Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ADM IM SCHEDULED ADDITIONAL

Facility

$66.00

Service Code	CPT 96372 59
Hospital Charge Code	8012945
Hospital Revenue Code	761
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Aetna of IA Medicare	$37.62
Rate for Payer: Amerigroup Medicaid	$38.07
Rate for Payer: Amerigroup Medicare	$30.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.70
Rate for Payer: Iowa Total Care Managed Medicaid	$37.70
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Medical Associates Managed Medicare	$29.70
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: Molina Healthcare Managed Medicaid	$38.25
Rate for Payer: Partners Health Alliance Commercial	$34.16
Rate for Payer: United Healthcare Commercial	$59.40
Rate for Payer: United Healthcare Managed Medicare	$38.94

ADM IM SCHEDULED ADDITIONAL

Facility

$66.00

Service Code	CPT 96372 59
Hospital Charge Code	8012945
Hospital Revenue Code	761
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: United Healthcare Commercial	$59.40

ADMIN FLU VACCINE

Facility

$45.00

Service Code	HCPCS G0008
Hospital Charge Code	8012757
Hospital Revenue Code	771
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: United Healthcare Commercial	$40.50

ADMIN FLU VACCINE

Facility

$45.00

Service Code	HCPCS G0008
Hospital Charge Code	8012757
Hospital Revenue Code	771
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Aetna of IA Medicare	$25.65
Rate for Payer: Amerigroup Medicaid	$25.96
Rate for Payer: Amerigroup Medicare	$20.45
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.25
Rate for Payer: Iowa Total Care Managed Medicaid	$25.70
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Medical Associates Managed Medicare	$20.25
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: Molina Healthcare Managed Medicaid	$26.08
Rate for Payer: Partners Health Alliance Commercial	$23.29
Rate for Payer: United Healthcare Commercial	$40.50
Rate for Payer: United Healthcare Managed Medicare	$26.55

ADMINISTER IM CHARGE

Professional

Both

$45.00

Service Code	CPT 96372
Hospital Charge Code	8068907
Hospital Revenue Code	983
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$33.75
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: Partners Health Alliance Commercial	$33.75
Rate for Payer: United Healthcare Commercial	$21.58

ADMIN PNEUMOVAC VACCINE

Facility

$15.00

Service Code	HCPCS G0009
Hospital Charge Code	8012758
Hospital Revenue Code	771
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of IA Commercial	$13.50
Rate for Payer: Aetna of IA Medical Rental Products	$13.50
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.25
Rate for Payer: Medical Associates Commercial	$11.25
Rate for Payer: Midlands Choice Commercial	$10.50
Rate for Payer: United Healthcare Commercial	$13.50

ADMIN PNEUMOVAC VACCINE

Facility

$15.00

Service Code	HCPCS G0009
Hospital Charge Code	8012758
Hospital Revenue Code	771
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of IA Commercial	$13.50
Rate for Payer: Aetna of IA Medical Rental Products	$13.50
Rate for Payer: Aetna of IA Medicare	$8.55
Rate for Payer: Amerigroup Medicaid	$8.65
Rate for Payer: Amerigroup Medicare	$6.82
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.75
Rate for Payer: Iowa Total Care Managed Medicaid	$8.57
Rate for Payer: Medical Associates Commercial	$11.25
Rate for Payer: Medical Associates Managed Medicare	$6.75
Rate for Payer: Midlands Choice Commercial	$10.50
Rate for Payer: Molina Healthcare Managed Medicaid	$8.69
Rate for Payer: Partners Health Alliance Commercial	$7.76
Rate for Payer: United Healthcare Commercial	$13.50
Rate for Payer: United Healthcare Managed Medicare	$8.85

ADM IVP EA ADDL SEQ SAME MED

Facility

$44.00

Service Code	CPT 96376
Hospital Charge Code	6922830
Hospital Revenue Code	260
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Aetna of IA Medicare	$25.08
Rate for Payer: Amerigroup Medicaid	$25.38
Rate for Payer: Amerigroup Medicare	$20.00
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$19.80
Rate for Payer: Iowa Total Care Managed Medicaid	$25.13
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Medical Associates Managed Medicare	$19.80
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: Molina Healthcare Managed Medicaid	$25.50
Rate for Payer: Partners Health Alliance Commercial	$22.77
Rate for Payer: United Healthcare Commercial	$39.60
Rate for Payer: United Healthcare Managed Medicare	$25.96

ADM IVP EA ADDL SEQ SAME MED

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	7984748
Hospital Revenue Code	260
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Aetna of IA Medicare	$26.22
Rate for Payer: Amerigroup Medicaid	$26.53
Rate for Payer: Amerigroup Medicare	$20.91
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.70
Rate for Payer: Iowa Total Care Managed Medicaid	$26.28
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Medical Associates Managed Medicare	$20.70
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: Molina Healthcare Managed Medicaid	$26.66
Rate for Payer: Partners Health Alliance Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$41.40
Rate for Payer: United Healthcare Managed Medicare	$27.14

ADM IVP EA ADDL SEQ SAME MED

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	4866828
Hospital Revenue Code	761
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Aetna of IA Medicare	$26.22
Rate for Payer: Amerigroup Medicaid	$26.53
Rate for Payer: Amerigroup Medicare	$20.91
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.70
Rate for Payer: Iowa Total Care Managed Medicaid	$26.28
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Medical Associates Managed Medicare	$20.70
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: Molina Healthcare Managed Medicaid	$26.66
Rate for Payer: Partners Health Alliance Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$41.40
Rate for Payer: United Healthcare Managed Medicare	$27.14

ADM IVP EA ADDL SEQ SAME MED

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	7984748
Hospital Revenue Code	260
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: United Healthcare Commercial	$41.40

ADM IVP EA ADDL SEQ SAME MED

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	4866828
Hospital Revenue Code	761
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: United Healthcare Commercial	$41.40

ADM IVP EA ADDL SEQ SAME MED

Facility

$44.00

Service Code	CPT 96376
Hospital Charge Code	6922830
Hospital Revenue Code	260
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of IA Commercial	$39.60
Rate for Payer: Aetna of IA Medical Rental Products	$39.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.00
Rate for Payer: Medical Associates Commercial	$33.00
Rate for Payer: Midlands Choice Commercial	$30.80
Rate for Payer: United Healthcare Commercial	$39.60

ADM IVP EA ADL SEQ SAME MED SC

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	8012942
Hospital Revenue Code	761
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Aetna of IA Medicare	$26.22
Rate for Payer: Amerigroup Medicaid	$26.53
Rate for Payer: Amerigroup Medicare	$20.91
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.70
Rate for Payer: Iowa Total Care Managed Medicaid	$26.28
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Medical Associates Managed Medicare	$20.70
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: Molina Healthcare Managed Medicaid	$26.66
Rate for Payer: Partners Health Alliance Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$41.40
Rate for Payer: United Healthcare Managed Medicare	$27.14

ADM IVP EA ADL SEQ SAME MED SC

Facility

$46.00

Service Code	CPT 96376
Hospital Charge Code	8012942
Hospital Revenue Code	761
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: United Healthcare Commercial	$41.40

ADM IVP TX

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	4866832
Hospital Revenue Code	260
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: United Healthcare Commercial	$97.20

ADM IVP TX

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	6922828
Hospital Revenue Code	260
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$62.29
Rate for Payer: Amerigroup Medicare	$49.09
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$48.60
Rate for Payer: Iowa Total Care Managed Medicaid	$61.69
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$48.60
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$62.60
Rate for Payer: Partners Health Alliance Commercial	$55.89
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

ADM IVP TX

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	4866832
Hospital Revenue Code	260
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$62.29
Rate for Payer: Amerigroup Medicare	$49.09
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$48.60
Rate for Payer: Iowa Total Care Managed Medicaid	$61.69
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$48.60
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$62.60
Rate for Payer: Partners Health Alliance Commercial	$55.89
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

ADM IVP TX

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	6922828
Hospital Revenue Code	260
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: United Healthcare Commercial	$97.20

ADM IVP TX EA ADD'L MED

Facility

$64.00

Service Code	CPT 96375
Hospital Charge Code	4866830
Hospital Revenue Code	260
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: United Healthcare Commercial	$57.60

ADM IVP TX EA ADD'L MED

Facility

$64.00

Service Code	CPT 96375
Hospital Charge Code	6922829
Hospital Revenue Code	260
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Aetna of IA Medicare	$36.48
Rate for Payer: Amerigroup Medicaid	$36.92
Rate for Payer: Amerigroup Medicare	$29.09
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.80
Rate for Payer: Iowa Total Care Managed Medicaid	$36.56
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Medical Associates Managed Medicare	$28.80
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: Molina Healthcare Managed Medicaid	$37.09
Rate for Payer: Partners Health Alliance Commercial	$33.12
Rate for Payer: United Healthcare Commercial	$57.60
Rate for Payer: United Healthcare Managed Medicare	$37.76

ADM IVP TX EA ADD'L MED

Facility

$64.00

Service Code	CPT 96375
Hospital Charge Code	4866830
Hospital Revenue Code	260
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Aetna of IA Medicare	$36.48
Rate for Payer: Amerigroup Medicaid	$36.92
Rate for Payer: Amerigroup Medicare	$29.09
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.80
Rate for Payer: Iowa Total Care Managed Medicaid	$36.56
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Medical Associates Managed Medicare	$28.80
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: Molina Healthcare Managed Medicaid	$37.09
Rate for Payer: Partners Health Alliance Commercial	$33.12
Rate for Payer: United Healthcare Commercial	$57.60
Rate for Payer: United Healthcare Managed Medicare	$37.76

ADM IVP TX EA ADD'L MED

Facility

$64.00

Service Code	CPT 96375
Hospital Charge Code	6922829
Hospital Revenue Code	260
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: United Healthcare Commercial	$57.60

ADM IVP TX, SCHEDULED

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	8012940
Hospital Revenue Code	761
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Aetna of IA Medicare	$61.56
Rate for Payer: Amerigroup Medicaid	$62.29
Rate for Payer: Amerigroup Medicare	$49.09
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$48.60
Rate for Payer: Iowa Total Care Managed Medicaid	$61.69
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Medical Associates Managed Medicare	$48.60
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: Molina Healthcare Managed Medicaid	$62.60
Rate for Payer: Partners Health Alliance Commercial	$55.89
Rate for Payer: United Healthcare Commercial	$97.20
Rate for Payer: United Healthcare Managed Medicare	$63.72

ADM IVP TX, SCHEDULED

Facility

$108.00

Service Code	CPT 96374
Hospital Charge Code	8012940
Hospital Revenue Code	761
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of IA Commercial	$97.20
Rate for Payer: Aetna of IA Medical Rental Products	$97.20
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.00
Rate for Payer: Medical Associates Commercial	$81.00
Rate for Payer: Midlands Choice Commercial	$75.60
Rate for Payer: United Healthcare Commercial	$97.20

Know your out-of-pocket cost for care.

All Charges