Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

PIN STEINMANN 9X.079 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8026279
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

PIN STEINMANN 9X.110 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8026226
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

PIN STEINMANN 9X.110 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8026226
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

PIN STEINMANN 9X.126 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046464
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

PIN STEINMANN 9X.126 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046464
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04

PIN STEINMANN 9X.126 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046940
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

PIN STEINMANN 9X.126 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046940
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

PIN STEINMANN 9X.142 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046466
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04

PIN STEINMANN 9X.142 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046466
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

PIN STEINMANN 9X.142 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046959
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

PIN STEINMANN 9X.142 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046959
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

PIN STEINMANN 9X.157 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046243
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04

PIN STEINMANN 9X.157 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8046243
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

PIN STEINMANN 9X.157 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046400
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

PIN STEINMANN 9X.157 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046400
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

PIN STEINMANN 9X.189 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8047035
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

PIN STEINMANN 9X.189 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8047035
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04

PIN STEINMANN 9X.189 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046920
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: United Healthcare Commercial	$46.80

PIN STEINMANN 9X.189 TROCAR POINTS

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	8046920
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of IA Commercial	$46.80
Rate for Payer: Aetna of IA Medical Rental Products	$46.80
Rate for Payer: Aetna of IA Medicare	$29.64
Rate for Payer: Amerigroup Medicaid	$29.99
Rate for Payer: Amerigroup Medicare	$23.63
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.40
Rate for Payer: Iowa Total Care Managed Medicaid	$29.70
Rate for Payer: Medical Associates Commercial	$39.00
Rate for Payer: Medical Associates Managed Medicare	$23.40
Rate for Payer: Midlands Choice Commercial	$36.40
Rate for Payer: Molina Healthcare Managed Medicaid	$30.14
Rate for Payer: Partners Health Alliance Commercial	$26.91
Rate for Payer: United Healthcare Commercial	$46.80
Rate for Payer: United Healthcare Managed Medicare	$30.68

PIN STEINMANN 9X9.094 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8026109
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Aetna of IA Medicare	$31.92
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$25.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.20
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Medical Associates Managed Medicare	$25.20
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: Molina Healthcare Managed Medicaid	$32.46
Rate for Payer: Partners Health Alliance Commercial	$28.98
Rate for Payer: United Healthcare Commercial	$50.40
Rate for Payer: United Healthcare Managed Medicare	$33.04

PIN STEINMANN 9X9.094 DIAMOND POINT

Facility

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	8026109
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of IA Commercial	$50.40
Rate for Payer: Aetna of IA Medical Rental Products	$50.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.00
Rate for Payer: Medical Associates Commercial	$42.00
Rate for Payer: Midlands Choice Commercial	$39.20
Rate for Payer: United Healthcare Commercial	$50.40

pioglitazone 15 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10413715
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
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	$0.73
Rate for Payer: Amerigroup Medicaid	$0.74
Rate for Payer: Amerigroup Medicare	$0.58
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.96
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.58
Rate for Payer: Iowa Total Care Managed Medicaid	$0.73
Rate for Payer: Medical Associates Commercial	$0.96
Rate for Payer: Medical Associates Managed Medicare	$0.58
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: Molina Healthcare Managed Medicaid	$0.74
Rate for Payer: Partners Health Alliance Commercial	$0.67
Rate for Payer: United Healthcare Commercial	$1.16
Rate for Payer: United Healthcare Managed Medicare	$0.76

pioglitazone 15 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10413715
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	$0.96
Rate for Payer: Medical Associates Commercial	$0.96
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]

Facility

$31.00

Service Code	HCPCS J2543
Hospital Charge Code	10413786
Hospital Revenue Code	259
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]

Facility

$31.00

Service Code	HCPCS J2543
Hospital Charge Code	10413786
Hospital Revenue Code	259
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$17.88
Rate for Payer: Amerigroup Medicare	$14.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.95
Rate for Payer: Iowa Total Care Managed Medicaid	$17.71
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$13.95
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$17.97
Rate for Payer: Partners Health Alliance Commercial	$16.04
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

Know your out-of-pocket cost for care.

All Charges