Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED ASNIS III 4.0X44MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046455
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X46MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046456
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X46MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046456
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X48MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046457
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X48MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046457
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X50MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046458
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X50MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046458
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X55MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046459
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X55MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046459
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X60MM

Facility

$203.00

Service Code	HCPCS C1713
Hospital Charge Code	8046460
Hospital Revenue Code	278
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of IA Commercial	$182.70
Rate for Payer: Aetna of IA Medical Rental Products	$182.70
Rate for Payer: Cash Price	$162.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$152.25
Rate for Payer: Medical Associates Commercial	$152.25
Rate for Payer: Midlands Choice Commercial	$142.10
Rate for Payer: United Healthcare Commercial	$182.70

SCREW CANNULATED ASNIS III 4.0X60MM

Facility

$203.00

Service Code	HCPCS C1713
Hospital Charge Code	8046460
Hospital Revenue Code	278
Min. Negotiated Rate	$91.35
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of IA Commercial	$182.70
Rate for Payer: Aetna of IA Medical Rental Products	$182.70
Rate for Payer: Aetna of IA Medicare	$115.71
Rate for Payer: Amerigroup Medicaid	$117.09
Rate for Payer: Amerigroup Medicare	$92.26
Rate for Payer: Cash Price	$162.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$152.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$91.35
Rate for Payer: Iowa Total Care Managed Medicaid	$115.95
Rate for Payer: Medical Associates Commercial	$152.25
Rate for Payer: Medical Associates Managed Medicare	$91.35
Rate for Payer: Midlands Choice Commercial	$142.10
Rate for Payer: Molina Healthcare Managed Medicaid	$117.66
Rate for Payer: Partners Health Alliance Commercial	$105.05
Rate for Payer: United Healthcare Commercial	$182.70
Rate for Payer: United Healthcare Managed Medicare	$119.77

SCREW CANNULATED HEADED 3.5X26MM

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	8047364
Hospital Revenue Code	278
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of IA Commercial	$336.60
Rate for Payer: Aetna of IA Medical Rental Products	$336.60
Rate for Payer: Aetna of IA Medicare	$213.18
Rate for Payer: Amerigroup Medicaid	$215.72
Rate for Payer: Amerigroup Medicare	$169.98
Rate for Payer: Cash Price	$299.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$280.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$168.30
Rate for Payer: Iowa Total Care Managed Medicaid	$213.63
Rate for Payer: Medical Associates Commercial	$280.50
Rate for Payer: Medical Associates Managed Medicare	$168.30
Rate for Payer: Midlands Choice Commercial	$261.80
Rate for Payer: Molina Healthcare Managed Medicaid	$216.77
Rate for Payer: Partners Health Alliance Commercial	$193.54
Rate for Payer: United Healthcare Commercial	$336.60
Rate for Payer: United Healthcare Managed Medicare	$220.66

SCREW CANNULATED HEADED 3.5X26MM

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	8047364
Hospital Revenue Code	278
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of IA Commercial	$336.60
Rate for Payer: Aetna of IA Medical Rental Products	$336.60
Rate for Payer: Cash Price	$299.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$280.50
Rate for Payer: Medical Associates Commercial	$280.50
Rate for Payer: Midlands Choice Commercial	$261.80
Rate for Payer: United Healthcare Commercial	$336.60

SCREW CANNULATED LAG, 4.5MM X 20MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047179
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 20MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047179
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 20MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047180
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 20MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047180
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 22MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047181
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 22MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047181
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 22MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047182
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 22MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047182
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 24MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047183
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 24MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047183
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 24MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047184
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 24MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047184
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Know your out-of-pocket cost for care.

All Charges