Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

lisinopril 20 mg Tab [VDMC]

Facility

$1.18

Service Code	HCPCS A9270
Hospital Charge Code	10429571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.06
Rate for Payer: Aetna of IA Commercial	$1.06
Rate for Payer: Aetna of IA Medical Rental Products	$1.06
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.88
Rate for Payer: Medical Associates Commercial	$0.88
Rate for Payer: Midlands Choice Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$1.06

lisinopril 5 mg Tab [VDMC]

Facility

$1.17

Service Code	HCPCS A9270
Hospital Charge Code	10401226
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.05
Rate for Payer: Aetna of IA Commercial	$1.05
Rate for Payer: Aetna of IA Medical Rental Products	$1.05
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.88
Rate for Payer: Medical Associates Commercial	$0.88
Rate for Payer: Midlands Choice Commercial	$0.82
Rate for Payer: United Healthcare Commercial	$1.05

lisinopril 5 mg Tab [VDMC]

Facility

$1.17

Service Code	HCPCS A9270
Hospital Charge Code	10401226
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.05
Rate for Payer: Aetna of IA Commercial	$1.05
Rate for Payer: Aetna of IA Medical Rental Products	$1.05
Rate for Payer: Aetna of IA Medicare	$0.67
Rate for Payer: Amerigroup Medicaid	$0.67
Rate for Payer: Amerigroup Medicare	$0.53
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.53
Rate for Payer: Iowa Total Care Managed Medicaid	$0.67
Rate for Payer: Medical Associates Commercial	$0.88
Rate for Payer: Medical Associates Managed Medicare	$0.53
Rate for Payer: Midlands Choice Commercial	$0.82
Rate for Payer: Molina Healthcare Managed Medicaid	$0.68
Rate for Payer: Partners Health Alliance Commercial	$0.60
Rate for Payer: United Healthcare Commercial	$1.05
Rate for Payer: United Healthcare Managed Medicare	$0.69

lisinopril-HCTZ 20mg-25mg tab [VDMC]

Facility

$1.14

Service Code	HCPCS A9270
Hospital Charge Code	23268711
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of IA Commercial	$1.03
Rate for Payer: Aetna of IA Medical Rental Products	$1.03
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Midlands Choice Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.03

lisinopril-HCTZ 20mg-25mg tab [VDMC]

Facility

$1.14

Service Code	HCPCS A9270
Hospital Charge Code	23268711
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of IA Commercial	$1.03
Rate for Payer: Aetna of IA Medical Rental Products	$1.03
Rate for Payer: Aetna of IA Medicare	$0.65
Rate for Payer: Amerigroup Medicaid	$0.66
Rate for Payer: Amerigroup Medicare	$0.52
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.51
Rate for Payer: Iowa Total Care Managed Medicaid	$0.65
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Medical Associates Managed Medicare	$0.51
Rate for Payer: Midlands Choice Commercial	$0.80
Rate for Payer: Molina Healthcare Managed Medicaid	$0.66
Rate for Payer: Partners Health Alliance Commercial	$0.59
Rate for Payer: United Healthcare Commercial	$1.03
Rate for Payer: United Healthcare Managed Medicare	$0.67

lithium 150 mg Cap [VDMC]

Facility

$1.47

Service Code	HCPCS A9270
Hospital Charge Code	18866238
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of IA Commercial	$1.32
Rate for Payer: Aetna of IA Medical Rental Products	$1.32
Rate for Payer: Aetna of IA Medicare	$0.84
Rate for Payer: Amerigroup Medicaid	$0.85
Rate for Payer: Amerigroup Medicare	$0.67
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.66
Rate for Payer: Iowa Total Care Managed Medicaid	$0.84
Rate for Payer: Medical Associates Commercial	$1.10
Rate for Payer: Medical Associates Managed Medicare	$0.66
Rate for Payer: Midlands Choice Commercial	$1.03
Rate for Payer: Molina Healthcare Managed Medicaid	$0.85
Rate for Payer: Partners Health Alliance Commercial	$0.76
Rate for Payer: United Healthcare Commercial	$1.32
Rate for Payer: United Healthcare Managed Medicare	$0.87

lithium 150 mg Cap [VDMC]

Facility

$1.47

Service Code	HCPCS A9270
Hospital Charge Code	18866238
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of IA Commercial	$1.32
Rate for Payer: Aetna of IA Medical Rental Products	$1.32
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.10
Rate for Payer: Medical Associates Commercial	$1.10
Rate for Payer: Midlands Choice Commercial	$1.03
Rate for Payer: United Healthcare Commercial	$1.32

lithium 300 mg Cap [VDMC]

Facility

$1.75

Service Code	HCPCS A9270
Hospital Charge Code	10401297
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of IA Commercial	$1.58
Rate for Payer: Aetna of IA Medical Rental Products	$1.58
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.32
Rate for Payer: Medical Associates Commercial	$1.32
Rate for Payer: Midlands Choice Commercial	$1.23
Rate for Payer: United Healthcare Commercial	$1.58

lithium 300 mg Cap [VDMC]

Facility

$1.75

Service Code	HCPCS A9270
Hospital Charge Code	10401297
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of IA Commercial	$1.58
Rate for Payer: Aetna of IA Medical Rental Products	$1.58
Rate for Payer: Aetna of IA Medicare	$1.00
Rate for Payer: Amerigroup Medicaid	$1.01
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.32
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.79
Rate for Payer: Iowa Total Care Managed Medicaid	$1.00
Rate for Payer: Medical Associates Commercial	$1.32
Rate for Payer: Medical Associates Managed Medicare	$0.79
Rate for Payer: Midlands Choice Commercial	$1.23
Rate for Payer: Molina Healthcare Managed Medicaid	$1.02
Rate for Payer: Partners Health Alliance Commercial	$0.91
Rate for Payer: United Healthcare Commercial	$1.58
Rate for Payer: United Healthcare Managed Medicare	$1.03

Lithium Level DMCL

Facility

$63.00

Service Code	CPT 80178
Hospital Charge Code	8037727
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of IA Commercial	$56.70
Rate for Payer: Aetna of IA Medical Rental Products	$56.70
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.25
Rate for Payer: Medical Associates Commercial	$47.25
Rate for Payer: Midlands Choice Commercial	$44.10
Rate for Payer: United Healthcare Commercial	$56.70

Lithium Level DMCL

Facility

$63.00

Service Code	CPT 80178
Hospital Charge Code	8037727
Hospital Revenue Code	301
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of IA Commercial	$56.70
Rate for Payer: Aetna of IA Medical Rental Products	$56.70
Rate for Payer: Aetna of IA Medicare	$35.91
Rate for Payer: Amerigroup Medicaid	$36.34
Rate for Payer: Amerigroup Medicare	$28.63
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.35
Rate for Payer: Iowa Total Care Managed Medicaid	$35.99
Rate for Payer: Medical Associates Commercial	$47.25
Rate for Payer: Medical Associates Managed Medicare	$28.35
Rate for Payer: Midlands Choice Commercial	$44.10
Rate for Payer: Molina Healthcare Managed Medicaid	$36.51
Rate for Payer: Partners Health Alliance Commercial	$32.60
Rate for Payer: United Healthcare Commercial	$56.70
Rate for Payer: United Healthcare Managed Medicare	$37.17

LITHOTRIPSY CHARGE

Facility

$4,114.00

Hospital Charge Code	8069084
Hospital Revenue Code	360
Min. Negotiated Rate	$2,879.80
Max. Negotiated Rate	$3,702.60
Rate for Payer: Aetna of IA Commercial	$3,702.60
Rate for Payer: Aetna of IA Medical Rental Products	$3,702.60
Rate for Payer: Cash Price	$3,291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,085.50
Rate for Payer: Medical Associates Commercial	$3,085.50
Rate for Payer: Midlands Choice Commercial	$2,879.80
Rate for Payer: United Healthcare Commercial	$3,702.60

LITHOTRIPSY CHARGE

Facility

$4,114.00

Hospital Charge Code	8069084
Hospital Revenue Code	360
Min. Negotiated Rate	$1,851.30
Max. Negotiated Rate	$3,702.60
Rate for Payer: Aetna of IA Commercial	$3,702.60
Rate for Payer: Aetna of IA Medical Rental Products	$3,702.60
Rate for Payer: Aetna of IA Medicare	$2,344.98
Rate for Payer: Amerigroup Medicaid	$2,372.96
Rate for Payer: Amerigroup Medicare	$1,869.81
Rate for Payer: Cash Price	$3,291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,085.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,851.30
Rate for Payer: Iowa Total Care Managed Medicaid	$2,349.92
Rate for Payer: Medical Associates Commercial	$3,085.50
Rate for Payer: Medical Associates Managed Medicare	$1,851.30
Rate for Payer: Midlands Choice Commercial	$2,879.80
Rate for Payer: Molina Healthcare Managed Medicaid	$2,384.47
Rate for Payer: Partners Health Alliance Commercial	$2,128.99
Rate for Payer: United Healthcare Commercial	$3,702.60
Rate for Payer: United Healthcare Managed Medicare	$2,427.26

LIVER PROFILE

Facility

$111.00

Service Code	CPT 80076
Hospital Charge Code	633744
Hospital Revenue Code	301
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of IA Commercial	$99.90
Rate for Payer: Aetna of IA Medical Rental Products	$99.90
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.25
Rate for Payer: Medical Associates Commercial	$83.25
Rate for Payer: Midlands Choice Commercial	$77.70
Rate for Payer: United Healthcare Commercial	$99.90

LIVER PROFILE

Facility

$111.00

Service Code	CPT 80076
Hospital Charge Code	633744
Hospital Revenue Code	301
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of IA Commercial	$99.90
Rate for Payer: Aetna of IA Medical Rental Products	$99.90
Rate for Payer: Aetna of IA Medicare	$63.27
Rate for Payer: Amerigroup Medicaid	$64.02
Rate for Payer: Amerigroup Medicare	$50.45
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$49.95
Rate for Payer: Iowa Total Care Managed Medicaid	$63.40
Rate for Payer: Medical Associates Commercial	$83.25
Rate for Payer: Medical Associates Managed Medicare	$49.95
Rate for Payer: Midlands Choice Commercial	$77.70
Rate for Payer: Molina Healthcare Managed Medicaid	$64.34
Rate for Payer: Partners Health Alliance Commercial	$57.44
Rate for Payer: United Healthcare Commercial	$99.90
Rate for Payer: United Healthcare Managed Medicare	$65.49

LOCKING COMPR BROAD 10 HOLE / L 191MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046758
Hospital Revenue Code	278
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: United Healthcare Commercial	$225.90

LOCKING COMPR BROAD 10 HOLE / L 191MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046758
Hospital Revenue Code	278
Min. Negotiated Rate	$112.95
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Aetna of IA Medicare	$143.07
Rate for Payer: Amerigroup Medicaid	$144.78
Rate for Payer: Amerigroup Medicare	$114.08
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$112.95
Rate for Payer: Iowa Total Care Managed Medicaid	$143.37
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Medical Associates Managed Medicare	$112.95
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: Molina Healthcare Managed Medicaid	$145.48
Rate for Payer: Partners Health Alliance Commercial	$129.89
Rate for Payer: United Healthcare Commercial	$225.90
Rate for Payer: United Healthcare Managed Medicare	$148.09

LOCKING COMPR BROAD 11 HOLE / L 209MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046759
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

LOCKING COMPR BROAD 11 HOLE / L 209MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046759
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

LOCKING COMPR BROAD 12 HOLE / L 227MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046760
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

LOCKING COMPR BROAD 12 HOLE / L 227MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046760
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

LOCKING COMPR BROAD 13 HOLE / L 245MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046761
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

LOCKING COMPR BROAD 13 HOLE / L 245MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046761
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

LOCKING COMPR BROAD 14 HOLE / L 263MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046762
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

LOCKING COMPR BROAD 14 HOLE / L 263MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8046762
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

Know your out-of-pocket cost for care.

All Charges