Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANN LAG 6.7MMX45MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047235
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 CANN LAG 6.7MMX50MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047236
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 CANN LAG 6.7MMX50MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047236
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX55MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047237
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 CANN LAG 6.7MMX55MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047237
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX60MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047238
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 CANN LAG 6.7MMX60MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047238
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX65MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047239
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 CANN LAG 6.7MMX65MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047239
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX70MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047240
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 CANN LAG 6.7MMX70MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047240
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX75MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047241
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 CANN LAG 6.7MMX75MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047241
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANN LAG 6.7MMX80MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047242
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 CANN LAG 6.7MMX80MM 18MM THREAD

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047242
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
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: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED 3.0 X 14MM

Facility

$351.00

Service Code	HCPCS C1713
Hospital Charge Code	8046301
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: United Healthcare Commercial	$315.90

SCREW CANNULATED 3.0 X 14MM

Facility

$351.00

Service Code	HCPCS C1713
Hospital Charge Code	8046301
Hospital Revenue Code	278
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Aetna of IA Medicare	$200.07
Rate for Payer: Amerigroup Medicaid	$202.46
Rate for Payer: Amerigroup Medicare	$159.53
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$157.95
Rate for Payer: Iowa Total Care Managed Medicaid	$200.49
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Medical Associates Managed Medicare	$157.95
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: Molina Healthcare Managed Medicaid	$203.44
Rate for Payer: Partners Health Alliance Commercial	$181.64
Rate for Payer: United Healthcare Commercial	$315.90
Rate for Payer: United Healthcare Managed Medicare	$207.09

SCREW CANNULATED 4.0 X 42

Facility

$369.00

Service Code	HCPCS C1713
Hospital Charge Code	8046303
Hospital Revenue Code	278
Min. Negotiated Rate	$166.05
Max. Negotiated Rate	$332.10
Rate for Payer: Aetna of IA Commercial	$332.10
Rate for Payer: Aetna of IA Medical Rental Products	$332.10
Rate for Payer: Aetna of IA Medicare	$210.33
Rate for Payer: Amerigroup Medicaid	$212.84
Rate for Payer: Amerigroup Medicare	$167.71
Rate for Payer: Cash Price	$295.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$276.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$166.05
Rate for Payer: Iowa Total Care Managed Medicaid	$210.77
Rate for Payer: Medical Associates Commercial	$276.75
Rate for Payer: Medical Associates Managed Medicare	$166.05
Rate for Payer: Midlands Choice Commercial	$258.30
Rate for Payer: Molina Healthcare Managed Medicaid	$213.87
Rate for Payer: Partners Health Alliance Commercial	$190.96
Rate for Payer: United Healthcare Commercial	$332.10
Rate for Payer: United Healthcare Managed Medicare	$217.71

SCREW CANNULATED 4.0 X 42

Facility

$369.00

Service Code	HCPCS C1713
Hospital Charge Code	8046303
Hospital Revenue Code	278
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$332.10
Rate for Payer: Aetna of IA Commercial	$332.10
Rate for Payer: Aetna of IA Medical Rental Products	$332.10
Rate for Payer: Cash Price	$295.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$276.75
Rate for Payer: Medical Associates Commercial	$276.75
Rate for Payer: Midlands Choice Commercial	$258.30
Rate for Payer: United Healthcare Commercial	$332.10

SCREW CANNULATED ASNIS III 4.0X14MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046440
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X14MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046440
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X16MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046441
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X16MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046441
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X18MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046442
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X18MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046442
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

Know your out-of-pocket cost for care.

All Charges