Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

HIP FEMORAL HEAD 32MM

Facility

$1,510.00

Service Code	HCPCS C1776
Hospital Charge Code	8025900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.00
Max. Negotiated Rate	$1,359.00
Rate for Payer: Aetna of IA Commercial	$1,359.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,359.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,132.50
Rate for Payer: Medical Associates Commercial	$1,132.50
Rate for Payer: Midlands Choice Commercial	$1,057.00
Rate for Payer: United Healthcare Commercial	$1,359.00

HIP REPLACEMENT

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.25
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Aetna of IA Medicare	$2,248.65
Rate for Payer: Amerigroup Medicaid	$2,275.48
Rate for Payer: Amerigroup Medicare	$1,793.00
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,775.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2,253.38
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Medical Associates Managed Medicare	$1,775.25
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2,286.52
Rate for Payer: Partners Health Alliance Commercial	$2,041.54
Rate for Payer: United Healthcare Commercial	$3,550.50
Rate for Payer: United Healthcare Managed Medicare	$2,327.55

HIP REPLACEMENT

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046928
Hospital Revenue Code	278
Min. Negotiated Rate	$2,761.50
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: United Healthcare Commercial	$3,550.50

HIP REPLACEMENT INSERT 32MM 0 POLYETHYL

Facility

$3,739.00

Service Code	HCPCS L8699
Hospital Charge Code	8046922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,617.30
Max. Negotiated Rate	$3,365.10
Rate for Payer: Aetna of IA Commercial	$3,365.10
Rate for Payer: Aetna of IA Medical Rental Products	$3,365.10
Rate for Payer: Cash Price	$2,991.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,804.25
Rate for Payer: Medical Associates Commercial	$2,804.25
Rate for Payer: Midlands Choice Commercial	$2,617.30
Rate for Payer: United Healthcare Commercial	$3,365.10

HIP REPLACEMENT INSERT 32MM 0 POLYETHYL

Facility

$3,739.00

Service Code	HCPCS L8699
Hospital Charge Code	8046922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,682.55
Max. Negotiated Rate	$3,365.10
Rate for Payer: Aetna of IA Commercial	$3,365.10
Rate for Payer: Aetna of IA Medical Rental Products	$3,365.10
Rate for Payer: Aetna of IA Medicare	$2,131.23
Rate for Payer: Amerigroup Medicaid	$2,156.66
Rate for Payer: Amerigroup Medicare	$1,699.38
Rate for Payer: Cash Price	$2,991.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,804.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,682.55
Rate for Payer: Iowa Total Care Managed Medicaid	$2,135.72
Rate for Payer: Medical Associates Commercial	$2,804.25
Rate for Payer: Medical Associates Managed Medicare	$1,682.55
Rate for Payer: Midlands Choice Commercial	$2,617.30
Rate for Payer: Molina Healthcare Managed Medicaid	$2,167.12
Rate for Payer: Partners Health Alliance Commercial	$1,934.93
Rate for Payer: United Healthcare Commercial	$3,365.10
Rate for Payer: United Healthcare Managed Medicare	$2,206.01

HIP REPLACEMENT INSERT-36D

Facility

$3,830.00

Service Code	HCPCS L8699
Hospital Charge Code	8046923
Hospital Revenue Code	278
Min. Negotiated Rate	$1,723.50
Max. Negotiated Rate	$3,447.00
Rate for Payer: Aetna of IA Commercial	$3,447.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,447.00
Rate for Payer: Aetna of IA Medicare	$2,183.10
Rate for Payer: Amerigroup Medicaid	$2,209.14
Rate for Payer: Amerigroup Medicare	$1,740.74
Rate for Payer: Cash Price	$3,064.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,872.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,723.50
Rate for Payer: Iowa Total Care Managed Medicaid	$2,187.70
Rate for Payer: Medical Associates Commercial	$2,872.50
Rate for Payer: Medical Associates Managed Medicare	$1,723.50
Rate for Payer: Midlands Choice Commercial	$2,681.00
Rate for Payer: Molina Healthcare Managed Medicaid	$2,219.87
Rate for Payer: Partners Health Alliance Commercial	$1,982.02
Rate for Payer: United Healthcare Commercial	$3,447.00
Rate for Payer: United Healthcare Managed Medicare	$2,259.70

HIP REPLACEMENT INSERT-36D

Facility

$3,830.00

Service Code	HCPCS L8699
Hospital Charge Code	8046923
Hospital Revenue Code	278
Min. Negotiated Rate	$2,681.00
Max. Negotiated Rate	$3,447.00
Rate for Payer: Aetna of IA Commercial	$3,447.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,447.00
Rate for Payer: Cash Price	$3,064.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,872.50
Rate for Payer: Medical Associates Commercial	$2,872.50
Rate for Payer: Midlands Choice Commercial	$2,681.00
Rate for Payer: United Healthcare Commercial	$3,447.00

HIP REPLACEMENT INSERT-36G

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046924
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.25
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Aetna of IA Medicare	$2,248.65
Rate for Payer: Amerigroup Medicaid	$2,275.48
Rate for Payer: Amerigroup Medicare	$1,793.00
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,775.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2,253.38
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Medical Associates Managed Medicare	$1,775.25
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2,286.52
Rate for Payer: Partners Health Alliance Commercial	$2,041.54
Rate for Payer: United Healthcare Commercial	$3,550.50
Rate for Payer: United Healthcare Managed Medicare	$2,327.55

HIP REPLACEMENT INSERT-36G

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046924
Hospital Revenue Code	278
Min. Negotiated Rate	$2,761.50
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: United Healthcare Commercial	$3,550.50

HIP REPLACEMENT INSERT 36MM 0 POLYETHYL

Facility

$4,082.00

Service Code	HCPCS L8699
Hospital Charge Code	8046925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,836.90
Max. Negotiated Rate	$3,673.80
Rate for Payer: Aetna of IA Commercial	$3,673.80
Rate for Payer: Aetna of IA Medical Rental Products	$3,673.80
Rate for Payer: Aetna of IA Medicare	$2,326.74
Rate for Payer: Amerigroup Medicaid	$2,354.50
Rate for Payer: Amerigroup Medicare	$1,855.27
Rate for Payer: Cash Price	$3,265.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,061.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,836.90
Rate for Payer: Iowa Total Care Managed Medicaid	$2,331.64
Rate for Payer: Medical Associates Commercial	$3,061.50
Rate for Payer: Medical Associates Managed Medicare	$1,836.90
Rate for Payer: Midlands Choice Commercial	$2,857.40
Rate for Payer: Molina Healthcare Managed Medicaid	$2,365.93
Rate for Payer: Partners Health Alliance Commercial	$2,112.44
Rate for Payer: United Healthcare Commercial	$3,673.80
Rate for Payer: United Healthcare Managed Medicare	$2,408.38

HIP REPLACEMENT INSERT 36MM 0 POLYETHYL

Facility

$4,082.00

Service Code	HCPCS L8699
Hospital Charge Code	8046925
Hospital Revenue Code	278
Min. Negotiated Rate	$2,857.40
Max. Negotiated Rate	$3,673.80
Rate for Payer: Aetna of IA Commercial	$3,673.80
Rate for Payer: Aetna of IA Medical Rental Products	$3,673.80
Rate for Payer: Cash Price	$3,265.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,061.50
Rate for Payer: Medical Associates Commercial	$3,061.50
Rate for Payer: Midlands Choice Commercial	$2,857.40
Rate for Payer: United Healthcare Commercial	$3,673.80

HIP REPLACEMENT INSERT 36MM POLYETHYLENE

Facility

$4,214.00

Service Code	HCPCS L8699
Hospital Charge Code	8046926
Hospital Revenue Code	278
Min. Negotiated Rate	$1,896.30
Max. Negotiated Rate	$3,792.60
Rate for Payer: Aetna of IA Commercial	$3,792.60
Rate for Payer: Aetna of IA Medical Rental Products	$3,792.60
Rate for Payer: Aetna of IA Medicare	$2,401.98
Rate for Payer: Amerigroup Medicaid	$2,430.64
Rate for Payer: Amerigroup Medicare	$1,915.26
Rate for Payer: Cash Price	$3,371.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,160.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,896.30
Rate for Payer: Iowa Total Care Managed Medicaid	$2,407.04
Rate for Payer: Medical Associates Commercial	$3,160.50
Rate for Payer: Medical Associates Managed Medicare	$1,896.30
Rate for Payer: Midlands Choice Commercial	$2,949.80
Rate for Payer: Molina Healthcare Managed Medicaid	$2,442.43
Rate for Payer: Partners Health Alliance Commercial	$2,180.74
Rate for Payer: United Healthcare Commercial	$3,792.60
Rate for Payer: United Healthcare Managed Medicare	$2,486.26

HIP REPLACEMENT INSERT 36MM POLYETHYLENE

Facility

$4,214.00

Service Code	HCPCS L8699
Hospital Charge Code	8046926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,949.80
Max. Negotiated Rate	$3,792.60
Rate for Payer: Aetna of IA Commercial	$3,792.60
Rate for Payer: Aetna of IA Medical Rental Products	$3,792.60
Rate for Payer: Cash Price	$3,371.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,160.50
Rate for Payer: Medical Associates Commercial	$3,160.50
Rate for Payer: Midlands Choice Commercial	$2,949.80
Rate for Payer: United Healthcare Commercial	$3,792.60

HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.25
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Aetna of IA Medicare	$2,248.65
Rate for Payer: Amerigroup Medicaid	$2,275.48
Rate for Payer: Amerigroup Medicare	$1,793.00
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,775.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2,253.38
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Medical Associates Managed Medicare	$1,775.25
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2,286.52
Rate for Payer: Partners Health Alliance Commercial	$2,041.54
Rate for Payer: United Healthcare Commercial	$3,550.50
Rate for Payer: United Healthcare Managed Medicare	$2,327.55

HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046927
Hospital Revenue Code	278
Min. Negotiated Rate	$2,761.50
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: United Healthcare Commercial	$3,550.50

HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046929
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.25
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Aetna of IA Medicare	$2,248.65
Rate for Payer: Amerigroup Medicaid	$2,275.48
Rate for Payer: Amerigroup Medicare	$1,793.00
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,775.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2,253.38
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Medical Associates Managed Medicare	$1,775.25
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2,286.52
Rate for Payer: Partners Health Alliance Commercial	$2,041.54
Rate for Payer: United Healthcare Commercial	$3,550.50
Rate for Payer: United Healthcare Managed Medicare	$2,327.55

HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2

Facility

$3,945.00

Service Code	HCPCS L8699
Hospital Charge Code	8046929
Hospital Revenue Code	278
Min. Negotiated Rate	$2,761.50
Max. Negotiated Rate	$3,550.50
Rate for Payer: Aetna of IA Commercial	$3,550.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,550.50
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,958.75
Rate for Payer: Medical Associates Commercial	$2,958.75
Rate for Payer: Midlands Choice Commercial	$2,761.50
Rate for Payer: United Healthcare Commercial	$3,550.50

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$33,206.19

Service Code	MSDRG 521
Min. Negotiated Rate	$32,724.92
Max. Negotiated Rate	$33,206.19
Rate for Payer: Amerigroup Medicaid	$33,045.76
Rate for Payer: Iowa Total Care Managed Medicaid	$32,724.92
Rate for Payer: Molina Healthcare Managed Medicaid	$33,206.19

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$25,969.53

Service Code	MSDRG 522
Min. Negotiated Rate	$25,593.15
Max. Negotiated Rate	$25,969.53
Rate for Payer: Amerigroup Medicaid	$25,844.07
Rate for Payer: Iowa Total Care Managed Medicaid	$25,593.15
Rate for Payer: Molina Healthcare Managed Medicaid	$25,969.53

HIP STEM #13

Facility

$9,255.00

Service Code	HCPCS L8699
Hospital Charge Code	8046890
Hospital Revenue Code	278
Min. Negotiated Rate	$6,478.50
Max. Negotiated Rate	$8,329.50
Rate for Payer: Aetna of IA Commercial	$8,329.50
Rate for Payer: Aetna of IA Medical Rental Products	$8,329.50
Rate for Payer: Cash Price	$7,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,941.25
Rate for Payer: Medical Associates Commercial	$6,941.25
Rate for Payer: Midlands Choice Commercial	$6,478.50
Rate for Payer: United Healthcare Commercial	$8,329.50

HIP STEM #13

Facility

$9,255.00

Service Code	HCPCS L8699
Hospital Charge Code	8046890
Hospital Revenue Code	278
Min. Negotiated Rate	$4,164.75
Max. Negotiated Rate	$8,329.50
Rate for Payer: Aetna of IA Commercial	$8,329.50
Rate for Payer: Aetna of IA Medical Rental Products	$8,329.50
Rate for Payer: Aetna of IA Medicare	$5,275.35
Rate for Payer: Amerigroup Medicaid	$5,338.28
Rate for Payer: Amerigroup Medicare	$4,206.40
Rate for Payer: Cash Price	$7,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,941.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4,164.75
Rate for Payer: Iowa Total Care Managed Medicaid	$5,286.46
Rate for Payer: Medical Associates Commercial	$6,941.25
Rate for Payer: Medical Associates Managed Medicare	$4,164.75
Rate for Payer: Midlands Choice Commercial	$6,478.50
Rate for Payer: Molina Healthcare Managed Medicaid	$5,364.20
Rate for Payer: Partners Health Alliance Commercial	$4,789.46
Rate for Payer: United Healthcare Commercial	$8,329.50
Rate for Payer: United Healthcare Managed Medicare	$5,460.45

HIP STEM #6

Facility

$9,255.00

Service Code	HCPCS L8699
Hospital Charge Code	8046308
Hospital Revenue Code	278
Min. Negotiated Rate	$6,478.50
Max. Negotiated Rate	$8,329.50
Rate for Payer: Aetna of IA Commercial	$8,329.50
Rate for Payer: Aetna of IA Medical Rental Products	$8,329.50
Rate for Payer: Cash Price	$7,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,941.25
Rate for Payer: Medical Associates Commercial	$6,941.25
Rate for Payer: Midlands Choice Commercial	$6,478.50
Rate for Payer: United Healthcare Commercial	$8,329.50

HIP STEM #6

Facility

$9,255.00

Service Code	HCPCS L8699
Hospital Charge Code	8046308
Hospital Revenue Code	278
Min. Negotiated Rate	$4,164.75
Max. Negotiated Rate	$8,329.50
Rate for Payer: Aetna of IA Commercial	$8,329.50
Rate for Payer: Aetna of IA Medical Rental Products	$8,329.50
Rate for Payer: Aetna of IA Medicare	$5,275.35
Rate for Payer: Amerigroup Medicaid	$5,338.28
Rate for Payer: Amerigroup Medicare	$4,206.40
Rate for Payer: Cash Price	$7,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,941.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4,164.75
Rate for Payer: Iowa Total Care Managed Medicaid	$5,286.46
Rate for Payer: Medical Associates Commercial	$6,941.25
Rate for Payer: Medical Associates Managed Medicare	$4,164.75
Rate for Payer: Midlands Choice Commercial	$6,478.50
Rate for Payer: Molina Healthcare Managed Medicaid	$5,364.20
Rate for Payer: Partners Health Alliance Commercial	$4,789.46
Rate for Payer: United Healthcare Commercial	$8,329.50
Rate for Payer: United Healthcare Managed Medicare	$5,460.45

Histoplasmosis Immunodiffusion DMCL

Facility

$114.00

Service Code	CPT 86698
Hospital Charge Code	8037874
Hospital Revenue Code	302
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

Histoplasmosis Immunodiffusion DMCL

Facility

$114.00

Service Code	CPT 86698
Hospital Charge Code	8037874
Hospital Revenue Code	302
Min. Negotiated Rate	$41.83
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$59.00
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

Know your out-of-pocket cost for care.

All Charges