Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANCELLOUS 4.0X40 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046608
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 4.0X45 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046609
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 4.0X45 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046609
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 4.0X50 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046610
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 4.0X50 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046610
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 4.0X55 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046611
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 4.0X55 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046611
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 4.0X60 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046612
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 4.0X60 PART THREADED

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046612
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 6.5 X 100MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046543
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 100MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046543
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 100MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046557
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 100MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046557
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 105MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046544
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 105MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046544
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 105MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046558
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 105MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046558
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 110MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046545
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 110MM 16MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046545
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 110MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046559
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 110MM 32MMT/L

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046559
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 200MM FULL THREAD

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046560
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: United Healthcare Commercial	$42.30

SCREW CANCELLOUS 6.5 X 200MM FULL THREAD

Facility

$47.00

Service Code	HCPCS C1713
Hospital Charge Code	8046560
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of IA Commercial	$42.30
Rate for Payer: Aetna of IA Medical Rental Products	$42.30
Rate for Payer: Aetna of IA Medicare	$26.79
Rate for Payer: Amerigroup Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$21.36
Rate for Payer: Cash Price	$37.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26.85
Rate for Payer: Medical Associates Commercial	$35.25
Rate for Payer: Medical Associates Managed Medicare	$21.15
Rate for Payer: Midlands Choice Commercial	$32.90
Rate for Payer: Molina Healthcare Managed Medicaid	$27.24
Rate for Payer: Partners Health Alliance Commercial	$24.32
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Managed Medicare	$27.73

SCREW CANCELLOUS 6.5 X 25MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046561
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 25MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046561
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

Know your out-of-pocket cost for care.

All Charges