Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

XR Fluoroscopy Over 1 Hour Non Rad

Facility

$354.00

Service Code	CPT 76001
Hospital Charge Code	1170177
Hospital Revenue Code	320
Min. Negotiated Rate	$247.80
Max. Negotiated Rate	$318.60
Rate for Payer: Aetna of IA Commercial	$318.60
Rate for Payer: Aetna of IA Medical Rental Products	$318.60
Rate for Payer: Cash Price	$283.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$265.50
Rate for Payer: Medical Associates Commercial	$265.50
Rate for Payer: Midlands Choice Commercial	$247.80
Rate for Payer: United Healthcare Commercial	$318.60

XR Fluoroscopy Over 1 Hour Non Rad

Facility

$354.00

Service Code	CPT 76001
Hospital Charge Code	1170177
Hospital Revenue Code	320
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$318.60
Rate for Payer: Aetna of IA Commercial	$318.60
Rate for Payer: Aetna of IA Medical Rental Products	$318.60
Rate for Payer: Aetna of IA Medicare	$201.78
Rate for Payer: Amerigroup Medicaid	$204.19
Rate for Payer: Amerigroup Medicare	$160.89
Rate for Payer: Cash Price	$283.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$265.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$159.30
Rate for Payer: Iowa Total Care Managed Medicaid	$202.20
Rate for Payer: Medical Associates Commercial	$265.50
Rate for Payer: Medical Associates Managed Medicare	$159.30
Rate for Payer: Midlands Choice Commercial	$247.80
Rate for Payer: Molina Healthcare Managed Medicaid	$205.18
Rate for Payer: Partners Health Alliance Commercial	$183.19
Rate for Payer: United Healthcare Commercial	$318.60
Rate for Payer: United Healthcare Managed Medicare	$208.86

XR Fluoroscopy Up to 1 Hour

Facility

$221.00

Service Code	CPT 76000
Hospital Charge Code	1170181
Hospital Revenue Code	320
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: United Healthcare Commercial	$198.90

XR Fluoroscopy Up to 1 Hour

Facility

$221.00

Service Code	CPT 76000
Hospital Charge Code	1170181
Hospital Revenue Code	320
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Aetna of IA Medicare	$125.97
Rate for Payer: Amerigroup Medicaid	$127.47
Rate for Payer: Amerigroup Medicare	$100.44
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$99.45
Rate for Payer: Iowa Total Care Managed Medicaid	$126.24
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Medical Associates Managed Medicare	$99.45
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: Molina Healthcare Managed Medicaid	$128.09
Rate for Payer: Partners Health Alliance Commercial	$114.37
Rate for Payer: United Healthcare Commercial	$198.90
Rate for Payer: United Healthcare Managed Medicare	$130.39

XR Fluoroscopy Up to 1 Hour NR

Facility

$221.00

Service Code	CPT 76000
Hospital Charge Code	5702788
Hospital Revenue Code	320
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: United Healthcare Commercial	$198.90

XR Fluoroscopy Up to 1 Hour NR

Facility

$221.00

Service Code	CPT 76000
Hospital Charge Code	5702788
Hospital Revenue Code	320
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Aetna of IA Medicare	$125.97
Rate for Payer: Amerigroup Medicaid	$127.47
Rate for Payer: Amerigroup Medicare	$100.44
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$99.45
Rate for Payer: Iowa Total Care Managed Medicaid	$126.24
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Medical Associates Managed Medicare	$99.45
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: Molina Healthcare Managed Medicaid	$128.09
Rate for Payer: Partners Health Alliance Commercial	$114.37
Rate for Payer: United Healthcare Commercial	$198.90
Rate for Payer: United Healthcare Managed Medicare	$130.39

XR Foot 2 Views Left

Facility

$127.00

Service Code	CPT 73620 LT
Hospital Charge Code	1170185
Hospital Revenue Code	320
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of IA Commercial	$114.30
Rate for Payer: Aetna of IA Medical Rental Products	$114.30
Rate for Payer: Cash Price	$101.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$95.25
Rate for Payer: Medical Associates Commercial	$95.25
Rate for Payer: Midlands Choice Commercial	$88.90
Rate for Payer: United Healthcare Commercial	$114.30

XR Foot 2 Views Left

Facility

$127.00

Service Code	CPT 73620 LT
Hospital Charge Code	1170185
Hospital Revenue Code	320
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of IA Commercial	$114.30
Rate for Payer: Aetna of IA Medical Rental Products	$114.30
Rate for Payer: Aetna of IA Medicare	$72.39
Rate for Payer: Amerigroup Medicaid	$73.25
Rate for Payer: Amerigroup Medicare	$57.72
Rate for Payer: Cash Price	$101.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$95.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.15
Rate for Payer: Iowa Total Care Managed Medicaid	$72.54
Rate for Payer: Medical Associates Commercial	$95.25
Rate for Payer: Medical Associates Managed Medicare	$57.15
Rate for Payer: Midlands Choice Commercial	$88.90
Rate for Payer: Molina Healthcare Managed Medicaid	$73.61
Rate for Payer: Partners Health Alliance Commercial	$65.72
Rate for Payer: United Healthcare Commercial	$114.30
Rate for Payer: United Healthcare Managed Medicare	$74.93

XR Foot 2 Views Right

Facility

$127.00

Service Code	CPT 73620 RT
Hospital Charge Code	1170187
Hospital Revenue Code	320
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of IA Commercial	$114.30
Rate for Payer: Aetna of IA Medical Rental Products	$114.30
Rate for Payer: Cash Price	$101.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$95.25
Rate for Payer: Medical Associates Commercial	$95.25
Rate for Payer: Midlands Choice Commercial	$88.90
Rate for Payer: United Healthcare Commercial	$114.30

XR Foot 2 Views Right

Facility

$127.00

Service Code	CPT 73620 RT
Hospital Charge Code	1170187
Hospital Revenue Code	320
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of IA Commercial	$114.30
Rate for Payer: Aetna of IA Medical Rental Products	$114.30
Rate for Payer: Aetna of IA Medicare	$72.39
Rate for Payer: Amerigroup Medicaid	$73.25
Rate for Payer: Amerigroup Medicare	$57.72
Rate for Payer: Cash Price	$101.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$95.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.15
Rate for Payer: Iowa Total Care Managed Medicaid	$72.54
Rate for Payer: Medical Associates Commercial	$95.25
Rate for Payer: Medical Associates Managed Medicare	$57.15
Rate for Payer: Midlands Choice Commercial	$88.90
Rate for Payer: Molina Healthcare Managed Medicaid	$73.61
Rate for Payer: Partners Health Alliance Commercial	$65.72
Rate for Payer: United Healthcare Commercial	$114.30
Rate for Payer: United Healthcare Managed Medicare	$74.93

XR Foot Complete Left

Facility

$146.00

Service Code	CPT 73630 LT
Hospital Charge Code	1170191
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 Foot Complete Left

Facility

$146.00

Service Code	CPT 73630 LT
Hospital Charge Code	1170191
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 Foot Complete Right

Facility

$146.00

Service Code	CPT 73630 RT
Hospital Charge Code	1170193
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 Foot Complete Right

Facility

$146.00

Service Code	CPT 73630 RT
Hospital Charge Code	1170193
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 Forearm 2 Views Left

Facility

$132.00

Service Code	CPT 73090 LT
Hospital Charge Code	1170197
Hospital Revenue Code	320
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of IA Commercial	$118.80
Rate for Payer: Aetna of IA Medical Rental Products	$118.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.00
Rate for Payer: Medical Associates Commercial	$99.00
Rate for Payer: Midlands Choice Commercial	$92.40
Rate for Payer: United Healthcare Commercial	$118.80

XR Forearm 2 Views Left

Facility

$132.00

Service Code	CPT 73090 LT
Hospital Charge Code	1170197
Hospital Revenue Code	320
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of IA Commercial	$118.80
Rate for Payer: Aetna of IA Medical Rental Products	$118.80
Rate for Payer: Aetna of IA Medicare	$75.24
Rate for Payer: Amerigroup Medicaid	$76.14
Rate for Payer: Amerigroup Medicare	$59.99
Rate for Payer: Cash Price	$105.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.40
Rate for Payer: Iowa Total Care Managed Medicaid	$75.40
Rate for Payer: Medical Associates Commercial	$99.00
Rate for Payer: Medical Associates Managed Medicare	$59.40
Rate for Payer: Midlands Choice Commercial	$92.40
Rate for Payer: Molina Healthcare Managed Medicaid	$76.51
Rate for Payer: Partners Health Alliance Commercial	$68.31
Rate for Payer: United Healthcare Commercial	$118.80
Rate for Payer: United Healthcare Managed Medicare	$77.88

XR Forearm 2 Views Right

Facility

$132.00

Service Code	CPT 73090 RT
Hospital Charge Code	1170199
Hospital Revenue Code	320
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of IA Commercial	$118.80
Rate for Payer: Aetna of IA Medical Rental Products	$118.80
Rate for Payer: Aetna of IA Medicare	$75.24
Rate for Payer: Amerigroup Medicaid	$76.14
Rate for Payer: Amerigroup Medicare	$59.99
Rate for Payer: Cash Price	$105.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.40
Rate for Payer: Iowa Total Care Managed Medicaid	$75.40
Rate for Payer: Medical Associates Commercial	$99.00
Rate for Payer: Medical Associates Managed Medicare	$59.40
Rate for Payer: Midlands Choice Commercial	$92.40
Rate for Payer: Molina Healthcare Managed Medicaid	$76.51
Rate for Payer: Partners Health Alliance Commercial	$68.31
Rate for Payer: United Healthcare Commercial	$118.80
Rate for Payer: United Healthcare Managed Medicare	$77.88

XR Forearm 2 Views Right

Facility

$132.00

Service Code	CPT 73090 RT
Hospital Charge Code	1170199
Hospital Revenue Code	320
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of IA Commercial	$118.80
Rate for Payer: Aetna of IA Medical Rental Products	$118.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.00
Rate for Payer: Medical Associates Commercial	$99.00
Rate for Payer: Midlands Choice Commercial	$92.40
Rate for Payer: United Healthcare Commercial	$118.80

XR Foreign Body Loc Eye Bilateral

Facility

$154.00

Service Code	CPT 70030 50
Hospital Charge Code	1170201
Hospital Revenue Code	320
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$138.60
Rate for Payer: Aetna of IA Commercial	$138.60
Rate for Payer: Aetna of IA Medical Rental Products	$138.60
Rate for Payer: Cash Price	$123.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$115.50
Rate for Payer: Medical Associates Commercial	$115.50
Rate for Payer: Midlands Choice Commercial	$107.80
Rate for Payer: United Healthcare Commercial	$138.60

XR Foreign Body Loc Eye Bilateral

Facility

$154.00

Service Code	CPT 70030 50
Hospital Charge Code	1170201
Hospital Revenue Code	320
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$138.60
Rate for Payer: Aetna of IA Commercial	$138.60
Rate for Payer: Aetna of IA Medical Rental Products	$138.60
Rate for Payer: Aetna of IA Medicare	$87.78
Rate for Payer: Amerigroup Medicaid	$88.83
Rate for Payer: Amerigroup Medicare	$69.99
Rate for Payer: Cash Price	$123.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$115.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.30
Rate for Payer: Iowa Total Care Managed Medicaid	$87.96
Rate for Payer: Medical Associates Commercial	$115.50
Rate for Payer: Medical Associates Managed Medicare	$69.30
Rate for Payer: Midlands Choice Commercial	$107.80
Rate for Payer: Molina Healthcare Managed Medicaid	$89.26
Rate for Payer: Partners Health Alliance Commercial	$79.69
Rate for Payer: United Healthcare Commercial	$138.60
Rate for Payer: United Healthcare Managed Medicare	$90.86

XR Gastrografin Enema

Facility

$718.00

Service Code	CPT 74270
Hospital Charge Code	1170209
Hospital Revenue Code	320
Min. Negotiated Rate	$323.10
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of IA Commercial	$646.20
Rate for Payer: Aetna of IA Medical Rental Products	$646.20
Rate for Payer: Aetna of IA Medicare	$409.26
Rate for Payer: Amerigroup Medicaid	$414.14
Rate for Payer: Amerigroup Medicare	$326.33
Rate for Payer: Cash Price	$574.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$538.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$323.10
Rate for Payer: Iowa Total Care Managed Medicaid	$410.12
Rate for Payer: Medical Associates Commercial	$538.50
Rate for Payer: Medical Associates Managed Medicare	$323.10
Rate for Payer: Midlands Choice Commercial	$502.60
Rate for Payer: Molina Healthcare Managed Medicaid	$416.15
Rate for Payer: Partners Health Alliance Commercial	$371.56
Rate for Payer: United Healthcare Commercial	$646.20
Rate for Payer: United Healthcare Managed Medicare	$423.62

XR Gastrografin Enema

Facility

$718.00

Service Code	CPT 74270
Hospital Charge Code	1170209
Hospital Revenue Code	320
Min. Negotiated Rate	$502.60
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of IA Commercial	$646.20
Rate for Payer: Aetna of IA Medical Rental Products	$646.20
Rate for Payer: Cash Price	$574.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$538.50
Rate for Payer: Medical Associates Commercial	$538.50
Rate for Payer: Midlands Choice Commercial	$502.60
Rate for Payer: United Healthcare Commercial	$646.20

XR GI Tube Inj for Placement

Facility

$432.00

Service Code	CPT 49465
Hospital Charge Code	7960844
Hospital Revenue Code	320
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Aetna of IA Medicare	$246.24
Rate for Payer: Amerigroup Medicaid	$249.18
Rate for Payer: Amerigroup Medicare	$196.34
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$194.40
Rate for Payer: Iowa Total Care Managed Medicaid	$246.76
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Medical Associates Managed Medicare	$194.40
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: Molina Healthcare Managed Medicaid	$250.39
Rate for Payer: Partners Health Alliance Commercial	$223.56
Rate for Payer: United Healthcare Commercial	$388.80
Rate for Payer: United Healthcare Managed Medicare	$254.88

XR GI Tube Inj for Placement

Facility

$432.00

Service Code	CPT 49465
Hospital Charge Code	7960844
Hospital Revenue Code	320
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna of IA Commercial	$388.80
Rate for Payer: Aetna of IA Medical Rental Products	$388.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$324.00
Rate for Payer: Medical Associates Commercial	$324.00
Rate for Payer: Midlands Choice Commercial	$302.40
Rate for Payer: United Healthcare Commercial	$388.80

XR Hand 2 Views Left

Facility

$127.00

Service Code	CPT 73120 LT
Hospital Charge Code	1170215
Hospital Revenue Code	320
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of IA Commercial	$114.30
Rate for Payer: Aetna of IA Medical Rental Products	$114.30
Rate for Payer: Cash Price	$101.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$95.25
Rate for Payer: Medical Associates Commercial	$95.25
Rate for Payer: Midlands Choice Commercial	$88.90
Rate for Payer: United Healthcare Commercial	$114.30

Know your out-of-pocket cost for care.

All Charges