Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

XENFORM TISSUE REPAIR 8MMX12MM

Facility

$2,530.00

Hospital Charge Code	8026509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,771.00
Max. Negotiated Rate	$2,277.00
Rate for Payer: Aetna of IA Commercial	$2,277.00
Rate for Payer: Aetna of IA Medical Rental Products	$2,277.00
Rate for Payer: Cash Price	$2,024.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,897.50
Rate for Payer: Medical Associates Commercial	$1,897.50
Rate for Payer: Midlands Choice Commercial	$1,771.00
Rate for Payer: United Healthcare Commercial	$2,277.00

X-LARGE PLUGS

Facility

$324.00

Service Code	HCPCS C1781
Hospital Charge Code	8417556
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

X-LARGE PLUGS

Facility

$324.00

Service Code	HCPCS C1781
Hospital Charge Code	8417556
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

XR Abdomen 2 View

Facility

$180.00

Service Code	CPT 74019
Hospital Charge Code	2408784
Hospital Revenue Code	320
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

XR Abdomen 2 View

Facility

$180.00

Service Code	CPT 74019
Hospital Charge Code	2408784
Hospital Revenue Code	320
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20

XR ABDOMEN AP

Facility

$150.00

Service Code	CPT 74018
Hospital Charge Code	1169926
Hospital Revenue Code	320
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Aetna of IA Medicare	$85.50
Rate for Payer: Amerigroup Medicaid	$86.52
Rate for Payer: Amerigroup Medicare	$68.17
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$85.68
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.94
Rate for Payer: Partners Health Alliance Commercial	$77.62
Rate for Payer: United Healthcare Commercial	$135.00
Rate for Payer: United Healthcare Managed Medicare	$88.50

XR ABDOMEN AP

Facility

$150.00

Service Code	CPT 74018
Hospital Charge Code	1169926
Hospital Revenue Code	320
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: United Healthcare Commercial	$135.00

XR Abdomen AP Obliques Cone Views

Facility

$202.00

Service Code	CPT 74010
Hospital Charge Code	1169928
Hospital Revenue Code	320
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

XR Abdomen AP Obliques Cone Views

Facility

$202.00

Service Code	CPT 74010
Hospital Charge Code	1169928
Hospital Revenue Code	320
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.53
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

XR Abdomen Complete w/ Decub/Erect

Facility

$180.00

Service Code	CPT 74021
Hospital Charge Code	1169930
Hospital Revenue Code	320
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

XR Abdomen Complete w/ Decub/Erect

Facility

$180.00

Service Code	CPT 74021
Hospital Charge Code	1169930
Hospital Revenue Code	320
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20

XR Abdomen Series w/ Chest 1 View

Facility

$180.00

Service Code	CPT 74022
Hospital Charge Code	1169932
Hospital Revenue Code	320
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

XR Abdomen Series w/ Chest 1 View

Facility

$180.00

Service Code	CPT 74022
Hospital Charge Code	1169932
Hospital Revenue Code	320
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20

XR AC Joints Bilateral w/ + w/o wts

Facility

$148.00

Service Code	CPT 73050
Hospital Charge Code	1169922
Hospital Revenue Code	320
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of IA Commercial	$133.20
Rate for Payer: Aetna of IA Medical Rental Products	$133.20
Rate for Payer: Aetna of IA Medicare	$84.36
Rate for Payer: Amerigroup Medicaid	$85.37
Rate for Payer: Amerigroup Medicare	$67.27
Rate for Payer: Cash Price	$118.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$66.60
Rate for Payer: Iowa Total Care Managed Medicaid	$84.54
Rate for Payer: Medical Associates Commercial	$111.00
Rate for Payer: Medical Associates Managed Medicare	$66.60
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: Molina Healthcare Managed Medicaid	$85.78
Rate for Payer: Partners Health Alliance Commercial	$76.59
Rate for Payer: United Healthcare Commercial	$133.20
Rate for Payer: United Healthcare Managed Medicare	$87.32

XR AC Joints Bilateral w/ + w/o wts

Facility

$148.00

Service Code	CPT 73050
Hospital Charge Code	1169922
Hospital Revenue Code	320
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of IA Commercial	$133.20
Rate for Payer: Aetna of IA Medical Rental Products	$133.20
Rate for Payer: Cash Price	$118.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.00
Rate for Payer: Medical Associates Commercial	$111.00
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: United Healthcare Commercial	$133.20

XR Ankle 2 Views Left

Facility

$133.00

Service Code	CPT 73600 LT
Hospital Charge Code	1169936
Hospital Revenue Code	320
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Aetna of IA Medicare	$75.81
Rate for Payer: Amerigroup Medicaid	$76.71
Rate for Payer: Amerigroup Medicare	$60.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.85
Rate for Payer: Iowa Total Care Managed Medicaid	$75.97
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Medical Associates Managed Medicare	$59.85
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: Molina Healthcare Managed Medicaid	$77.09
Rate for Payer: Partners Health Alliance Commercial	$68.83
Rate for Payer: United Healthcare Commercial	$119.70
Rate for Payer: United Healthcare Managed Medicare	$78.47

XR Ankle 2 Views Left

Facility

$133.00

Service Code	CPT 73600 LT
Hospital Charge Code	1169936
Hospital Revenue Code	320
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: United Healthcare Commercial	$119.70

XR Ankle 2 Views Right

Facility

$133.00

Service Code	CPT 73600 RT
Hospital Charge Code	1169938
Hospital Revenue Code	320
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: United Healthcare Commercial	$119.70

XR Ankle 2 Views Right

Facility

$133.00

Service Code	CPT 73600 RT
Hospital Charge Code	1169938
Hospital Revenue Code	320
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Aetna of IA Medicare	$75.81
Rate for Payer: Amerigroup Medicaid	$76.71
Rate for Payer: Amerigroup Medicare	$60.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.85
Rate for Payer: Iowa Total Care Managed Medicaid	$75.97
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Medical Associates Managed Medicare	$59.85
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: Molina Healthcare Managed Medicaid	$77.09
Rate for Payer: Partners Health Alliance Commercial	$68.83
Rate for Payer: United Healthcare Commercial	$119.70
Rate for Payer: United Healthcare Managed Medicare	$78.47

XR Ankle Complete Left

Facility

$146.00

Service Code	CPT 73610 LT
Hospital Charge Code	1169942
Hospital Revenue Code	320
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Aetna of IA Medicare	$83.22
Rate for Payer: Amerigroup Medicaid	$84.21
Rate for Payer: Amerigroup Medicare	$66.36
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$65.70
Rate for Payer: Iowa Total Care Managed Medicaid	$83.40
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Medical Associates Managed Medicare	$65.70
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: Molina Healthcare Managed Medicaid	$84.62
Rate for Payer: Partners Health Alliance Commercial	$75.56
Rate for Payer: United Healthcare Commercial	$131.40
Rate for Payer: United Healthcare Managed Medicare	$86.14

XR Ankle Complete Left

Facility

$146.00

Service Code	CPT 73610 LT
Hospital Charge Code	1169942
Hospital Revenue Code	320
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: United Healthcare Commercial	$131.40

XR Ankle Complete Right

Facility

$146.00

Service Code	CPT 73610 RT
Hospital Charge Code	1169944
Hospital Revenue Code	320
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Aetna of IA Medicare	$83.22
Rate for Payer: Amerigroup Medicaid	$84.21
Rate for Payer: Amerigroup Medicare	$66.36
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$65.70
Rate for Payer: Iowa Total Care Managed Medicaid	$83.40
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Medical Associates Managed Medicare	$65.70
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: Molina Healthcare Managed Medicaid	$84.62
Rate for Payer: Partners Health Alliance Commercial	$75.56
Rate for Payer: United Healthcare Commercial	$131.40
Rate for Payer: United Healthcare Managed Medicare	$86.14

XR Ankle Complete Right

Facility

$146.00

Service Code	CPT 73610 RT
Hospital Charge Code	1169944
Hospital Revenue Code	320
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: United Healthcare Commercial	$131.40

XR Arthrogram Knee Left

Facility

$723.00

Service Code	CPT 73580 LT
Hospital Charge Code	1169970
Hospital Revenue Code	322
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of IA Commercial	$650.70
Rate for Payer: Aetna of IA Medical Rental Products	$650.70
Rate for Payer: Aetna of IA Medicare	$412.11
Rate for Payer: Amerigroup Medicaid	$417.03
Rate for Payer: Amerigroup Medicare	$328.60
Rate for Payer: Cash Price	$578.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$542.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$325.35
Rate for Payer: Iowa Total Care Managed Medicaid	$412.98
Rate for Payer: Medical Associates Commercial	$542.25
Rate for Payer: Medical Associates Managed Medicare	$325.35
Rate for Payer: Midlands Choice Commercial	$506.10
Rate for Payer: Molina Healthcare Managed Medicaid	$419.05
Rate for Payer: Partners Health Alliance Commercial	$374.15
Rate for Payer: United Healthcare Commercial	$650.70
Rate for Payer: United Healthcare Managed Medicare	$426.57

XR Arthrogram Knee Left

Facility

$723.00

Service Code	CPT 73580 LT
Hospital Charge Code	1169970
Hospital Revenue Code	322
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of IA Commercial	$650.70
Rate for Payer: Aetna of IA Medical Rental Products	$650.70
Rate for Payer: Cash Price	$578.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$542.25
Rate for Payer: Medical Associates Commercial	$542.25
Rate for Payer: Midlands Choice Commercial	$506.10
Rate for Payer: United Healthcare Commercial	$650.70

Know your out-of-pocket cost for care.

All Charges