Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

PLATE 10 HOLE DYNAMIC COMP

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	8046462
Hospital Revenue Code	278
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

PLATE 5 DISTAL LATERAL FIBULA

Facility

$884.00

Service Code	HCPCS L8699
Hospital Charge Code	8046706
Hospital Revenue Code	278
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$795.60
Rate for Payer: Aetna of IA Commercial	$795.60
Rate for Payer: Aetna of IA Medical Rental Products	$795.60
Rate for Payer: Cash Price	$707.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$663.00
Rate for Payer: Medical Associates Commercial	$663.00
Rate for Payer: Midlands Choice Commercial	$618.80
Rate for Payer: United Healthcare Commercial	$795.60

PLATE 5 DISTAL LATERAL FIBULA

Facility

$884.00

Service Code	HCPCS L8699
Hospital Charge Code	8046706
Hospital Revenue Code	278
Min. Negotiated Rate	$397.80
Max. Negotiated Rate	$795.60
Rate for Payer: Aetna of IA Commercial	$795.60
Rate for Payer: Aetna of IA Medical Rental Products	$795.60
Rate for Payer: Aetna of IA Medicare	$503.88
Rate for Payer: Amerigroup Medicaid	$509.89
Rate for Payer: Amerigroup Medicare	$401.78
Rate for Payer: Cash Price	$707.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$663.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$397.80
Rate for Payer: Iowa Total Care Managed Medicaid	$504.94
Rate for Payer: Medical Associates Commercial	$663.00
Rate for Payer: Medical Associates Managed Medicare	$397.80
Rate for Payer: Midlands Choice Commercial	$618.80
Rate for Payer: Molina Healthcare Managed Medicaid	$512.37
Rate for Payer: Partners Health Alliance Commercial	$457.47
Rate for Payer: United Healthcare Commercial	$795.60
Rate for Payer: United Healthcare Managed Medicare	$521.56

PLATE 5 HOLE SM FRAGMENT

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	8047015
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Aetna of IA Medicare	$74.10
Rate for Payer: Amerigroup Medicaid	$74.98
Rate for Payer: Amerigroup Medicare	$59.09
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.50
Rate for Payer: Iowa Total Care Managed Medicaid	$74.26
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Medical Associates Managed Medicare	$58.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: Molina Healthcare Managed Medicaid	$75.35
Rate for Payer: Partners Health Alliance Commercial	$67.28
Rate for Payer: United Healthcare Commercial	$117.00
Rate for Payer: United Healthcare Managed Medicare	$76.70

PLATE 5 HOLE SM FRAGMENT

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	8047015
Hospital Revenue Code	278
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: United Healthcare Commercial	$117.00

PLATE 5TH MET HOOK LEFT

Facility

$2,070.00

Service Code	HCPCS L8699
Hospital Charge Code	8793247
Hospital Revenue Code	278
Min. Negotiated Rate	$1,449.00
Max. Negotiated Rate	$1,863.00
Rate for Payer: Aetna of IA Commercial	$1,863.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,863.00
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,552.50
Rate for Payer: Medical Associates Commercial	$1,552.50
Rate for Payer: Midlands Choice Commercial	$1,449.00
Rate for Payer: United Healthcare Commercial	$1,863.00

PLATE 5TH MET HOOK LEFT

Facility

$2,070.00

Service Code	HCPCS L8699
Hospital Charge Code	8793247
Hospital Revenue Code	278
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,863.00
Rate for Payer: Aetna of IA Commercial	$1,863.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,863.00
Rate for Payer: Aetna of IA Medicare	$1,179.90
Rate for Payer: Amerigroup Medicaid	$1,193.98
Rate for Payer: Amerigroup Medicare	$940.82
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,552.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$931.50
Rate for Payer: Iowa Total Care Managed Medicaid	$1,182.38
Rate for Payer: Medical Associates Commercial	$1,552.50
Rate for Payer: Medical Associates Managed Medicare	$931.50
Rate for Payer: Midlands Choice Commercial	$1,449.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,199.77
Rate for Payer: Partners Health Alliance Commercial	$1,071.22
Rate for Payer: United Healthcare Commercial	$1,863.00
Rate for Payer: United Healthcare Managed Medicare	$1,221.30

PLATE 6 HOLE DYNAMIC COMP

Facility

$254.00

Service Code	HCPCS C1713
Hospital Charge Code	8046314
Hospital Revenue Code	278
Min. Negotiated Rate	$177.80
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of IA Commercial	$228.60
Rate for Payer: Aetna of IA Medical Rental Products	$228.60
Rate for Payer: Cash Price	$203.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$190.50
Rate for Payer: Medical Associates Commercial	$190.50
Rate for Payer: Midlands Choice Commercial	$177.80
Rate for Payer: United Healthcare Commercial	$228.60

PLATE 6 HOLE DYNAMIC COMP

Facility

$254.00

Service Code	HCPCS C1713
Hospital Charge Code	8046314
Hospital Revenue Code	278
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of IA Commercial	$228.60
Rate for Payer: Aetna of IA Medical Rental Products	$228.60
Rate for Payer: Aetna of IA Medicare	$144.78
Rate for Payer: Amerigroup Medicaid	$146.51
Rate for Payer: Amerigroup Medicare	$115.44
Rate for Payer: Cash Price	$203.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$190.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$114.30
Rate for Payer: Iowa Total Care Managed Medicaid	$145.08
Rate for Payer: Medical Associates Commercial	$190.50
Rate for Payer: Medical Associates Managed Medicare	$114.30
Rate for Payer: Midlands Choice Commercial	$177.80
Rate for Payer: Molina Healthcare Managed Medicaid	$147.22
Rate for Payer: Partners Health Alliance Commercial	$131.44
Rate for Payer: United Healthcare Commercial	$228.60
Rate for Payer: United Healthcare Managed Medicare	$149.86

PLATE 6 HOLE SM FRAGMENT

Facility

$129.00

Service Code	HCPCS C1713
Hospital Charge Code	8046719
Hospital Revenue Code	278
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11

PLATE 6 HOLE SM FRAGMENT

Facility

$129.00

Service Code	HCPCS C1713
Hospital Charge Code	8046719
Hospital Revenue Code	278
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

PLATE 7 HOLE DYNAMIC COMP

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	8046393
Hospital Revenue Code	278
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

PLATE 7 HOLE DYNAMIC COMP

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	8046393
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25

PLATE 7 HOLE SM FRAGMENT

Facility

$129.00

Service Code	HCPCS Q4107
Hospital Charge Code	8046723
Hospital Revenue Code	278
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11

PLATE 7 HOLE SM FRAGMENT

Facility

$129.00

Service Code	HCPCS Q4107
Hospital Charge Code	8046723
Hospital Revenue Code	278
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

PLATE 8 HOLE DYNAMIC COMP

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	8046318
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25

PLATE 8 HOLE DYNAMIC COMP

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	8046318
Hospital Revenue Code	278
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

PLATE 8 HOLE SM FRAGMENT

Facility

$134.00

Service Code	HCPCS C1713
Hospital Charge Code	8046720
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna of IA Commercial	$120.60
Rate for Payer: Aetna of IA Medical Rental Products	$120.60
Rate for Payer: Cash Price	$107.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$100.50
Rate for Payer: Medical Associates Commercial	$100.50
Rate for Payer: Midlands Choice Commercial	$93.80
Rate for Payer: United Healthcare Commercial	$120.60

PLATE 8 HOLE SM FRAGMENT

Facility

$134.00

Service Code	HCPCS C1713
Hospital Charge Code	8046720
Hospital Revenue Code	278
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna of IA Commercial	$120.60
Rate for Payer: Aetna of IA Medical Rental Products	$120.60
Rate for Payer: Aetna of IA Medicare	$76.38
Rate for Payer: Amerigroup Medicaid	$77.29
Rate for Payer: Amerigroup Medicare	$60.90
Rate for Payer: Cash Price	$107.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$100.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.30
Rate for Payer: Iowa Total Care Managed Medicaid	$76.54
Rate for Payer: Medical Associates Commercial	$100.50
Rate for Payer: Medical Associates Managed Medicare	$60.30
Rate for Payer: Midlands Choice Commercial	$93.80
Rate for Payer: Molina Healthcare Managed Medicaid	$77.67
Rate for Payer: Partners Health Alliance Commercial	$69.34
Rate for Payer: United Healthcare Commercial	$120.60
Rate for Payer: United Healthcare Managed Medicare	$79.06

PLATE AXSOS COMPRESSION LOCKING 10HOLE

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	8046734
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of IA Commercial	$189.00
Rate for Payer: Aetna of IA Medical Rental Products	$189.00
Rate for Payer: Aetna of IA Medicare	$119.70
Rate for Payer: Amerigroup Medicaid	$121.13
Rate for Payer: Amerigroup Medicare	$95.44
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$157.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$94.50
Rate for Payer: Iowa Total Care Managed Medicaid	$119.95
Rate for Payer: Medical Associates Commercial	$157.50
Rate for Payer: Medical Associates Managed Medicare	$94.50
Rate for Payer: Midlands Choice Commercial	$147.00
Rate for Payer: Molina Healthcare Managed Medicaid	$121.72
Rate for Payer: Partners Health Alliance Commercial	$108.67
Rate for Payer: United Healthcare Commercial	$189.00
Rate for Payer: United Healthcare Managed Medicare	$123.90

PLATE AXSOS COMPRESSION LOCKING 10HOLE

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	8046734
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of IA Commercial	$189.00
Rate for Payer: Aetna of IA Medical Rental Products	$189.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$157.50
Rate for Payer: Medical Associates Commercial	$157.50
Rate for Payer: Midlands Choice Commercial	$147.00
Rate for Payer: United Healthcare Commercial	$189.00

PLATE AXSOS COMPRESSION LOCKING 4 HOLE

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	8046730
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of IA Commercial	$130.50
Rate for Payer: Aetna of IA Medical Rental Products	$130.50
Rate for Payer: Aetna of IA Medicare	$82.65
Rate for Payer: Amerigroup Medicaid	$83.64
Rate for Payer: Amerigroup Medicare	$65.90
Rate for Payer: Cash Price	$116.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$65.25
Rate for Payer: Iowa Total Care Managed Medicaid	$82.82
Rate for Payer: Medical Associates Commercial	$108.75
Rate for Payer: Medical Associates Managed Medicare	$65.25
Rate for Payer: Midlands Choice Commercial	$101.50
Rate for Payer: Molina Healthcare Managed Medicaid	$84.04
Rate for Payer: Partners Health Alliance Commercial	$75.04
Rate for Payer: United Healthcare Commercial	$130.50
Rate for Payer: United Healthcare Managed Medicare	$85.55

PLATE AXSOS COMPRESSION LOCKING 4 HOLE

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	8046730
Hospital Revenue Code	278
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of IA Commercial	$130.50
Rate for Payer: Aetna of IA Medical Rental Products	$130.50
Rate for Payer: Cash Price	$116.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.75
Rate for Payer: Medical Associates Commercial	$108.75
Rate for Payer: Midlands Choice Commercial	$101.50
Rate for Payer: United Healthcare Commercial	$130.50

PLATE AXSOS COMPRESSION LOCKING 6 HOLE

Facility

$177.00

Service Code	HCPCS C1713
Hospital Charge Code	8046731
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: United Healthcare Commercial	$159.30

PLATE AXSOS COMPRESSION LOCKING 6 HOLE

Facility

$177.00

Service Code	HCPCS C1713
Hospital Charge Code	8046731
Hospital Revenue Code	278
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Aetna of IA Medicare	$100.89
Rate for Payer: Amerigroup Medicaid	$102.09
Rate for Payer: Amerigroup Medicare	$80.45
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.65
Rate for Payer: Iowa Total Care Managed Medicaid	$101.10
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Medical Associates Managed Medicare	$79.65
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: Molina Healthcare Managed Medicaid	$102.59
Rate for Payer: Partners Health Alliance Commercial	$91.60
Rate for Payer: United Healthcare Commercial	$159.30
Rate for Payer: United Healthcare Managed Medicare	$104.43

Know your out-of-pocket cost for care.

All Charges