partners Health Alliance Commercial	$0.93
Rate for Payer: United Healthcare Commercial	$1.62
Rate for Payer: United Healthcare Managed Medicare	$1.06

CARBON DIOXIDE LEVEL

Facility

$44.00

Service Code	CPT 82374
Hospital Charge Code	1628888
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Aetna of IA Medicare	$25.08
Rate for Payer: Amerigroup Medicaid	$25.38
Rate for Payer: Amerigroup Medicare	$20.00
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$19.80
Rate for Payer: Iowa Total Care Managed Medicaid	$25.13
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Medical Associates Managed Medicare	$19.80
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: Molina Healthcare Managed Medicaid	$25.50
Rate for Payer: Partners Health Alliance Commercial	$22.77
Rate for Payer: United Healthcare Commercial	$39.60
Rate for Payer: United Healthcare Managed Medicare	$25.96

CARBON DIOXIDE LEVEL

Facility

$44.00

Service Code	CPT 82374
Hospital Charge Code	1628888
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: United Healthcare Commercial	$39.60

CARBOXYHEMOGLOBIN

Facility

$117.00

Service Code	CPT 82375
Hospital Charge Code	7928765
Hospital Revenue Code	301
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: United Healthcare Commercial	$105.30

CARBOXYHEMOGLOBIN

Facility

$117.00

Service Code	CPT 82375
Hospital Charge Code	7928765
Hospital Revenue Code	301
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Aetna of IA Medicare	$66.69
Rate for Payer: Amerigroup Medicaid	$67.49
Rate for Payer: Amerigroup Medicare	$53.18
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.65
Rate for Payer: Iowa Total Care Managed Medicaid	$66.83
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Medical Associates Managed Medicare	$52.65
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: Molina Healthcare Managed Medicaid	$67.81
Rate for Payer: Partners Health Alliance Commercial	$60.55
Rate for Payer: United Healthcare Commercial	$105.30
Rate for Payer: United Healthcare Managed Medicare	$69.03

Carboxyhemoglobin Venous

Facility

$117.00

Service Code	CPT 82375
Hospital Charge Code	8208908
Hospital Revenue Code	301
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: United Healthcare Commercial	$105.30

Carboxyhemoglobin Venous

Facility

$117.00

Service Code	CPT 82375
Hospital Charge Code	8208908
Hospital Revenue Code	301
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Aetna of IA Medicare	$66.69
Rate for Payer: Amerigroup Medicaid	$67.49
Rate for Payer: Amerigroup Medicare	$53.18
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.65
Rate for Payer: Iowa Total Care Managed Medicaid	$66.83
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Medical Associates Managed Medicare	$52.65
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: Molina Healthcare Managed Medicaid	$67.81
Rate for Payer: Partners Health Alliance Commercial	$60.55
Rate for Payer: United Healthcare Commercial	$105.30
Rate for Payer: United Healthcare Managed Medicare	$69.03

Carcinoembryonic Antigen DMCL

Facility

$129.00

Service Code	CPT 82378
Hospital Charge Code	8037509
Hospital Revenue Code	301
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11

Carcinoembryonic Antigen DMCL

Facility

$129.00

Service Code	CPT 82378
Hospital Charge Code	8037509
Hospital Revenue Code	301
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

CARDIAC REHAB PHASE III

Facility

$5.00

Hospital Charge Code	5684784
Hospital Revenue Code	943
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of IA Commercial	$4.50
Rate for Payer: Aetna of IA Medical Rental Products	$4.50
Rate for Payer: Aetna of IA Medicare	$2.85
Rate for Payer: Amerigroup Medicaid	$2.88
Rate for Payer: Amerigroup Medicare	$2.27
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2.86
Rate for Payer: Medical Associates Commercial	$3.75
Rate for Payer: Medical Associates Managed Medicare	$2.25
Rate for Payer: Midlands Choice Commercial	$3.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2.90
Rate for Payer: Partners Health Alliance Commercial	$2.59
Rate for Payer: United Healthcare Commercial	$4.50
Rate for Payer: United Healthcare Managed Medicare	$2.95

CARDIAC REHAB PHASE III

Facility

$5.00

Hospital Charge Code	5684784
Hospital Revenue Code	943
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of IA Commercial	$4.50
Rate for Payer: Aetna of IA Medical Rental Products	$4.50
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.75
Rate for Payer: Medical Associates Commercial	$3.75
Rate for Payer: Midlands Choice Commercial	$3.50
Rate for Payer: United Healthcare Commercial	$4.50

CARDIOLOGY

Facility

$1,338.00

Service Code	CPT 93306
Hospital Charge Code	8300852
Hospital Revenue Code	480
Min. Negotiated Rate	$602.10
Max. Negotiated Rate	$1,204.20
Rate for Payer: Aetna of IA Commercial	$1,204.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,204.20
Rate for Payer: Aetna of IA Medicare	$762.66
Rate for Payer: Amerigroup Medicaid	$771.76
Rate for Payer: Amerigroup Medicare	$608.12
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,003.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$602.10
Rate for Payer: Iowa Total Care Managed Medicaid	$764.27
Rate for Payer: Medical Associates Commercial	$1,003.50
Rate for Payer: Medical Associates Managed Medicare	$602.10
Rate for Payer: Midlands Choice Commercial	$936.60
Rate for Payer: Molina Healthcare Managed Medicaid	$775.50
Rate for Payer: Partners Health Alliance Commercial	$692.41
Rate for Payer: United Healthcare Commercial	$1,204.20
Rate for Payer: United Healthcare Managed Medicare	$789.42

Know your out-of-pocket cost for care.

All Charges