Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW 2.2X18MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8815108
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND

Facility

$599.00

Service Code	HCPCS C1713
Hospital Charge Code	8047019
Hospital Revenue Code	278
Min. Negotiated Rate	$269.55
Max. Negotiated Rate	$539.10
Rate for Payer: Aetna of IA Commercial	$539.10
Rate for Payer: Aetna of IA Medical Rental Products	$539.10
Rate for Payer: Aetna of IA Medicare	$341.43
Rate for Payer: Amerigroup Medicaid	$345.50
Rate for Payer: Amerigroup Medicare	$272.25
Rate for Payer: Cash Price	$479.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$449.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$269.55
Rate for Payer: Iowa Total Care Managed Medicaid	$342.15
Rate for Payer: Medical Associates Commercial	$449.25
Rate for Payer: Medical Associates Managed Medicare	$269.55
Rate for Payer: Midlands Choice Commercial	$419.30
Rate for Payer: Molina Healthcare Managed Medicaid	$347.18
Rate for Payer: Partners Health Alliance Commercial	$309.98
Rate for Payer: United Healthcare Commercial	$539.10
Rate for Payer: United Healthcare Managed Medicare	$353.41

SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND

Facility

$599.00

Service Code	HCPCS C1713
Hospital Charge Code	8047019
Hospital Revenue Code	278
Min. Negotiated Rate	$419.30
Max. Negotiated Rate	$539.10
Rate for Payer: Aetna of IA Commercial	$539.10
Rate for Payer: Aetna of IA Medical Rental Products	$539.10
Rate for Payer: Cash Price	$479.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$449.25
Rate for Payer: Medical Associates Commercial	$449.25
Rate for Payer: Midlands Choice Commercial	$419.30
Rate for Payer: United Healthcare Commercial	$539.10

SCREW BONE 6.5MM X 50MM

Facility

$290.00

Service Code	HCPCS C1713
Hospital Charge Code	8047032
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of IA Commercial	$261.00
Rate for Payer: Aetna of IA Medical Rental Products	$261.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$217.50
Rate for Payer: Medical Associates Commercial	$217.50
Rate for Payer: Midlands Choice Commercial	$203.00
Rate for Payer: United Healthcare Commercial	$261.00

SCREW BONE 6.5MM X 50MM

Facility

$290.00

Service Code	HCPCS C1713
Hospital Charge Code	8047032
Hospital Revenue Code	278
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of IA Commercial	$261.00
Rate for Payer: Aetna of IA Medical Rental Products	$261.00
Rate for Payer: Aetna of IA Medicare	$165.30
Rate for Payer: Amerigroup Medicaid	$167.27
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$232.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$217.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$165.65
Rate for Payer: Medical Associates Commercial	$217.50
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$203.00
Rate for Payer: Molina Healthcare Managed Medicaid	$168.08
Rate for Payer: Partners Health Alliance Commercial	$150.08
Rate for Payer: United Healthcare Commercial	$261.00
Rate for Payer: United Healthcare Managed Medicare	$171.10

SCREW BONE T10 3.5X12MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046712
Hospital Revenue Code	278
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$59.99
Rate for Payer: Amerigroup Medicare	$47.27
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.80
Rate for Payer: Iowa Total Care Managed Medicaid	$59.40
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$46.80
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$60.28
Rate for Payer: Partners Health Alliance Commercial	$53.82
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T10 3.5X12MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046712
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T10 3.5X30MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046713
Hospital Revenue Code	278
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$59.99
Rate for Payer: Amerigroup Medicare	$47.27
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.80
Rate for Payer: Iowa Total Care Managed Medicaid	$59.40
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$46.80
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$60.28
Rate for Payer: Partners Health Alliance Commercial	$53.82
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T10 3.5X30MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046713
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T10 3.5X55MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046714
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T10 3.5X55MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8046714
Hospital Revenue Code	278
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$59.99
Rate for Payer: Amerigroup Medicare	$47.27
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.80
Rate for Payer: Iowa Total Care Managed Medicaid	$59.40
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$46.80
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$60.28
Rate for Payer: Partners Health Alliance Commercial	$53.82
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T7 2.7X14MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046809
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$48.45
Rate for Payer: Amerigroup Medicare	$38.18
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.80
Rate for Payer: Iowa Total Care Managed Medicaid	$47.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$37.80
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$48.69
Rate for Payer: Partners Health Alliance Commercial	$43.47
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW BONE T7 2.7X14MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046809
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW BONE T7 2.7X16MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046810
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$48.45
Rate for Payer: Amerigroup Medicare	$38.18
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.80
Rate for Payer: Iowa Total Care Managed Medicaid	$47.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$37.80
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$48.69
Rate for Payer: Partners Health Alliance Commercial	$43.47
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW BONE T7 2.7X16MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046810
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW BONE T7 2.7X18MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046811
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$48.45
Rate for Payer: Amerigroup Medicare	$38.18
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.80
Rate for Payer: Iowa Total Care Managed Medicaid	$47.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$37.80
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$48.69
Rate for Payer: Partners Health Alliance Commercial	$43.47
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW BONE T7 2.7X18MM

Facility

$84.00

Service Code	HCPCS C1713
Hospital Charge Code	8046811
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW CANCELLOUS

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046595
Hospital Revenue Code	278
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: United Healthcare Commercial	$21.60

SCREW CANCELLOUS

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046595
Hospital Revenue Code	278
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Aetna of IA Medicare	$13.68
Rate for Payer: Amerigroup Medicaid	$13.84
Rate for Payer: Amerigroup Medicare	$10.91
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.80
Rate for Payer: Iowa Total Care Managed Medicaid	$13.71
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Medical Associates Managed Medicare	$10.80
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: Molina Healthcare Managed Medicaid	$13.91
Rate for Payer: Partners Health Alliance Commercial	$12.42
Rate for Payer: United Healthcare Commercial	$21.60
Rate for Payer: United Healthcare Managed Medicare	$14.16

SCREW CANCELLOUS 3.0 X 10MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047083
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CANCELLOUS 3.0 X 10MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047083
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CANCELLOUS 3.0 X 12MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047084
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CANCELLOUS 3.0 X 12MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047084
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CANCELLOUS 3.0 X 14MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047085
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CANCELLOUS 3.0 X 14MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047085
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

Know your out-of-pocket cost for care.

All Charges