Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Irrigation sodium chloride 0.9% Sol 3000 mL [VDMC]

Facility

$77.88

Service Code	NDC 00990-7972-08
Hospital Charge Code	10438346
Hospital Revenue Code	259
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$70.09
Rate for Payer: Aetna of IA Commercial	$70.09
Rate for Payer: Aetna of IA Medical Rental Products	$70.09
Rate for Payer: Cash Price	$62.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$58.41
Rate for Payer: Medical Associates Commercial	$58.41
Rate for Payer: Midlands Choice Commercial	$54.52
Rate for Payer: United Healthcare Commercial	$70.09

Irrigation sodium chloride 0.9% Sol 500 mL Bottle [VDMC]

Facility

$71.10

Service Code	NDC 00338-0048-03
Hospital Charge Code	10438413
Hospital Revenue Code	259
Min. Negotiated Rate	$49.77
Max. Negotiated Rate	$63.99
Rate for Payer: Aetna of IA Commercial	$63.99
Rate for Payer: Aetna of IA Medical Rental Products	$63.99
Rate for Payer: Cash Price	$56.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.32
Rate for Payer: Medical Associates Commercial	$53.32
Rate for Payer: Midlands Choice Commercial	$49.77
Rate for Payer: United Healthcare Commercial	$63.99

Irrigation sodium chloride 0.9% Sol 500 mL Bottle [VDMC]

Facility

$71.10

Service Code	NDC 00338-0048-03
Hospital Charge Code	10438413
Hospital Revenue Code	259
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$63.99
Rate for Payer: Aetna of IA Commercial	$63.99
Rate for Payer: Aetna of IA Medical Rental Products	$63.99
Rate for Payer: Aetna of IA Medicare	$40.53
Rate for Payer: Amerigroup Medicaid	$35.88
Rate for Payer: Amerigroup Medicare	$35.91
Rate for Payer: Cash Price	$56.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.32
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$35.55
Rate for Payer: Iowa Total Care Managed Medicaid	$35.54
Rate for Payer: Medical Associates Commercial	$53.32
Rate for Payer: Medical Associates Managed Medicare	$35.55
Rate for Payer: Midlands Choice Commercial	$49.77
Rate for Payer: Molina Healthcare Managed Medicaid	$36.08
Rate for Payer: Molina Healthcare Managed Medicare	$36.06
Rate for Payer: Oscar Health of IA Commercial	$53.32
Rate for Payer: Partners Health Alliance Commercial	$53.32
Rate for Payer: United Healthcare Commercial	$63.99
Rate for Payer: United Healthcare Managed Medicare	$41.95

IRRIG DRUG DELIVERY DEVICE

Facility

$157.00

Service Code	CPT 96523
Hospital Charge Code	4866826
Hospital Revenue Code	760
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

IRRIG DRUG DELIVERY DEVICE

Facility

$157.00

Service Code	CPT 96523
Hospital Charge Code	8398094
Hospital Revenue Code	260
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

IRRIG DRUG DELIVERY DEVICE

Facility

$157.00

Service Code	CPT 96523
Hospital Charge Code	4866826
Hospital Revenue Code	760
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$403.74
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	$79.24
Rate for Payer: Amerigroup Medicare	$79.28
Rate for Payer: Cash Price	$125.60
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	$78.50
Rate for Payer: Iowa Total Care Managed Medicaid	$78.47
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Medical Associates Managed Medicare	$78.50
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: Molina Healthcare Managed Medicaid	$79.68
Rate for Payer: Molina Healthcare Managed Medicare	$79.63
Rate for Payer: Oscar Health of IA Commercial	$117.75
Rate for Payer: Partners Health Alliance Commercial	$117.75
Rate for Payer: United Healthcare Commercial	$141.30
Rate for Payer: United Healthcare Managed Medicare	$92.63
Rate for Payer: Wellmark IA HMO	$367.04
Rate for Payer: Wellmark IA PPO	$403.74

IRRIG DRUG DELIVERY DEVICE

Facility

$157.00

Service Code	CPT 96523
Hospital Charge Code	8398094
Hospital Revenue Code	260
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$403.74
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	$79.24
Rate for Payer: Amerigroup Medicare	$79.28
Rate for Payer: Cash Price	$125.60
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	$78.50
Rate for Payer: Iowa Total Care Managed Medicaid	$78.47
Rate for Payer: Medical Associates Commercial	$117.75
Rate for Payer: Medical Associates Managed Medicare	$78.50
Rate for Payer: Midlands Choice Commercial	$109.90
Rate for Payer: Molina Healthcare Managed Medicaid	$79.68
Rate for Payer: Molina Healthcare Managed Medicare	$79.63
Rate for Payer: Oscar Health of IA Commercial	$117.75
Rate for Payer: Partners Health Alliance Commercial	$117.75
Rate for Payer: United Healthcare Commercial	$141.30
Rate for Payer: United Healthcare Managed Medicare	$92.63
Rate for Payer: Wellmark IA HMO	$367.04
Rate for Payer: Wellmark IA PPO	$403.74

Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent With CC

Facility

$19,925.96

Service Code	MS-DRG 062
Hospital Charge Code	742
Min. Negotiated Rate	$19,637.18
Max. Negotiated Rate	$19,925.96
Rate for Payer: Amerigroup Medicaid	$19,829.70
Rate for Payer: Iowa Total Care Managed Medicaid	$19,637.18
Rate for Payer: Molina Healthcare Managed Medicaid	$19,925.96

Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent With MCC

Facility

$23,987.94

Service Code	MS-DRG 061
Hospital Charge Code	741
Min. Negotiated Rate	$23,640.28
Max. Negotiated Rate	$23,987.94
Rate for Payer: Amerigroup Medicaid	$23,872.05
Rate for Payer: Iowa Total Care Managed Medicaid	$23,640.28
Rate for Payer: Molina Healthcare Managed Medicaid	$23,987.94

Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent Without CC/MCC

Facility

$17,694.69

Service Code	MS-DRG 063
Hospital Charge Code	743
Min. Negotiated Rate	$17,438.25
Max. Negotiated Rate	$17,694.69
Rate for Payer: Amerigroup Medicaid	$17,609.21
Rate for Payer: Iowa Total Care Managed Medicaid	$17,438.25
Rate for Payer: Molina Healthcare Managed Medicaid	$17,694.69

Isolation

Facility

$230.00

Hospital Charge Code	7861839
Hospital Revenue Code	110
Min. Negotiated Rate	$114.95
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$131.10
Rate for Payer: Amerigroup Medicaid	$116.08
Rate for Payer: Amerigroup Medicare	$116.15
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$115.00
Rate for Payer: Iowa Total Care Managed Medicaid	$114.95
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$115.00
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicaid	$116.72
Rate for Payer: Molina Healthcare Managed Medicare	$116.66
Rate for Payer: Oscar Health of IA Commercial	$172.50
Rate for Payer: Partners Health Alliance Commercial	$172.50
Rate for Payer: United Healthcare Commercial	$207.00

Isolation

Facility

$230.00

Hospital Charge Code	7861839
Hospital Revenue Code	110
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$9,842.42
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$2,258.00
Rate for Payer: Amerigroup Medicare	$2,054.34
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$2,034.00
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicare	$9,842.42
Rate for Payer: Oscar Health of IA Commercial	$3,051.00
Rate for Payer: Partners Health Alliance Commercial	$2,339.10
Rate for Payer: United Healthcare Commercial	$207.00
Rate for Payer: United Healthcare Managed Medicare	$1,306.00

isoniazid 100 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10397637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Aetna of IA Medicare	$0.74
Rate for Payer: Amerigroup Medicaid	$0.65
Rate for Payer: Amerigroup Medicare	$0.65
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.65
Rate for Payer: Iowa Total Care Managed Medicaid	$0.64
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: Molina Healthcare Managed Medicaid	$0.65
Rate for Payer: Molina Healthcare Managed Medicare	$0.65
Rate for Payer: Oscar Health of IA Commercial	$0.97
Rate for Payer: Partners Health Alliance Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.16
Rate for Payer: United Healthcare Managed Medicare	$0.76

isoniazid 100 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10397637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

isosorbide mononitrate 20 mg Tab [VDMC]

Facility

$1.53

Service Code	HCPCS A9270
Hospital Charge Code	10397848
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of IA Commercial	$1.38
Rate for Payer: Aetna of IA Medical Rental Products	$1.38
Rate for Payer: Aetna of IA Medicare	$0.87
Rate for Payer: Amerigroup Medicaid	$0.77
Rate for Payer: Amerigroup Medicare	$0.77
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.15
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	$0.76
Rate for Payer: Medical Associates Commercial	$1.15
Rate for Payer: Medical Associates Managed Medicare	$0.77
Rate for Payer: Midlands Choice Commercial	$1.07
Rate for Payer: Molina Healthcare Managed Medicaid	$0.78
Rate for Payer: Molina Healthcare Managed Medicare	$0.78
Rate for Payer: Oscar Health of IA Commercial	$1.15
Rate for Payer: Partners Health Alliance Commercial	$1.15
Rate for Payer: United Healthcare Commercial	$1.38
Rate for Payer: United Healthcare Managed Medicare	$0.90

isosorbide mononitrate 20 mg Tab [VDMC]

Facility

$1.53

Service Code	HCPCS A9270
Hospital Charge Code	10397848
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of IA Commercial	$1.38
Rate for Payer: Aetna of IA Medical Rental Products	$1.38
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.15
Rate for Payer: Medical Associates Commercial	$1.15
Rate for Payer: Midlands Choice Commercial	$1.07
Rate for Payer: United Healthcare Commercial	$1.38

isosorbide mononitrate 30 mg ER Tab [VDMC]

Facility

$2.40

Service Code	HCPCS A9270
Hospital Charge Code	10397917
Hospital Revenue Code	259
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna of IA Commercial	$2.16
Rate for Payer: Aetna of IA Medical Rental Products	$2.16
Rate for Payer: Aetna of IA Medicare	$1.37
Rate for Payer: Amerigroup Medicaid	$1.21
Rate for Payer: Amerigroup Medicare	$1.21
Rate for Payer: Cash Price	$1.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.80
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.20
Rate for Payer: Iowa Total Care Managed Medicaid	$1.20
Rate for Payer: Medical Associates Commercial	$1.80
Rate for Payer: Medical Associates Managed Medicare	$1.20
Rate for Payer: Midlands Choice Commercial	$1.68
Rate for Payer: Molina Healthcare Managed Medicaid	$1.22
Rate for Payer: Molina Healthcare Managed Medicare	$1.22
Rate for Payer: Oscar Health of IA Commercial	$1.80
Rate for Payer: Partners Health Alliance Commercial	$1.80
Rate for Payer: United Healthcare Commercial	$2.16
Rate for Payer: United Healthcare Managed Medicare	$1.42

isosorbide mononitrate 30 mg ER Tab [VDMC]

Facility

$2.40

Service Code	HCPCS A9270
Hospital Charge Code	10397917
Hospital Revenue Code	259
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna of IA Commercial	$2.16
Rate for Payer: Aetna of IA Medical Rental Products	$2.16
Rate for Payer: Cash Price	$1.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.80
Rate for Payer: Medical Associates Commercial	$1.80
Rate for Payer: Midlands Choice Commercial	$1.68
Rate for Payer: United Healthcare Commercial	$2.16

ITM

Facility

$531.00

Service Code	CPT 62322
Hospital Charge Code	7984738
Hospital Revenue Code	720
Min. Negotiated Rate	$371.70
Max. Negotiated Rate	$477.90
Rate for Payer: Aetna of IA Commercial	$477.90
Rate for Payer: Aetna of IA Medical Rental Products	$477.90
Rate for Payer: Cash Price	$424.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$398.25
Rate for Payer: Medical Associates Commercial	$398.25
Rate for Payer: Midlands Choice Commercial	$371.70
Rate for Payer: United Healthcare Commercial	$477.90

ITM

Facility

$531.00

Service Code	CPT 62322
Hospital Charge Code	7984738
Hospital Revenue Code	720
Min. Negotiated Rate	$265.39
Max. Negotiated Rate	$1,487.44
Rate for Payer: Aetna of IA Commercial	$477.90
Rate for Payer: Aetna of IA Medical Rental Products	$477.90
Rate for Payer: Aetna of IA Medicare	$302.67
Rate for Payer: Amerigroup Medicaid	$268.00
Rate for Payer: Amerigroup Medicare	$268.16
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cash Price	$424.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$398.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$265.50
Rate for Payer: Iowa Total Care Managed Medicaid	$265.39
Rate for Payer: Medical Associates Commercial	$398.25
Rate for Payer: Medical Associates Managed Medicare	$265.50
Rate for Payer: Midlands Choice Commercial	$371.70
Rate for Payer: Molina Healthcare Managed Medicaid	$269.48
Rate for Payer: Molina Healthcare Managed Medicare	$269.32
Rate for Payer: Oscar Health of IA Commercial	$398.25
Rate for Payer: Partners Health Alliance Commercial	$398.25
Rate for Payer: United Healthcare Commercial	$477.90
Rate for Payer: United Healthcare Managed Medicare	$313.29
Rate for Payer: Wellmark IA HMO	$1,352.22
Rate for Payer: Wellmark IA PPO	$1,487.44

itraconazole 100 mg Cap [VDMC]

Facility

$5.34

Service Code	HCPCS A9270
Hospital Charge Code	10398128
Hospital Revenue Code	259
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$4.81
Rate for Payer: Aetna of IA Commercial	$4.81
Rate for Payer: Aetna of IA Medical Rental Products	$4.81
Rate for Payer: Aetna of IA Medicare	$3.04
Rate for Payer: Amerigroup Medicaid	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: Cash Price	$4.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.67
Rate for Payer: Iowa Total Care Managed Medicaid	$2.67
Rate for Payer: Medical Associates Commercial	$4.00
Rate for Payer: Medical Associates Managed Medicare	$2.67
Rate for Payer: Midlands Choice Commercial	$3.74
Rate for Payer: Molina Healthcare Managed Medicaid	$2.71
Rate for Payer: Molina Healthcare Managed Medicare	$2.71
Rate for Payer: Oscar Health of IA Commercial	$4.00
Rate for Payer: Partners Health Alliance Commercial	$4.00
Rate for Payer: United Healthcare Commercial	$4.81
Rate for Payer: United Healthcare Managed Medicare	$3.15

itraconazole 100 mg Cap [VDMC]

Facility

$5.34

Service Code	HCPCS A9270
Hospital Charge Code	10398128
Hospital Revenue Code	259
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$4.81
Rate for Payer: Aetna of IA Commercial	$4.81
Rate for Payer: Aetna of IA Medical Rental Products	$4.81
Rate for Payer: Cash Price	$4.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.00
Rate for Payer: Medical Associates Commercial	$4.00
Rate for Payer: Midlands Choice Commercial	$3.74
Rate for Payer: United Healthcare Commercial	$4.81

IUD REMOVAL CHARGE

Professional

Both

$315.00

Service Code	CPT 58301
Hospital Charge Code	8068939
Hospital Revenue Code	975
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$143.67
Rate for Payer: Aetna of IA Medicare	$59.68
Rate for Payer: Amerigroup Medicaid	$61.71
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$71.62
Rate for Payer: Iowa Total Care Managed Medicaid	$60.87
Rate for Payer: Medical Associates Commercial	$113.39
Rate for Payer: Medical Associates Managed Medicare	$59.68
Rate for Payer: Midlands Choice Commercial	$143.67
Rate for Payer: Oscar Health of IA Commercial	$103.25
Rate for Payer: Partners Health Alliance Commercial	$89.52

IV CONSCIOUS SEDATION CHARGE

Professional

Both

$258.00

Hospital Charge Code	8084811
Hospital Revenue Code	964
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$193.50
Rate for Payer: Cash Price	$206.40
Rate for Payer: Medical Associates Commercial	$193.50
Rate for Payer: Midlands Choice Commercial	$180.60

IVP MED ADMIN EA ADDL SEQUENTL

Facility

$64.00

Service Code	CPT 96375
Hospital Charge Code	7984747
Hospital Revenue Code	260
Min. Negotiated Rate	$31.99
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Aetna of IA Medicare	$36.48
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$32.32
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.00
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Medical Associates Managed Medicare	$32.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: Molina Healthcare Managed Medicaid	$32.48
Rate for Payer: Molina Healthcare Managed Medicare	$32.46
Rate for Payer: Oscar Health of IA Commercial	$48.00
Rate for Payer: Partners Health Alliance Commercial	$48.00
Rate for Payer: United Healthcare Commercial	$57.60
Rate for Payer: United Healthcare Managed Medicare	$37.76

Know your out-of-pocket cost for care.

All Charges