Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SUTURETAK PERCUTA

Facility

$351.00

Service Code	CPT C1713
Hospital Charge Code	8047065
Hospital Revenue Code	278
Min. Negotiated Rate	$175.43
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	$177.15
Rate for Payer: Amerigroup Medicare	$177.26
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	$175.50
Rate for Payer: Iowa Total Care Managed Medicaid	$175.43
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Medical Associates Managed Medicare	$175.50
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: Molina Healthcare Managed Medicaid	$178.13
Rate for Payer: Molina Healthcare Managed Medicare	$178.03
Rate for Payer: Oscar Health of IA Commercial	$263.25
Rate for Payer: Partners Health Alliance Commercial	$263.25
Rate for Payer: United Healthcare Commercial	$315.90
Rate for Payer: United Healthcare Managed Medicare	$207.09

SUTURETAK PERCUTA

Facility

$351.00

Service Code	CPT 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

SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE

Facility

$90.00

Service Code	CPT C1713
Hospital Charge Code	8771314
Hospital Revenue Code	278
Min. Negotiated Rate	$44.98
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	$45.42
Rate for Payer: Amerigroup Medicare	$45.45
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	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$44.98
Rate for Payer: Medical Associates Commercial	$67.50
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$63.00
Rate for Payer: Molina Healthcare Managed Medicaid	$45.68
Rate for Payer: Molina Healthcare Managed Medicare	$45.65
Rate for Payer: Oscar Health of IA Commercial	$67.50
Rate for Payer: Partners Health Alliance Commercial	$67.50
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	CPT 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

$195.00

Service Code	CPT 92610 GN
Hospital Charge Code	8000750
Hospital Revenue Code	444
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of IA Commercial	$175.50
Rate for Payer: Aetna of IA Medical Rental Products	$175.50
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$146.25
Rate for Payer: Medical Associates Commercial	$146.25
Rate for Payer: Midlands Choice Commercial	$136.50
Rate for Payer: United Healthcare Commercial	$175.50

SWALLOW FUNCTION EVAL

Facility

$195.00

Service Code	CPT 92610 GN
Hospital Charge Code	8000750
Hospital Revenue Code	444
Min. Negotiated Rate	$97.46
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of IA Commercial	$175.50
Rate for Payer: Aetna of IA Medical Rental Products	$175.50
Rate for Payer: Aetna of IA Medicare	$111.15
Rate for Payer: Amerigroup Medicaid	$98.42
Rate for Payer: Amerigroup Medicare	$98.48
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$146.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$97.50
Rate for Payer: Iowa Total Care Managed Medicaid	$97.46
Rate for Payer: Medical Associates Commercial	$146.25
Rate for Payer: Medical Associates Managed Medicare	$97.50
Rate for Payer: Midlands Choice Commercial	$136.50
Rate for Payer: Molina Healthcare Managed Medicaid	$98.96
Rate for Payer: Molina Healthcare Managed Medicare	$98.90
Rate for Payer: Oscar Health of IA Commercial	$146.25
Rate for Payer: Partners Health Alliance Commercial	$146.25
Rate for Payer: United Healthcare Commercial	$175.50
Rate for Payer: United Healthcare Managed Medicare	$115.05

SWALLOW /ORAL FUNCT TREATMENT

Facility

$163.00

Service Code	CPT 92526 GN
Hospital Charge Code	5534782
Hospital Revenue Code	440
Min. Negotiated Rate	$81.47
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of IA Commercial	$146.70
Rate for Payer: Aetna of IA Medical Rental Products	$146.70
Rate for Payer: Aetna of IA Medicare	$92.91
Rate for Payer: Amerigroup Medicaid	$82.27
Rate for Payer: Amerigroup Medicare	$82.32
Rate for Payer: Cash Price	$130.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$122.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.50
Rate for Payer: Iowa Total Care Managed Medicaid	$81.47
Rate for Payer: Medical Associates Commercial	$122.25
Rate for Payer: Medical Associates Managed Medicare	$81.50
Rate for Payer: Midlands Choice Commercial	$114.10
Rate for Payer: Molina Healthcare Managed Medicaid	$82.72
Rate for Payer: Molina Healthcare Managed Medicare	$82.67
Rate for Payer: Oscar Health of IA Commercial	$122.25
Rate for Payer: Partners Health Alliance Commercial	$122.25
Rate for Payer: United Healthcare Commercial	$146.70
Rate for Payer: United Healthcare Managed Medicare	$96.17

SWALLOW /ORAL FUNCT TREATMENT

Facility

$163.00

Service Code	CPT 92526 GN
Hospital Charge Code	5534782
Hospital Revenue Code	440
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of IA Commercial	$146.70
Rate for Payer: Aetna of IA Medical Rental Products	$146.70
Rate for Payer: Cash Price	$130.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$122.25
Rate for Payer: Medical Associates Commercial	$122.25
Rate for Payer: Midlands Choice Commercial	$114.10
Rate for Payer: United Healthcare Commercial	$146.70

Syncope and Collapse

Facility

$6,449.74

Service Code	MS-DRG 312
Hospital Charge Code	169
Min. Negotiated Rate	$6,356.26
Max. Negotiated Rate	$6,449.74
Rate for Payer: Amerigroup Medicaid	$6,418.58
Rate for Payer: Iowa Total Care Managed Medicaid	$6,356.26
Rate for Payer: Molina Healthcare Managed Medicaid	$6,449.74

SYNDESMOTIC FIXATION KIT

Facility

$2,457.00

Service Code	CPT C1713
Hospital Charge Code	8943981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.01
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	$1,240.05
Rate for Payer: Amerigroup Medicare	$1,240.78
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	$1,228.50
Rate for Payer: Iowa Total Care Managed Medicaid	$1,228.01
Rate for Payer: Medical Associates Commercial	$1,842.75
Rate for Payer: Medical Associates Managed Medicare	$1,228.50
Rate for Payer: Midlands Choice Commercial	$1,719.90
Rate for Payer: Molina Healthcare Managed Medicaid	$1,246.93
Rate for Payer: Molina Healthcare Managed Medicare	$1,246.19
Rate for Payer: Oscar Health of IA Commercial	$1,842.75
Rate for Payer: Partners Health Alliance Commercial	$1,842.75
Rate for Payer: United Healthcare Commercial	$2,211.30
Rate for Payer: United Healthcare Managed Medicare	$1,449.63

SYNDESMOTIC FIXATION KIT

Facility

$2,457.00

Service Code	CPT 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

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	$47.12
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	$81.26
Rate for Payer: Amerigroup Medicare	$81.30
Rate for Payer: Cash Price	$128.80
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	$80.50
Rate for Payer: Iowa Total Care Managed Medicaid	$80.47
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Medical Associates Managed Medicare	$80.50
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Molina Healthcare Managed Medicaid	$81.71
Rate for Payer: Molina Healthcare Managed Medicare	$81.66
Rate for Payer: Oscar Health of IA Commercial	$120.75
Rate for Payer: Partners Health Alliance Commercial	$120.75
Rate for Payer: United Healthcare Commercial	$144.90
Rate for Payer: United Healthcare Managed Medicare	$94.99
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

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 Reverse DMCL

Facility

$129.00

Service Code	CPT 84482
Hospital Charge Code	8037805
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
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	$65.11
Rate for Payer: Amerigroup Medicare	$65.14
Rate for Payer: Cash Price	$103.20
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	$64.50
Rate for Payer: Iowa Total Care Managed Medicaid	$64.47
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$64.50
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$65.47
Rate for Payer: Molina Healthcare Managed Medicare	$65.43
Rate for Payer: Oscar Health of IA Commercial	$96.75
Rate for Payer: Partners Health Alliance Commercial	$96.75
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

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

T3 Total DMCL

Facility

$104.00

Service Code	CPT 84480
Hospital Charge Code	8037806
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
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	$52.49
Rate for Payer: Amerigroup Medicare	$52.52
Rate for Payer: Cash Price	$83.20
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	$52.00
Rate for Payer: Iowa Total Care Managed Medicaid	$51.98
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$52.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$52.78
Rate for Payer: Molina Healthcare Managed Medicare	$52.75
Rate for Payer: Oscar Health of IA Commercial	$78.00
Rate for Payer: Partners Health Alliance Commercial	$78.00
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

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	$32.49
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	$32.81
Rate for Payer: Amerigroup Medicare	$32.82
Rate for Payer: Cash Price	$52.00
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	$32.50
Rate for Payer: Iowa Total Care Managed Medicaid	$32.49
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Medical Associates Managed Medicare	$32.50
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: Molina Healthcare Managed Medicaid	$32.99
Rate for Payer: Molina Healthcare Managed Medicare	$32.97
Rate for Payer: Oscar Health of IA Commercial	$48.75
Rate for Payer: Partners Health Alliance Commercial	$48.75
Rate for Payer: United Healthcare Commercial	$58.50
Rate for Payer: United Healthcare Managed Medicare	$38.35
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

T4 FREE

Facility

$82.00

Service Code	CPT 84439
Hospital Charge Code	4021360
Hospital Revenue Code	301
Min. Negotiated Rate	$57.40
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: Cash Price	$65.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.50
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: United Healthcare Commercial	$73.80

T4 FREE

Facility

$82.00

Service Code	CPT 84439
Hospital Charge Code	4021360
Hospital Revenue Code	301
Min. Negotiated Rate	$40.98
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	$41.39
Rate for Payer: Amerigroup Medicare	$41.41
Rate for Payer: Cash Price	$65.60
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	$41.00
Rate for Payer: Iowa Total Care Managed Medicaid	$40.98
Rate for Payer: Medical Associates Commercial	$61.50
Rate for Payer: Medical Associates Managed Medicare	$41.00
Rate for Payer: Midlands Choice Commercial	$57.40
Rate for Payer: Molina Healthcare Managed Medicaid	$41.62
Rate for Payer: Molina Healthcare Managed Medicare	$41.59
Rate for Payer: Oscar Health of IA Commercial	$61.50
Rate for Payer: Partners Health Alliance Commercial	$61.50
Rate for Payer: United Healthcare Commercial	$73.80
Rate for Payer: United Healthcare Managed Medicare	$48.38
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

TA 45 3.5MM LOAD

Facility

$119.00

Hospital Charge Code	8026284
Hospital Revenue Code	272
Min. Negotiated Rate	$59.48
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of IA Commercial	$107.10
Rate for Payer: Aetna of IA Medical Rental Products	$107.10
Rate for Payer: Aetna of IA Medicare	$67.83
Rate for Payer: Amerigroup Medicaid	$60.06
Rate for Payer: Amerigroup Medicare	$60.10
Rate for Payer: Cash Price	$95.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$89.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.50
Rate for Payer: Iowa Total Care Managed Medicaid	$59.48
Rate for Payer: Medical Associates Commercial	$89.25
Rate for Payer: Medical Associates Managed Medicare	$59.50
Rate for Payer: Midlands Choice Commercial	$83.30
Rate for Payer: Molina Healthcare Managed Medicaid	$60.39
Rate for Payer: Molina Healthcare Managed Medicare	$60.36
Rate for Payer: Oscar Health of IA Commercial	$89.25
Rate for Payer: Partners Health Alliance Commercial	$89.25
Rate for Payer: United Healthcare Commercial	$107.10
Rate for Payer: United Healthcare Managed Medicare	$70.21

TA 45 3.5MM LOAD

Facility

$119.00

Hospital Charge Code	8026284
Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of IA Commercial	$107.10
Rate for Payer: Aetna of IA Medical Rental Products	$107.10
Rate for Payer: Cash Price	$95.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$89.25
Rate for Payer: Medical Associates Commercial	$89.25
Rate for Payer: Midlands Choice Commercial	$83.30
Rate for Payer: United Healthcare Commercial	$107.10

TA 45 3.5MM STAPLER

Facility

$477.00

Hospital Charge Code	8026072
Hospital Revenue Code	272
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: United Healthcare Commercial	$429.30

TA 45 3.5MM STAPLER

Facility

$477.00

Hospital Charge Code	8026072
Hospital Revenue Code	272
Min. Negotiated Rate	$238.40
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Aetna of IA Medicare	$271.89
Rate for Payer: Amerigroup Medicaid	$240.74
Rate for Payer: Amerigroup Medicare	$240.88
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$238.50
Rate for Payer: Iowa Total Care Managed Medicaid	$238.40
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Medical Associates Managed Medicare	$238.50
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: Molina Healthcare Managed Medicaid	$242.08
Rate for Payer: Molina Healthcare Managed Medicare	$241.93
Rate for Payer: Oscar Health of IA Commercial	$357.75
Rate for Payer: Partners Health Alliance Commercial	$357.75
Rate for Payer: United Healthcare Commercial	$429.30
Rate for Payer: United Healthcare Managed Medicare	$281.43

Know your out-of-pocket cost for care.

All Charges