Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

E4713 Thawed Aph FFP ACDA 1

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	6702792
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E4717 Thawed Aph FFP ACDA 2

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	6702787
Hospital Revenue Code	390
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$113.05
Rate for Payer: Amerigroup Medicare	$89.08
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.20
Rate for Payer: Iowa Total Care Managed Medicaid	$111.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$88.20
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$113.60
Rate for Payer: Partners Health Alliance Commercial	$101.43
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64

E4717 Thawed Aph FFP ACDA 2

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	6702787
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E4721 Thawed Aph FFP ACDA 3

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	6702800
Hospital Revenue Code	390
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$113.05
Rate for Payer: Amerigroup Medicare	$89.08
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.20
Rate for Payer: Iowa Total Care Managed Medicaid	$111.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$88.20
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$113.60
Rate for Payer: Partners Health Alliance Commercial	$101.43
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64

E4721 Thawed Aph FFP ACDA 3

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	6702800
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5548 Thawed Aph Plasma ACDA <24h 1

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	8072797
Hospital Revenue Code	390
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$113.05
Rate for Payer: Amerigroup Medicare	$89.08
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.20
Rate for Payer: Iowa Total Care Managed Medicaid	$111.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$88.20
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$113.60
Rate for Payer: Partners Health Alliance Commercial	$101.43
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64

E5548 Thawed Aph Plasma ACDA <24h 1

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	8072797
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5549 Thawed Aph Plasma ACDA <24h 2

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	8405423
Hospital Revenue Code	390
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: United Healthcare Commercial	$176.40

E5549 Thawed Aph Plasma ACDA <24h 2

Facility

$196.00

Service Code	HCPCS P9017
Hospital Charge Code	8405423
Hospital Revenue Code	390
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of IA Commercial	$176.40
Rate for Payer: Aetna of IA Medical Rental Products	$176.40
Rate for Payer: Aetna of IA Medicare	$111.72
Rate for Payer: Amerigroup Medicaid	$113.05
Rate for Payer: Amerigroup Medicare	$89.08
Rate for Payer: Cash Price	$156.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.20
Rate for Payer: Iowa Total Care Managed Medicaid	$111.96
Rate for Payer: Medical Associates Commercial	$147.00
Rate for Payer: Medical Associates Managed Medicare	$88.20
Rate for Payer: Midlands Choice Commercial	$137.20
Rate for Payer: Molina Healthcare Managed Medicaid	$113.60
Rate for Payer: Partners Health Alliance Commercial	$101.43
Rate for Payer: United Healthcare Commercial	$176.40
Rate for Payer: United Healthcare Managed Medicare	$115.64

E5709 Pooled Plt CP2D LR Irr

Facility

$881.00

Service Code	HCPCS P9037
Hospital Charge Code	6702807
Hospital Revenue Code	390
Min. Negotiated Rate	$396.45
Max. Negotiated Rate	$792.90
Rate for Payer: Aetna of IA Commercial	$792.90
Rate for Payer: Aetna of IA Medical Rental Products	$792.90
Rate for Payer: Aetna of IA Medicare	$502.17
Rate for Payer: Amerigroup Medicaid	$508.16
Rate for Payer: Amerigroup Medicare	$400.41
Rate for Payer: Cash Price	$704.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$660.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$396.45
Rate for Payer: Iowa Total Care Managed Medicaid	$503.23
Rate for Payer: Medical Associates Commercial	$660.75
Rate for Payer: Medical Associates Managed Medicare	$396.45
Rate for Payer: Midlands Choice Commercial	$616.70
Rate for Payer: Molina Healthcare Managed Medicaid	$510.63
Rate for Payer: Partners Health Alliance Commercial	$455.92
Rate for Payer: United Healthcare Commercial	$792.90
Rate for Payer: United Healthcare Managed Medicare	$519.79

E5709 Pooled Plt CP2D LR Irr

Facility

$881.00

Service Code	HCPCS P9037
Hospital Charge Code	6702807
Hospital Revenue Code	390
Min. Negotiated Rate	$616.70
Max. Negotiated Rate	$792.90
Rate for Payer: Aetna of IA Commercial	$792.90
Rate for Payer: Aetna of IA Medical Rental Products	$792.90
Rate for Payer: Cash Price	$704.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$660.75
Rate for Payer: Medical Associates Commercial	$660.75
Rate for Payer: Midlands Choice Commercial	$616.70
Rate for Payer: United Healthcare Commercial	$792.90

E5710 Pooled Plt CP2D LR

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	6702815
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E5710 Pooled Plt CP2D LR

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	6702815
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9228 Aph Plt ACDA LR BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758106
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9228 Aph Plt ACDA LR BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758106
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E9229 Aph Plt ACDA LR 1 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758121
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E9229 Aph Plt ACDA LR 1 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758121
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9230 Aph Plt ACDA LR 2 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758126
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E9230 Aph Plt ACDA LR 2 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758126
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9231 Aph Plt ACDA LR 3 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758116
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9231 Aph Plt ACDA LR 3 BTD5

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758116
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E9232 Aph Plt ACDA LR BTD6

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758111
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9232 Aph Plt ACDA LR BTD6

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758111
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

E9233 Aph Plt ACDA LR 1 BTD6

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758104
Hospital Revenue Code	390
Min. Negotiated Rate	$681.80
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: United Healthcare Commercial	$876.60

E9233 Aph Plt ACDA LR 1 BTD6

Facility

$974.00

Service Code	HCPCS P9035
Hospital Charge Code	8758104
Hospital Revenue Code	390
Min. Negotiated Rate	$438.30
Max. Negotiated Rate	$876.60
Rate for Payer: Aetna of IA Commercial	$876.60
Rate for Payer: Aetna of IA Medical Rental Products	$876.60
Rate for Payer: Aetna of IA Medicare	$555.18
Rate for Payer: Amerigroup Medicaid	$561.80
Rate for Payer: Amerigroup Medicare	$442.68
Rate for Payer: Cash Price	$779.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$730.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$438.30
Rate for Payer: Iowa Total Care Managed Medicaid	$556.35
Rate for Payer: Medical Associates Commercial	$730.50
Rate for Payer: Medical Associates Managed Medicare	$438.30
Rate for Payer: Midlands Choice Commercial	$681.80
Rate for Payer: Molina Healthcare Managed Medicaid	$564.53
Rate for Payer: Partners Health Alliance Commercial	$504.05
Rate for Payer: United Healthcare Commercial	$876.60
Rate for Payer: United Healthcare Managed Medicare	$574.66

Know your out-of-pocket cost for care.

All Charges