Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

LENS 9.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047347
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS 9.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047347
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS 9.5 SN60WF95

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896453
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS 9.5 SN60WF95

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896453
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ACROSOFT SINGLE PIECE

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047372
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ACROSOFT SINGLE PIECE

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047372
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS ACRYSOLF IQ TORIC 8.0

Facility

$375.00

Service Code	HCPCS V2787
Hospital Charge Code	8900235
Hospital Revenue Code	276
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna of IA Commercial	$337.50
Rate for Payer: Aetna of IA Medical Rental Products	$337.50
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$281.25
Rate for Payer: Medical Associates Commercial	$281.25
Rate for Payer: Midlands Choice Commercial	$262.50
Rate for Payer: United Healthcare Commercial	$337.50

LENS ACRYSOLF IQ TORIC 8.0

Facility

$375.00

Service Code	HCPCS V2787
Hospital Charge Code	8900235
Hospital Revenue Code	276
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna of IA Commercial	$337.50
Rate for Payer: Aetna of IA Medical Rental Products	$337.50
Rate for Payer: Aetna of IA Medicare	$213.75
Rate for Payer: Amerigroup Medicaid	$216.30
Rate for Payer: Amerigroup Medicare	$170.44
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$281.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$168.75
Rate for Payer: Iowa Total Care Managed Medicaid	$214.20
Rate for Payer: Medical Associates Commercial	$281.25
Rate for Payer: Medical Associates Managed Medicare	$168.75
Rate for Payer: Midlands Choice Commercial	$262.50
Rate for Payer: Molina Healthcare Managed Medicaid	$217.35
Rate for Payer: Partners Health Alliance Commercial	$194.06
Rate for Payer: United Healthcare Commercial	$337.50
Rate for Payer: United Healthcare Managed Medicare	$221.25

LENS ALCON 17.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896429
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ALCON 17.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896429
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS ALCON 19.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896431
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS ALCON 19.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896431
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ALCON 21.0

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896433
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ALCON 21.0

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896433
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS ALCON 24.5

Facility

$270.00

Service Code	HCPCS V2787
Hospital Charge Code	8896437
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ALCON 24.5

Facility

$270.00

Service Code	HCPCS V2787
Hospital Charge Code	8896437
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS ALCON 9.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896435
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS ALCON 9.5

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8896435
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS-PANOPTIX

Facility

$845.00

Service Code	HCPCS V2788
Hospital Charge Code	8818765
Hospital Revenue Code	276
Min. Negotiated Rate	$380.25
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of IA Commercial	$760.50
Rate for Payer: Aetna of IA Medical Rental Products	$760.50
Rate for Payer: Aetna of IA Medicare	$481.65
Rate for Payer: Amerigroup Medicaid	$487.40
Rate for Payer: Amerigroup Medicare	$384.05
Rate for Payer: Cash Price	$676.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$633.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$380.25
Rate for Payer: Iowa Total Care Managed Medicaid	$482.66
Rate for Payer: Medical Associates Commercial	$633.75
Rate for Payer: Medical Associates Managed Medicare	$380.25
Rate for Payer: Midlands Choice Commercial	$591.50
Rate for Payer: Molina Healthcare Managed Medicaid	$489.76
Rate for Payer: Partners Health Alliance Commercial	$437.29
Rate for Payer: United Healthcare Commercial	$760.50
Rate for Payer: United Healthcare Managed Medicare	$498.55

LENS-PANOPTIX

Facility

$845.00

Service Code	HCPCS V2788
Hospital Charge Code	8818765
Hospital Revenue Code	276
Min. Negotiated Rate	$591.50
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of IA Commercial	$760.50
Rate for Payer: Aetna of IA Medical Rental Products	$760.50
Rate for Payer: Cash Price	$676.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$633.75
Rate for Payer: Medical Associates Commercial	$633.75
Rate for Payer: Midlands Choice Commercial	$591.50
Rate for Payer: United Healthcare Commercial	$760.50

LENS POSTERIOR 5.0

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047351
Hospital Revenue Code	276
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

LENS POSTERIOR 5.0

Facility

$270.00

Service Code	HCPCS V2632
Hospital Charge Code	8047351
Hospital Revenue Code	276
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

LENS RESTORE

Facility

$845.00

Service Code	HCPCS C1781
Hospital Charge Code	8046977
Hospital Revenue Code	276
Min. Negotiated Rate	$380.25
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of IA Commercial	$760.50
Rate for Payer: Aetna of IA Medical Rental Products	$760.50
Rate for Payer: Aetna of IA Medicare	$481.65
Rate for Payer: Amerigroup Medicaid	$487.40
Rate for Payer: Amerigroup Medicare	$384.05
Rate for Payer: Cash Price	$676.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$633.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$380.25
Rate for Payer: Iowa Total Care Managed Medicaid	$482.66
Rate for Payer: Medical Associates Commercial	$633.75
Rate for Payer: Medical Associates Managed Medicare	$380.25
Rate for Payer: Midlands Choice Commercial	$591.50
Rate for Payer: Molina Healthcare Managed Medicaid	$489.76
Rate for Payer: Partners Health Alliance Commercial	$437.29
Rate for Payer: United Healthcare Commercial	$760.50
Rate for Payer: United Healthcare Managed Medicare	$498.55

LENS RESTORE

Facility

$845.00

Service Code	HCPCS C1781
Hospital Charge Code	8046977
Hospital Revenue Code	276
Min. Negotiated Rate	$591.50
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of IA Commercial	$760.50
Rate for Payer: Aetna of IA Medical Rental Products	$760.50
Rate for Payer: Cash Price	$676.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$633.75
Rate for Payer: Medical Associates Commercial	$633.75
Rate for Payer: Midlands Choice Commercial	$591.50
Rate for Payer: United Healthcare Commercial	$760.50

LENS TORIC ASTIGMATISM-OR TO PROVIDE REF

Facility

$375.00

Service Code	HCPCS V2787
Hospital Charge Code	8046975
Hospital Revenue Code	276
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna of IA Commercial	$337.50
Rate for Payer: Aetna of IA Medical Rental Products	$337.50
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$281.25
Rate for Payer: Medical Associates Commercial	$281.25
Rate for Payer: Midlands Choice Commercial	$262.50
Rate for Payer: United Healthcare Commercial	$337.50

Know your out-of-pocket cost for care.

All Charges