Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW SOLID LAG, 5.5MM X 55MM

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047225
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW SOLID LAG, 5.5MM X 55MM (X2)

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047228
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW SOLID LAG, 5.5MM X 55MM (X2)

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047228
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW SOLID LAG, 5.5MM X 55MM (X2)-PT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047227
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW SOLID LAG, 5.5MM X 55MM (X2)-PT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047227
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW SOLID LAG, 5.5MM X 60MM

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047226
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW SOLID LAG, 5.5MM X 60MM

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047226
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW TIGER CANNULATED 4.0MMX24MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713565
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 TIGER CANNULATED 4.0MMX24MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713565
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 TIGER CANNULATED 4.0MMX28MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713567
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 TIGER CANNULATED 4.0MMX28MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713567
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

SCU

Facility

$2,034.00

Hospital Charge Code	8002748
Hospital Revenue Code	200
Min. Negotiated Rate	$1,306.00
Max. Negotiated Rate	$2,580.60
Rate for Payer: Aetna of IA Commercial	$1,830.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,830.60
Rate for Payer: Aetna of IA Medicare	$2,258.00
Rate for Payer: Amerigroup Medicare	$2,266.44
Rate for Payer: Cash Price	$1,627.20
Rate for Payer: Cash Price	$1,627.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,525.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,244.00
Rate for Payer: Medical Associates Commercial	$1,525.50
Rate for Payer: Medical Associates Managed Medicare	$2,244.00
Rate for Payer: Midlands Choice Commercial	$1,423.80
Rate for Payer: Partners Health Alliance Commercial	$2,580.60
Rate for Payer: United Healthcare Commercial	$1,830.60
Rate for Payer: United Healthcare Managed Medicare	$1,306.00

SED RATE

Facility

$36.00

Service Code	CPT 85652
Hospital Charge Code	4006783
Hospital Revenue Code	305
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24
Rate for Payer: Wellmark IA HMO WHPI	$29.07
Rate for Payer: Wellmark IA PPO	$32.02

SED RATE

Facility

$36.00

Service Code	CPT 85652
Hospital Charge Code	4006783
Hospital Revenue Code	305
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

SEIZURES WITH MCC

Facility

$11,527.75

Service Code	MSDRG 100
Min. Negotiated Rate	$11,360.68
Max. Negotiated Rate	$11,527.75
Rate for Payer: Amerigroup Medicaid	$11,472.06
Rate for Payer: Iowa Total Care Managed Medicaid	$11,360.68
Rate for Payer: Molina Healthcare Managed Medicaid	$11,527.75

SEIZURES WITHOUT MCC

Facility

$6,073.52

Service Code	MSDRG 101
Min. Negotiated Rate	$5,985.50
Max. Negotiated Rate	$6,073.52
Rate for Payer: Amerigroup Medicaid	$6,044.18
Rate for Payer: Iowa Total Care Managed Medicaid	$5,985.50
Rate for Payer: Molina Healthcare Managed Medicaid	$6,073.52

SELECTIVE DEBRIDEMENT EA ADD'L 20 SQ CM

Professional

Both

$207.00

Service Code	CPT 97598
Hospital Charge Code	8068909
Hospital Revenue Code	983
Min. Negotiated Rate	$43.51
Max. Negotiated Rate	$155.25
Rate for Payer: Amerigroup Medicaid	$56.43
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Iowa Total Care Managed Medicaid	$55.89
Rate for Payer: Medical Associates Commercial	$155.25
Rate for Payer: Midlands Choice Commercial	$144.90
Rate for Payer: Molina Healthcare Managed Medicaid	$56.16
Rate for Payer: Partners Health Alliance Commercial	$155.25
Rate for Payer: United Healthcare Commercial	$43.51
Rate for Payer: Wellmark IA HMO WHPI	$65.40
Rate for Payer: Wellmark IA PPO	$65.40

SELECTIVE DEBRIDEMENT FIRST 20 SQ CM

Facility

$266.00

Service Code	CPT 97597
Hospital Charge Code	7440831
Hospital Revenue Code	510
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna of IA Commercial	$239.40
Rate for Payer: Aetna of IA Medical Rental Products	$239.40
Rate for Payer: Cash Price	$212.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$199.50
Rate for Payer: Medical Associates Commercial	$199.50
Rate for Payer: Midlands Choice Commercial	$186.20
Rate for Payer: United Healthcare Commercial	$239.40

SELECTIVE DEBRIDEMENT FIRST 20 SQ CM

Professional

Both

$266.00

Service Code	CPT 97597
Hospital Charge Code	7440831
Hospital Revenue Code	983
Min. Negotiated Rate	$45.69
Max. Negotiated Rate	$199.50
Rate for Payer: Amerigroup Medicaid	$46.13
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Iowa Total Care Managed Medicaid	$45.69
Rate for Payer: Medical Associates Commercial	$199.50
Rate for Payer: Midlands Choice Commercial	$186.20
Rate for Payer: Molina Healthcare Managed Medicaid	$45.91
Rate for Payer: Partners Health Alliance Commercial	$199.50
Rate for Payer: United Healthcare Commercial	$91.23
Rate for Payer: Wellmark IA HMO WHPI	$146.80
Rate for Payer: Wellmark IA PPO	$146.80

SELECTIVE DEBRIDEMENT FIRST 20 SQ CM

Facility

$266.00

Service Code	CPT 97597
Hospital Charge Code	7440831
Hospital Revenue Code	510
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$657.60
Rate for Payer: Aetna of IA Commercial	$239.40
Rate for Payer: Aetna of IA Medical Rental Products	$239.40
Rate for Payer: Aetna of IA Medicare	$151.62
Rate for Payer: Amerigroup Medicaid	$153.43
Rate for Payer: Amerigroup Medicare	$120.90
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$199.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$119.70
Rate for Payer: Iowa Total Care Managed Medicaid	$151.94
Rate for Payer: Medical Associates Commercial	$199.50
Rate for Payer: Medical Associates Managed Medicare	$119.70
Rate for Payer: Midlands Choice Commercial	$186.20
Rate for Payer: Molina Healthcare Managed Medicaid	$154.17
Rate for Payer: Partners Health Alliance Commercial	$137.66
Rate for Payer: United Healthcare Commercial	$239.40
Rate for Payer: United Healthcare Managed Medicare	$156.94
Rate for Payer: Wellmark IA HMO WHPI	$596.98
Rate for Payer: Wellmark IA PPO	$657.60

SEMEN VASECTOMY

Facility

$74.00

Service Code	CPT 89321
Hospital Charge Code	3527268
Hospital Revenue Code	309
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: United Healthcare Commercial	$66.60

SEMEN VASECTOMY

Facility

$74.00

Service Code	CPT 89321
Hospital Charge Code	3527268
Hospital Revenue Code	309
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of IA Commercial	$66.60
Rate for Payer: Aetna of IA Medical Rental Products	$66.60
Rate for Payer: Aetna of IA Medicare	$42.18
Rate for Payer: Amerigroup Medicaid	$42.68
Rate for Payer: Amerigroup Medicare	$33.63
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$55.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.30
Rate for Payer: Iowa Total Care Managed Medicaid	$42.27
Rate for Payer: Medical Associates Commercial	$55.50
Rate for Payer: Medical Associates Managed Medicare	$33.30
Rate for Payer: Midlands Choice Commercial	$51.80
Rate for Payer: Molina Healthcare Managed Medicaid	$42.89
Rate for Payer: Partners Health Alliance Commercial	$38.30
Rate for Payer: United Healthcare Commercial	$66.60
Rate for Payer: United Healthcare Managed Medicare	$43.66
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

senna 8.6 mg Tab [VDMC]

Facility

$1.12

Service Code	HCPCS A9270
Hospital Charge Code	10420307
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Aetna of IA Medicare	$0.64
Rate for Payer: Amerigroup Medicaid	$0.64
Rate for Payer: Amerigroup Medicare	$0.51
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.84
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.50
Rate for Payer: Iowa Total Care Managed Medicaid	$0.64
Rate for Payer: Medical Associates Commercial	$0.84
Rate for Payer: Medical Associates Managed Medicare	$0.50
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: Molina Healthcare Managed Medicaid	$0.65
Rate for Payer: Partners Health Alliance Commercial	$0.58
Rate for Payer: United Healthcare Commercial	$1.00
Rate for Payer: United Healthcare Managed Medicare	$0.66

senna 8.6 mg Tab [VDMC]

Facility

$1.12

Service Code	HCPCS A9270
Hospital Charge Code	10420307
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.84
Rate for Payer: Medical Associates Commercial	$0.84
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.00

senna-docusate-8.6 mg-50 mg Tab [VDMC]

Facility

$1.38

Service Code	HCPCS A9270
Hospital Charge Code	10384311
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of IA Commercial	$1.25
Rate for Payer: Aetna of IA Medical Rental Products	$1.25
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.04
Rate for Payer: Medical Associates Commercial	$1.04
Rate for Payer: Midlands Choice Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.25

Know your out-of-pocket cost for care.

All Charges