Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

vecuronium 10 mg Pow[VDMC]

Facility

$42.55

Service Code	HCPCS J3490
Hospital Charge Code	11348952
Hospital Revenue Code	259
Min. Negotiated Rate	$29.78
Max. Negotiated Rate	$38.29
Rate for Payer: Aetna of IA Commercial	$38.29
Rate for Payer: Aetna of IA Medical Rental Products	$38.29
Rate for Payer: Cash Price	$34.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.91
Rate for Payer: Medical Associates Commercial	$31.91
Rate for Payer: Midlands Choice Commercial	$29.78
Rate for Payer: United Healthcare Commercial	$38.29

Vedolizumab 300 mg SDV [VDMC]

Facility

$18,819.82

Service Code	HCPCS J3380
Hospital Charge Code	19779403
Hospital Revenue Code	259
Min. Negotiated Rate	$13,173.87
Max. Negotiated Rate	$16,937.84
Rate for Payer: Aetna of IA Commercial	$16,937.84
Rate for Payer: Aetna of IA Medical Rental Products	$16,937.84
Rate for Payer: Cash Price	$15,055.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,114.86
Rate for Payer: Medical Associates Commercial	$14,114.86
Rate for Payer: Midlands Choice Commercial	$13,173.87
Rate for Payer: United Healthcare Commercial	$16,937.84

Vedolizumab 300 mg SDV [VDMC]

Facility

$18,819.82

Service Code	HCPCS J3380
Hospital Charge Code	19779403
Hospital Revenue Code	259
Min. Negotiated Rate	$8,468.92
Max. Negotiated Rate	$16,937.84
Rate for Payer: Aetna of IA Commercial	$16,937.84
Rate for Payer: Aetna of IA Medical Rental Products	$16,937.84
Rate for Payer: Aetna of IA Medicare	$10,727.30
Rate for Payer: Amerigroup Medicaid	$10,855.27
Rate for Payer: Amerigroup Medicare	$8,553.61
Rate for Payer: Cash Price	$15,055.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,114.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8,468.92
Rate for Payer: Iowa Total Care Managed Medicaid	$10,749.88
Rate for Payer: Medical Associates Commercial	$14,114.86
Rate for Payer: Medical Associates Managed Medicare	$8,468.92
Rate for Payer: Midlands Choice Commercial	$13,173.87
Rate for Payer: Molina Healthcare Managed Medicaid	$10,907.97
Rate for Payer: Partners Health Alliance Commercial	$9,739.26
Rate for Payer: United Healthcare Commercial	$16,937.84
Rate for Payer: United Healthcare Managed Medicare	$11,103.69

VENIPUNCTURE

Facility

$21.00

Service Code	CPT 36415
Hospital Charge Code	1779400
Hospital Revenue Code	300
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of IA Commercial	$18.90
Rate for Payer: Aetna of IA Medical Rental Products	$18.90
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.75
Rate for Payer: Medical Associates Commercial	$15.75
Rate for Payer: Midlands Choice Commercial	$14.70
Rate for Payer: United Healthcare Commercial	$18.90

VENIPUNCTURE

Facility

$21.00

Service Code	CPT 36415
Hospital Charge Code	1779400
Hospital Revenue Code	300
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of IA Commercial	$18.90
Rate for Payer: Aetna of IA Medical Rental Products	$18.90
Rate for Payer: Aetna of IA Medicare	$11.97
Rate for Payer: Amerigroup Medicaid	$12.11
Rate for Payer: Amerigroup Medicare	$9.54
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.45
Rate for Payer: Iowa Total Care Managed Medicaid	$12.00
Rate for Payer: Medical Associates Commercial	$15.75
Rate for Payer: Medical Associates Managed Medicare	$9.45
Rate for Payer: Midlands Choice Commercial	$14.70
Rate for Payer: Molina Healthcare Managed Medicaid	$12.17
Rate for Payer: Partners Health Alliance Commercial	$10.87
Rate for Payer: United Healthcare Commercial	$18.90
Rate for Payer: United Healthcare Managed Medicare	$12.39

venlafaxine 37.5 mg ER Cap [VDMC]

Facility

$1.20

Service Code	HCPCS A9270
Hospital Charge Code	10427797
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of IA Commercial	$1.08
Rate for Payer: Aetna of IA Medical Rental Products	$1.08
Rate for Payer: Aetna of IA Medicare	$0.68
Rate for Payer: Amerigroup Medicaid	$0.69
Rate for Payer: Amerigroup Medicare	$0.55
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.54
Rate for Payer: Iowa Total Care Managed Medicaid	$0.69
Rate for Payer: Medical Associates Commercial	$0.90
Rate for Payer: Medical Associates Managed Medicare	$0.54
Rate for Payer: Midlands Choice Commercial	$0.84
Rate for Payer: Molina Healthcare Managed Medicaid	$0.70
Rate for Payer: Partners Health Alliance Commercial	$0.62
Rate for Payer: United Healthcare Commercial	$1.08
Rate for Payer: United Healthcare Managed Medicare	$0.71

venlafaxine 37.5 mg ER Cap [VDMC]

Facility

$1.20

Service Code	HCPCS A9270
Hospital Charge Code	10427797
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of IA Commercial	$1.08
Rate for Payer: Aetna of IA Medical Rental Products	$1.08
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.90
Rate for Payer: Medical Associates Commercial	$0.90
Rate for Payer: Midlands Choice Commercial	$0.84
Rate for Payer: United Healthcare Commercial	$1.08

venlafaxine 75 mg ER Cap [VDMC]

Facility

$1.22

Service Code	HCPCS A9270
Hospital Charge Code	10427868
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna of IA Commercial	$1.10
Rate for Payer: Aetna of IA Medical Rental Products	$1.10
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.92
Rate for Payer: Medical Associates Commercial	$0.92
Rate for Payer: Midlands Choice Commercial	$0.86
Rate for Payer: United Healthcare Commercial	$1.10

venlafaxine 75 mg ER Cap [VDMC]

Facility

$1.22

Service Code	HCPCS A9270
Hospital Charge Code	10427868
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna of IA Commercial	$1.10
Rate for Payer: Aetna of IA Medical Rental Products	$1.10
Rate for Payer: Aetna of IA Medicare	$0.70
Rate for Payer: Amerigroup Medicaid	$0.71
Rate for Payer: Amerigroup Medicare	$0.56
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.92
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.55
Rate for Payer: Iowa Total Care Managed Medicaid	$0.70
Rate for Payer: Medical Associates Commercial	$0.92
Rate for Payer: Medical Associates Managed Medicare	$0.55
Rate for Payer: Midlands Choice Commercial	$0.86
Rate for Payer: Molina Healthcare Managed Medicaid	$0.71
Rate for Payer: Partners Health Alliance Commercial	$0.63
Rate for Payer: United Healthcare Commercial	$1.10
Rate for Payer: United Healthcare Managed Medicare	$0.72

VENT ASSIST MGMT,INITIAL

Facility

$1,078.00

Service Code	CPT 94002
Hospital Charge Code	4770840
Hospital Revenue Code	410
Min. Negotiated Rate	$754.60
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: United Healthcare Commercial	$970.20

VENT ASSIST MGMT,INITIAL

Facility

$1,078.00

Service Code	CPT 94002
Hospital Charge Code	4770840
Hospital Revenue Code	410
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Aetna of IA Medicare	$614.46
Rate for Payer: Amerigroup Medicaid	$621.79
Rate for Payer: Amerigroup Medicare	$489.95
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$485.10
Rate for Payer: Iowa Total Care Managed Medicaid	$615.75
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Medical Associates Managed Medicare	$485.10
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: Molina Healthcare Managed Medicaid	$624.81
Rate for Payer: Partners Health Alliance Commercial	$557.87
Rate for Payer: United Healthcare Commercial	$970.20
Rate for Payer: United Healthcare Managed Medicare	$636.02

VENT ASSIST MGNT SUBSQ DAY

Facility

$1,078.00

Service Code	CPT 94003
Hospital Charge Code	4770839
Hospital Revenue Code	410
Min. Negotiated Rate	$754.60
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: United Healthcare Commercial	$970.20

VENT ASSIST MGNT SUBSQ DAY

Facility

$1,078.00

Service Code	CPT 94003
Hospital Charge Code	4770839
Hospital Revenue Code	410
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Aetna of IA Medicare	$614.46
Rate for Payer: Amerigroup Medicaid	$621.79
Rate for Payer: Amerigroup Medicare	$489.95
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$485.10
Rate for Payer: Iowa Total Care Managed Medicaid	$615.75
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Medical Associates Managed Medicare	$485.10
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: Molina Healthcare Managed Medicaid	$624.81
Rate for Payer: Partners Health Alliance Commercial	$557.87
Rate for Payer: United Healthcare Commercial	$970.20
Rate for Payer: United Healthcare Managed Medicare	$636.02

VENTRAL EX LARGE MESH

Facility

$1,053.00

Service Code	HCPCS C1781
Hospital Charge Code	8449030
Hospital Revenue Code	278
Min. Negotiated Rate	$737.10
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of IA Commercial	$947.70
Rate for Payer: Aetna of IA Medical Rental Products	$947.70
Rate for Payer: Cash Price	$842.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$789.75
Rate for Payer: Medical Associates Commercial	$789.75
Rate for Payer: Midlands Choice Commercial	$737.10
Rate for Payer: United Healthcare Commercial	$947.70

VENTRAL EX LARGE MESH

Facility

$1,053.00

Service Code	HCPCS C1781
Hospital Charge Code	8449030
Hospital Revenue Code	278
Min. Negotiated Rate	$473.85
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of IA Commercial	$947.70
Rate for Payer: Aetna of IA Medical Rental Products	$947.70
Rate for Payer: Aetna of IA Medicare	$600.21
Rate for Payer: Amerigroup Medicaid	$607.37
Rate for Payer: Amerigroup Medicare	$478.59
Rate for Payer: Cash Price	$842.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$789.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$473.85
Rate for Payer: Iowa Total Care Managed Medicaid	$601.47
Rate for Payer: Medical Associates Commercial	$789.75
Rate for Payer: Medical Associates Managed Medicare	$473.85
Rate for Payer: Midlands Choice Commercial	$737.10
Rate for Payer: Molina Healthcare Managed Medicaid	$610.32
Rate for Payer: Partners Health Alliance Commercial	$544.93
Rate for Payer: United Healthcare Commercial	$947.70
Rate for Payer: United Healthcare Managed Medicare	$621.27

VENTRAL EX MEDIUM MESH

Facility

$828.00

Service Code	HCPCS C1781
Hospital Charge Code	8449028
Hospital Revenue Code	278
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of IA Commercial	$745.20
Rate for Payer: Aetna of IA Medical Rental Products	$745.20
Rate for Payer: Aetna of IA Medicare	$471.96
Rate for Payer: Amerigroup Medicaid	$477.59
Rate for Payer: Amerigroup Medicare	$376.33
Rate for Payer: Cash Price	$662.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$621.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$372.60
Rate for Payer: Iowa Total Care Managed Medicaid	$472.95
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Medical Associates Managed Medicare	$372.60
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: Molina Healthcare Managed Medicaid	$479.91
Rate for Payer: Partners Health Alliance Commercial	$428.49
Rate for Payer: United Healthcare Commercial	$745.20
Rate for Payer: United Healthcare Managed Medicare	$488.52

VENTRAL EX MEDIUM MESH

Facility

$828.00

Service Code	HCPCS C1781
Hospital Charge Code	8449028
Hospital Revenue Code	278
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of IA Commercial	$745.20
Rate for Payer: Aetna of IA Medical Rental Products	$745.20
Rate for Payer: Cash Price	$662.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$621.00
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: United Healthcare Commercial	$745.20

VENTRAL EX SMALL MESH

Facility

$693.00

Service Code	HCPCS C1781
Hospital Charge Code	8463903
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: United Healthcare Commercial	$623.70

VENTRAL EX SMALL MESH

Facility

$693.00

Service Code	HCPCS C1781
Hospital Charge Code	8463903
Hospital Revenue Code	278
Min. Negotiated Rate	$311.85
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Aetna of IA Medicare	$395.01
Rate for Payer: Amerigroup Medicaid	$399.72
Rate for Payer: Amerigroup Medicare	$314.97
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$311.85
Rate for Payer: Iowa Total Care Managed Medicaid	$395.84
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Medical Associates Managed Medicare	$311.85
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: Molina Healthcare Managed Medicaid	$401.66
Rate for Payer: Partners Health Alliance Commercial	$358.63
Rate for Payer: United Healthcare Commercial	$623.70
Rate for Payer: United Healthcare Managed Medicare	$408.87

VENTRALIGHT MESH 15X20CM

Facility

$1,804.00

Service Code	HCPCS C1781
Hospital Charge Code	8481703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.80
Max. Negotiated Rate	$1,623.60
Rate for Payer: Aetna of IA Commercial	$1,623.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,623.60
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,353.00
Rate for Payer: Medical Associates Commercial	$1,353.00
Rate for Payer: Midlands Choice Commercial	$1,262.80
Rate for Payer: United Healthcare Commercial	$1,623.60

VENTRALIGHT MESH 15X20CM

Facility

$1,804.00

Service Code	HCPCS C1781
Hospital Charge Code	8481703
Hospital Revenue Code	278
Min. Negotiated Rate	$811.80
Max. Negotiated Rate	$1,623.60
Rate for Payer: Aetna of IA Commercial	$1,623.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,623.60
Rate for Payer: Aetna of IA Medicare	$1,028.28
Rate for Payer: Amerigroup Medicaid	$1,040.55
Rate for Payer: Amerigroup Medicare	$819.92
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,353.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$811.80
Rate for Payer: Iowa Total Care Managed Medicaid	$1,030.44
Rate for Payer: Medical Associates Commercial	$1,353.00
Rate for Payer: Medical Associates Managed Medicare	$811.80
Rate for Payer: Midlands Choice Commercial	$1,262.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,045.60
Rate for Payer: Partners Health Alliance Commercial	$933.57
Rate for Payer: United Healthcare Commercial	$1,623.60
Rate for Payer: United Healthcare Managed Medicare	$1,064.36

VENTRALIGHT ST MESH CIRCLE 4.5

Facility

$1,272.51

Service Code	HCPCS C1713
Hospital Charge Code	8992493
Hospital Revenue Code	278
Min. Negotiated Rate	$890.76
Max. Negotiated Rate	$1,145.26
Rate for Payer: Aetna of IA Commercial	$1,145.26
Rate for Payer: Aetna of IA Medical Rental Products	$1,145.26
Rate for Payer: Cash Price	$1,018.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$954.38
Rate for Payer: Medical Associates Commercial	$954.38
Rate for Payer: Midlands Choice Commercial	$890.76
Rate for Payer: United Healthcare Commercial	$1,145.26

VENTRALIGHT ST MESH CIRCLE 4.5

Facility

$1,272.51

Service Code	HCPCS C1713
Hospital Charge Code	8992493
Hospital Revenue Code	278
Min. Negotiated Rate	$572.63
Max. Negotiated Rate	$1,145.26
Rate for Payer: Aetna of IA Commercial	$1,145.26
Rate for Payer: Aetna of IA Medical Rental Products	$1,145.26
Rate for Payer: Aetna of IA Medicare	$725.33
Rate for Payer: Amerigroup Medicaid	$733.98
Rate for Payer: Amerigroup Medicare	$578.36
Rate for Payer: Cash Price	$1,018.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$954.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$572.63
Rate for Payer: Iowa Total Care Managed Medicaid	$726.86
Rate for Payer: Medical Associates Commercial	$954.38
Rate for Payer: Medical Associates Managed Medicare	$572.63
Rate for Payer: Midlands Choice Commercial	$890.76
Rate for Payer: Molina Healthcare Managed Medicaid	$737.55
Rate for Payer: Partners Health Alliance Commercial	$658.52
Rate for Payer: United Healthcare Commercial	$1,145.26
Rate for Payer: United Healthcare Managed Medicare	$750.78

VENTRIO LG CIRCLE HERNIA PATCH

Facility

$1,305.00

Service Code	HCPCS C1781
Hospital Charge Code	8026204
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of IA Commercial	$1,174.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,174.50
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$978.75
Rate for Payer: Medical Associates Commercial	$978.75
Rate for Payer: Midlands Choice Commercial	$913.50
Rate for Payer: United Healthcare Commercial	$1,174.50

VENTRIO LG CIRCLE HERNIA PATCH

Facility

$1,305.00

Service Code	HCPCS C1781
Hospital Charge Code	8026204
Hospital Revenue Code	278
Min. Negotiated Rate	$587.25
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of IA Commercial	$1,174.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,174.50
Rate for Payer: Aetna of IA Medicare	$743.85
Rate for Payer: Amerigroup Medicaid	$752.72
Rate for Payer: Amerigroup Medicare	$593.12
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$978.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$587.25
Rate for Payer: Iowa Total Care Managed Medicaid	$745.42
Rate for Payer: Medical Associates Commercial	$978.75
Rate for Payer: Medical Associates Managed Medicare	$587.25
Rate for Payer: Midlands Choice Commercial	$913.50
Rate for Payer: Molina Healthcare Managed Medicaid	$756.38
Rate for Payer: Partners Health Alliance Commercial	$675.34
Rate for Payer: United Healthcare Commercial	$1,174.50
Rate for Payer: United Healthcare Managed Medicare	$769.95

Know your out-of-pocket cost for care.

All Charges