Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SUTURETAK KIT

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8026399
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

SUTURETAK KIT

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8026399
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

SUTURETAK KIT 2.4

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8026416
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

SUTURETAK KIT 2.4

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8026416
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

SUTURETAK KIT 3.0

Facility

$288.00

Service Code	HCPCS L8699
Hospital Charge Code	8026419
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$259.20
Rate for Payer: Aetna of IA Commercial	$259.20
Rate for Payer: Aetna of IA Medical Rental Products	$259.20
Rate for Payer: Cash Price	$230.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$216.00
Rate for Payer: Medical Associates Commercial	$216.00
Rate for Payer: Midlands Choice Commercial	$201.60
Rate for Payer: United Healthcare Commercial	$259.20

SUTURETAK KIT 3.0

Facility

$288.00

Service Code	HCPCS L8699
Hospital Charge Code	8026419
Hospital Revenue Code	278
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$259.20
Rate for Payer: Aetna of IA Commercial	$259.20
Rate for Payer: Aetna of IA Medical Rental Products	$259.20
Rate for Payer: Aetna of IA Medicare	$164.16
Rate for Payer: Amerigroup Medicaid	$166.12
Rate for Payer: Amerigroup Medicare	$130.90
Rate for Payer: Cash Price	$230.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$216.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$129.60
Rate for Payer: Iowa Total Care Managed Medicaid	$164.51
Rate for Payer: Medical Associates Commercial	$216.00
Rate for Payer: Medical Associates Managed Medicare	$129.60
Rate for Payer: Midlands Choice Commercial	$201.60
Rate for Payer: Molina Healthcare Managed Medicaid	$166.92
Rate for Payer: Partners Health Alliance Commercial	$149.04
Rate for Payer: United Healthcare Commercial	$259.20
Rate for Payer: United Healthcare Managed Medicare	$169.92

SUTURETAK PERCUTA

Facility

$351.00

Service Code	HCPCS C1713
Hospital Charge Code	8047065
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

SUTURETAK PERCUTA

Facility

$351.00

Service Code	HCPCS C1713
Hospital Charge Code	8047065
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

SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE

Facility

$90.00

Service Code	HCPCS C1713
Hospital Charge Code	8771314
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of IA Commercial	$81.00
Rate for Payer: Aetna of IA Medical Rental Products	$81.00
Rate for Payer: Aetna of IA Medicare	$51.30
Rate for Payer: Amerigroup Medicaid	$51.91
Rate for Payer: Amerigroup Medicare	$40.91
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$67.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.50
Rate for Payer: Iowa Total Care Managed Medicaid	$51.41
Rate for Payer: Medical Associates Commercial	$67.50
Rate for Payer: Medical Associates Managed Medicare	$40.50
Rate for Payer: Midlands Choice Commercial	$63.00
Rate for Payer: Molina Healthcare Managed Medicaid	$52.16
Rate for Payer: Partners Health Alliance Commercial	$46.58
Rate for Payer: United Healthcare Commercial	$81.00
Rate for Payer: United Healthcare Managed Medicare	$53.10

SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE

Facility

$90.00

Service Code	HCPCS C1713
Hospital Charge Code	8771314
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of IA Commercial	$81.00
Rate for Payer: Aetna of IA Medical Rental Products	$81.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$67.50
Rate for Payer: Medical Associates Commercial	$67.50
Rate for Payer: Midlands Choice Commercial	$63.00
Rate for Payer: United Healthcare Commercial	$81.00

SWALLOW FUNCTION EVAL

Facility

$230.00

Service Code	CPT 92610 GN
Hospital Charge Code	8000750
Hospital Revenue Code	444
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: United Healthcare Commercial	$207.00

SWALLOW FUNCTION EVAL

Facility

$230.00

Service Code	CPT 92610 GN
Hospital Charge Code	8000750
Hospital Revenue Code	444
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$131.10
Rate for Payer: Amerigroup Medicaid	$132.66
Rate for Payer: Amerigroup Medicare	$104.53
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$103.50
Rate for Payer: Iowa Total Care Managed Medicaid	$131.38
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$103.50
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicaid	$133.31
Rate for Payer: Partners Health Alliance Commercial	$119.03
Rate for Payer: United Healthcare Commercial	$207.00
Rate for Payer: United Healthcare Managed Medicare	$135.70

SWALLOW /ORAL FUNCT TREATMENT

Facility

$170.00

Service Code	CPT 92526 GN
Hospital Charge Code	5534782
Hospital Revenue Code	440
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Aetna of IA Medicare	$96.90
Rate for Payer: Amerigroup Medicaid	$98.06
Rate for Payer: Amerigroup Medicare	$77.27
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.50
Rate for Payer: Iowa Total Care Managed Medicaid	$97.10
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Medical Associates Managed Medicare	$76.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: Molina Healthcare Managed Medicaid	$98.53
Rate for Payer: Partners Health Alliance Commercial	$87.97
Rate for Payer: United Healthcare Commercial	$153.00
Rate for Payer: United Healthcare Managed Medicare	$100.30

SWALLOW /ORAL FUNCT TREATMENT

Facility

$170.00

Service Code	CPT 92526 GN
Hospital Charge Code	5534782
Hospital Revenue Code	440
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: United Healthcare Commercial	$153.00

SYNDESMOTIC FIXATION KIT

Facility

$2,457.00

Service Code	HCPCS C1713
Hospital Charge Code	8943981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,719.90
Max. Negotiated Rate	$2,211.30
Rate for Payer: Aetna of IA Commercial	$2,211.30
Rate for Payer: Aetna of IA Medical Rental Products	$2,211.30
Rate for Payer: Cash Price	$1,965.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,842.75
Rate for Payer: Medical Associates Commercial	$1,842.75
Rate for Payer: Midlands Choice Commercial	$1,719.90
Rate for Payer: United Healthcare Commercial	$2,211.30

SYNDESMOTIC FIXATION KIT

Facility

$2,457.00

Service Code	HCPCS C1713
Hospital Charge Code	8943981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,105.65
Max. Negotiated Rate	$2,211.30
Rate for Payer: Aetna of IA Commercial	$2,211.30
Rate for Payer: Aetna of IA Medical Rental Products	$2,211.30
Rate for Payer: Aetna of IA Medicare	$1,400.49
Rate for Payer: Amerigroup Medicaid	$1,417.20
Rate for Payer: Amerigroup Medicare	$1,116.71
Rate for Payer: Cash Price	$1,965.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,842.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,105.65
Rate for Payer: Iowa Total Care Managed Medicaid	$1,403.44
Rate for Payer: Medical Associates Commercial	$1,842.75
Rate for Payer: Medical Associates Managed Medicare	$1,105.65
Rate for Payer: Midlands Choice Commercial	$1,719.90
Rate for Payer: Molina Healthcare Managed Medicaid	$1,424.08
Rate for Payer: Partners Health Alliance Commercial	$1,271.50
Rate for Payer: United Healthcare Commercial	$2,211.30
Rate for Payer: United Healthcare Managed Medicare	$1,449.63

T3 Free DMCL

Facility

$161.00

Service Code	CPT 84481
Hospital Charge Code	8037804
Hospital Revenue Code	301
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: United Healthcare Commercial	$144.90

T3 Free DMCL

Facility

$161.00

Service Code	CPT 84481
Hospital Charge Code	8037804
Hospital Revenue Code	301
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Aetna of IA Medicare	$91.77
Rate for Payer: Amerigroup Medicaid	$92.86
Rate for Payer: Amerigroup Medicare	$73.17
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.45
Rate for Payer: Iowa Total Care Managed Medicaid	$91.96
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Medical Associates Managed Medicare	$72.45
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Molina Healthcare Managed Medicaid	$93.32
Rate for Payer: Partners Health Alliance Commercial	$83.32
Rate for Payer: United Healthcare Commercial	$144.90
Rate for Payer: United Healthcare Managed Medicare	$94.99

T3 Reverse DMCL

Facility

$129.00

Service Code	CPT 84482
Hospital Charge Code	8037805
Hospital Revenue Code	301
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11

T3 Reverse DMCL

Facility

$129.00

Service Code	CPT 84482
Hospital Charge Code	8037805
Hospital Revenue Code	301
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

T3 Total DMCL

Facility

$104.00

Service Code	CPT 84480
Hospital Charge Code	8037806
Hospital Revenue Code	301
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

T3 Total DMCL

Facility

$104.00

Service Code	CPT 84480
Hospital Charge Code	8037806
Hospital Revenue Code	301
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

Facility

$65.00

Service Code	CPT 84436
Hospital Charge Code	7928767
Hospital Revenue Code	301
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: United Healthcare Commercial	$58.50

Facility

$65.00

Service Code	CPT 84436
Hospital Charge Code	7928767
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Aetna of IA Medicare	$37.05
Rate for Payer: Amerigroup Medicaid	$37.49
Rate for Payer: Amerigroup Medicare	$29.54
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.25
Rate for Payer: Iowa Total Care Managed Medicaid	$37.13
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Medical Associates Managed Medicare	$29.25
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: Molina Healthcare Managed Medicaid	$37.67
Rate for Payer: Partners Health Alliance Commercial	$33.64
Rate for Payer: United Healthcare Commercial	$58.50
Rate for Payer: United Healthcare Managed Medicare	$38.35

T4 FREE

Facility

$82.00

Service Code	CPT 84439
Hospital Charge Code	4021360
Hospital Revenue Code	301
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of IA Commercial	$73.80
Rate for Payer: Aetna of IA Medical Rental Products	$73.80
Rate for Payer: Aetna of IA Medicare	$46.74
Rate for Payer: Amerigroup Medicaid	$47.30
Rate for Payer: Amerigroup Medicare	$37.27
Rate for Payer: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$36.90
Rate for Payer: Iowa Total Care Managed Medicaid	$46.84
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Medical Associates Managed Medicare	$36.90
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: Molina Healthcare Managed Medicaid	$47.53
Rate for Payer: Partners Health Alliance Commercial	$42.44
Rate for Payer: United Healthcare Commercial	$73.80
Rate for Payer: United Healthcare Managed Medicare	$48.38

Know your out-of-pocket cost for care.

All Charges