Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW LOCKING AXSOS 5.0MM X L40

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046664
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L42

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046665
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L42

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046665
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L44

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046666
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L44

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046666
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L46MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046667
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L46MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046667
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L48MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046668
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L48MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046668
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L50MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046669
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L50MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046669
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L55MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046670
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L55MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046670
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L60MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046671
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L60MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046671
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L65 MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046672
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L65 MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046672
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L70MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046673
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L70MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046673
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L75

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046674
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L75

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046674
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L80

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046675
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L80

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046675
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

SCREW LOCKING AXSOS 5.0MM X L85MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046676
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

SCREW LOCKING AXSOS 5.0MM X L85MM

Facility

$159.00

Service Code	HCPCS C1713
Hospital Charge Code	8046676
Hospital Revenue Code	278
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$91.71
Rate for Payer: Amerigroup Medicare	$72.27
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$71.55
Rate for Payer: Iowa Total Care Managed Medicaid	$90.82
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$71.55
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$92.16
Rate for Payer: Partners Health Alliance Commercial	$82.28
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

Know your out-of-pocket cost for care.

All Charges