Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

CT Wrist w/o Contrast Left

Facility

$1,121.00

Service Code	CPT 73200 LT
Hospital Charge Code	1168341
Hospital Revenue Code	350
Min. Negotiated Rate	$784.70
Max. Negotiated Rate	$1,008.90
Rate for Payer: Aetna of IA Commercial	$1,008.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,008.90
Rate for Payer: Cash Price	$896.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$840.75
Rate for Payer: Medical Associates Commercial	$840.75
Rate for Payer: Midlands Choice Commercial	$784.70
Rate for Payer: United Healthcare Commercial	$1,008.90

CT Wrist w/o Contrast Right

Facility

$1,121.00

Service Code	CPT 73200 RT
Hospital Charge Code	1168343
Hospital Revenue Code	350
Min. Negotiated Rate	$784.70
Max. Negotiated Rate	$1,008.90
Rate for Payer: Aetna of IA Commercial	$1,008.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,008.90
Rate for Payer: Cash Price	$896.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$840.75
Rate for Payer: Medical Associates Commercial	$840.75
Rate for Payer: Midlands Choice Commercial	$784.70
Rate for Payer: United Healthcare Commercial	$1,008.90

CT Wrist w/o Contrast Right

Facility

$1,121.00

Service Code	CPT 73200 RT
Hospital Charge Code	1168343
Hospital Revenue Code	350
Min. Negotiated Rate	$312.67
Max. Negotiated Rate	$1,008.90
Rate for Payer: Aetna of IA Commercial	$1,008.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,008.90
Rate for Payer: Aetna of IA Medicare	$638.97
Rate for Payer: Amerigroup Medicaid	$646.59
Rate for Payer: Amerigroup Medicare	$509.49
Rate for Payer: Cash Price	$896.80
Rate for Payer: Cash Price	$896.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$840.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$504.45
Rate for Payer: Iowa Total Care Managed Medicaid	$640.32
Rate for Payer: Medical Associates Commercial	$840.75
Rate for Payer: Medical Associates Managed Medicare	$504.45
Rate for Payer: Midlands Choice Commercial	$784.70
Rate for Payer: Molina Healthcare Managed Medicaid	$649.73
Rate for Payer: Partners Health Alliance Commercial	$580.12
Rate for Payer: United Healthcare Commercial	$1,008.90
Rate for Payer: United Healthcare Managed Medicare	$661.39
Rate for Payer: Wellmark IA HMO WHPI	$312.67
Rate for Payer: Wellmark IA PPO	$344.42

CT Wrist w/ + w/o Contrast Left

Facility

$1,321.00

Service Code	CPT 73202 LT
Hospital Charge Code	1168329
Hospital Revenue Code	352
Min. Negotiated Rate	$594.45
Max. Negotiated Rate	$1,188.90
Rate for Payer: Aetna of IA Commercial	$1,188.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,188.90
Rate for Payer: Aetna of IA Medicare	$752.97
Rate for Payer: Amerigroup Medicaid	$761.95
Rate for Payer: Amerigroup Medicare	$600.39
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$990.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$594.45
Rate for Payer: Iowa Total Care Managed Medicaid	$754.56
Rate for Payer: Medical Associates Commercial	$990.75
Rate for Payer: Medical Associates Managed Medicare	$594.45
Rate for Payer: Midlands Choice Commercial	$924.70
Rate for Payer: Molina Healthcare Managed Medicaid	$765.65
Rate for Payer: Partners Health Alliance Commercial	$683.62
Rate for Payer: United Healthcare Commercial	$1,188.90
Rate for Payer: United Healthcare Managed Medicare	$779.39
Rate for Payer: Wellmark IA HMO WHPI	$832.37
Rate for Payer: Wellmark IA PPO	$916.89

CT Wrist w/ + w/o Contrast Left

Facility

$1,321.00

Service Code	CPT 73202 LT
Hospital Charge Code	1168329
Hospital Revenue Code	352
Min. Negotiated Rate	$924.70
Max. Negotiated Rate	$1,188.90
Rate for Payer: Aetna of IA Commercial	$1,188.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,188.90
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$990.75
Rate for Payer: Medical Associates Commercial	$990.75
Rate for Payer: Midlands Choice Commercial	$924.70
Rate for Payer: United Healthcare Commercial	$1,188.90

CT Wrist w/ + w/o Contrast Right

Facility

$1,321.00

Service Code	CPT 73202 RT
Hospital Charge Code	1168331
Hospital Revenue Code	352
Min. Negotiated Rate	$924.70
Max. Negotiated Rate	$1,188.90
Rate for Payer: Aetna of IA Commercial	$1,188.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,188.90
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$990.75
Rate for Payer: Medical Associates Commercial	$990.75
Rate for Payer: Midlands Choice Commercial	$924.70
Rate for Payer: United Healthcare Commercial	$1,188.90

CT Wrist w/ + w/o Contrast Right

Facility

$1,321.00

Service Code	CPT 73202 RT
Hospital Charge Code	1168331
Hospital Revenue Code	352
Min. Negotiated Rate	$594.45
Max. Negotiated Rate	$1,188.90
Rate for Payer: Aetna of IA Commercial	$1,188.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,188.90
Rate for Payer: Aetna of IA Medicare	$752.97
Rate for Payer: Amerigroup Medicaid	$761.95
Rate for Payer: Amerigroup Medicare	$600.39
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Cash Price	$1,056.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$990.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$594.45
Rate for Payer: Iowa Total Care Managed Medicaid	$754.56
Rate for Payer: Medical Associates Commercial	$990.75
Rate for Payer: Medical Associates Managed Medicare	$594.45
Rate for Payer: Midlands Choice Commercial	$924.70
Rate for Payer: Molina Healthcare Managed Medicaid	$765.65
Rate for Payer: Partners Health Alliance Commercial	$683.62
Rate for Payer: United Healthcare Commercial	$1,188.90
Rate for Payer: United Healthcare Managed Medicare	$779.39
Rate for Payer: Wellmark IA HMO WHPI	$832.37
Rate for Payer: Wellmark IA PPO	$916.89

Culture AFB DMCL

Facility

$100.00

Service Code	CPT 87116
Hospital Charge Code	8735093
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

Culture AFB DMCL

Facility

$100.00

Service Code	CPT 87116
Hospital Charge Code	8735093
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE ANAEROBIC

Facility

$48.00

Service Code	CPT 87075
Hospital Charge Code	633881
Hospital Revenue Code	306
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

CULTURE ANAEROBIC

Facility

$48.00

Service Code	CPT 87075
Hospital Charge Code	633881
Hospital Revenue Code	306
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	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE BLOOD

Facility

$107.00

Service Code	CPT 87040
Hospital Charge Code	633882
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of IA Commercial	$96.30
Rate for Payer: Aetna of IA Medical Rental Products	$96.30
Rate for Payer: Aetna of IA Medicare	$60.99
Rate for Payer: Amerigroup Medicaid	$61.72
Rate for Payer: Amerigroup Medicare	$48.63
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$48.15
Rate for Payer: Iowa Total Care Managed Medicaid	$61.12
Rate for Payer: Medical Associates Commercial	$80.25
Rate for Payer: Medical Associates Managed Medicare	$48.15
Rate for Payer: Midlands Choice Commercial	$74.90
Rate for Payer: Molina Healthcare Managed Medicaid	$62.02
Rate for Payer: Partners Health Alliance Commercial	$55.37
Rate for Payer: United Healthcare Commercial	$96.30
Rate for Payer: United Healthcare Managed Medicare	$63.13
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE BLOOD

Facility

$107.00

Service Code	CPT 87040
Hospital Charge Code	633882
Hospital Revenue Code	306
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of IA Commercial	$96.30
Rate for Payer: Aetna of IA Medical Rental Products	$96.30
Rate for Payer: Cash Price	$85.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$80.25
Rate for Payer: Medical Associates Commercial	$80.25
Rate for Payer: Midlands Choice Commercial	$74.90
Rate for Payer: United Healthcare Commercial	$96.30

Culture Fungal DMCL

Facility

$56.00

Service Code	CPT 87102
Hospital Charge Code	8735096
Hospital Revenue Code	306
Min. Negotiated Rate	$25.20
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: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
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	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

Culture Fungal DMCL

Facility

$56.00

Service Code	CPT 87102
Hospital Charge Code	8040999
Hospital Revenue Code	306
Min. Negotiated Rate	$25.20
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: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
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	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

Culture Fungal DMCL

Facility

$56.00

Service Code	CPT 87102
Hospital Charge Code	8040999
Hospital Revenue Code	306
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

Culture Fungal DMCL

Facility

$56.00

Service Code	CPT 87102
Hospital Charge Code	8735096
Hospital Revenue Code	306
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

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633890
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633883
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633886
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	7902907
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633892
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	7902907
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633886
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CULTURE OTHER

Facility

$100.00

Service Code	CPT 87070
Hospital Charge Code	633883
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

Know your out-of-pocket cost for care.

All Charges