Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

2.2MM X 10MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8807705
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: United Healthcare Commercial	$299.70

2.2MM X 10MM NON-LOCKING SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8993360
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

2.2MM X 10MM NON-LOCKING SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8993360
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

2.2MM X 12MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8807707
Hospital Revenue Code	278
Min. Negotiated Rate	$149.85
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Aetna of IA Medicare	$189.81
Rate for Payer: Amerigroup Medicaid	$192.07
Rate for Payer: Amerigroup Medicare	$151.35
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$149.85
Rate for Payer: Iowa Total Care Managed Medicaid	$190.21
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Medical Associates Managed Medicare	$149.85
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: Molina Healthcare Managed Medicaid	$193.01
Rate for Payer: Partners Health Alliance Commercial	$172.33
Rate for Payer: United Healthcare Commercial	$299.70
Rate for Payer: United Healthcare Managed Medicare	$196.47

2.2MM X 12MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8807707
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: United Healthcare Commercial	$299.70

2.2MM X 12MM NON LOCKING SCREW

Facility

$216.00

Service Code	HCPCS C1713
Hospital Charge Code	8956476
Hospital Revenue Code	278
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of IA Commercial	$194.40
Rate for Payer: Aetna of IA Medical Rental Products	$194.40
Rate for Payer: Aetna of IA Medicare	$123.12
Rate for Payer: Amerigroup Medicaid	$124.59
Rate for Payer: Amerigroup Medicare	$98.17
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$162.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$97.20
Rate for Payer: Iowa Total Care Managed Medicaid	$123.38
Rate for Payer: Medical Associates Commercial	$162.00
Rate for Payer: Medical Associates Managed Medicare	$97.20
Rate for Payer: Midlands Choice Commercial	$151.20
Rate for Payer: Molina Healthcare Managed Medicaid	$125.19
Rate for Payer: Partners Health Alliance Commercial	$111.78
Rate for Payer: United Healthcare Commercial	$194.40
Rate for Payer: United Healthcare Managed Medicare	$127.44

2.2MM X 12MM NON LOCKING SCREW

Facility

$216.00

Service Code	HCPCS C1713
Hospital Charge Code	8956476
Hospital Revenue Code	278
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of IA Commercial	$194.40
Rate for Payer: Aetna of IA Medical Rental Products	$194.40
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$162.00
Rate for Payer: Medical Associates Commercial	$162.00
Rate for Payer: Midlands Choice Commercial	$151.20
Rate for Payer: United Healthcare Commercial	$194.40

2.2MM X 18MM LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8956484
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

2.2MM X 18MM LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8956484
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

2.2MM X 20MM LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8956486
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

2.2MM X 20MM LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8956486
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

2.2MM X 6MM LOCKING SCREW

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8993362
Hospital Revenue Code	278
Min. Negotiated Rate	$214.65
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Aetna of IA Medicare	$271.89
Rate for Payer: Amerigroup Medicaid	$275.13
Rate for Payer: Amerigroup Medicare	$216.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$214.65
Rate for Payer: Iowa Total Care Managed Medicaid	$272.46
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Medical Associates Managed Medicare	$214.65
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: Molina Healthcare Managed Medicaid	$276.47
Rate for Payer: Partners Health Alliance Commercial	$246.85
Rate for Payer: United Healthcare Commercial	$429.30
Rate for Payer: United Healthcare Managed Medicare	$281.43

2.2MM X 6MM LOCKING SCREW

Facility

$477.00

Service Code	HCPCS C1713
Hospital Charge Code	8993362
Hospital Revenue Code	278
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of IA Commercial	$429.30
Rate for Payer: Aetna of IA Medical Rental Products	$429.30
Rate for Payer: Cash Price	$381.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$357.75
Rate for Payer: Medical Associates Commercial	$357.75
Rate for Payer: Midlands Choice Commercial	$333.90
Rate for Payer: United Healthcare Commercial	$429.30

2.2MM X 8MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8807703
Hospital Revenue Code	278
Min. Negotiated Rate	$149.85
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Aetna of IA Medicare	$189.81
Rate for Payer: Amerigroup Medicaid	$192.07
Rate for Payer: Amerigroup Medicare	$151.35
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$149.85
Rate for Payer: Iowa Total Care Managed Medicaid	$190.21
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Medical Associates Managed Medicare	$149.85
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: Molina Healthcare Managed Medicaid	$193.01
Rate for Payer: Partners Health Alliance Commercial	$172.33
Rate for Payer: United Healthcare Commercial	$299.70
Rate for Payer: United Healthcare Managed Medicare	$196.47

2.2MM X 8MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8807703
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: United Healthcare Commercial	$299.70

24105 BURSECTOMY ELBOW

Professional

Both

$1,169.00

Service Code	CPT 24105
Hospital Charge Code	8068901
Hospital Revenue Code	975
Min. Negotiated Rate	$275.70
Max. Negotiated Rate	$876.75
Rate for Payer: Amerigroup Medicaid	$278.40
Rate for Payer: Cash Price	$935.20
Rate for Payer: Cash Price	$935.20
Rate for Payer: Iowa Total Care Managed Medicaid	$275.70
Rate for Payer: Medical Associates Commercial	$876.75
Rate for Payer: Midlands Choice Commercial	$818.30
Rate for Payer: Molina Healthcare Managed Medicaid	$277.05
Rate for Payer: Partners Health Alliance Commercial	$876.75
Rate for Payer: United Healthcare Commercial	$533.10
Rate for Payer: Wellmark IA HMO WHPI	$699.40
Rate for Payer: Wellmark IA PPO	$822.90

2.4MMX10MM TIGER CANNULATED SCREW

Facility

$207.00

Service Code	HCPCS C1713
Hospital Charge Code	8865231
Hospital Revenue Code	278
Min. Negotiated Rate	$144.90
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of IA Commercial	$186.30
Rate for Payer: Aetna of IA Medical Rental Products	$186.30
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$155.25
Rate for Payer: Medical Associates Commercial	$155.25
Rate for Payer: Midlands Choice Commercial	$144.90
Rate for Payer: United Healthcare Commercial	$186.30

2.4MMX10MM TIGER CANNULATED SCREW

Facility

$207.00

Service Code	HCPCS C1713
Hospital Charge Code	8865231
Hospital Revenue Code	278
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of IA Commercial	$186.30
Rate for Payer: Aetna of IA Medical Rental Products	$186.30
Rate for Payer: Aetna of IA Medicare	$117.99
Rate for Payer: Amerigroup Medicaid	$119.40
Rate for Payer: Amerigroup Medicare	$94.08
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$155.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$93.15
Rate for Payer: Iowa Total Care Managed Medicaid	$118.24
Rate for Payer: Medical Associates Commercial	$155.25
Rate for Payer: Medical Associates Managed Medicare	$93.15
Rate for Payer: Midlands Choice Commercial	$144.90
Rate for Payer: Molina Healthcare Managed Medicaid	$119.98
Rate for Payer: Partners Health Alliance Commercial	$107.12
Rate for Payer: United Healthcare Commercial	$186.30
Rate for Payer: United Healthcare Managed Medicare	$122.13

2.4mm x12mm TIGER CANNULATED SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8463417
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

2.4mm x12mm TIGER CANNULATED SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8463417
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

2.4MM X 14 GL SCREW

Facility

$144.00

Service Code	HCPCS C1713
Hospital Charge Code	8700304
Hospital Revenue Code	278
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of IA Commercial	$129.60
Rate for Payer: Aetna of IA Medical Rental Products	$129.60
Rate for Payer: Aetna of IA Medicare	$82.08
Rate for Payer: Amerigroup Medicaid	$83.06
Rate for Payer: Amerigroup Medicare	$65.45
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$64.80
Rate for Payer: Iowa Total Care Managed Medicaid	$82.25
Rate for Payer: Medical Associates Commercial	$108.00
Rate for Payer: Medical Associates Managed Medicare	$64.80
Rate for Payer: Midlands Choice Commercial	$100.80
Rate for Payer: Molina Healthcare Managed Medicaid	$83.46
Rate for Payer: Partners Health Alliance Commercial	$74.52
Rate for Payer: United Healthcare Commercial	$129.60
Rate for Payer: United Healthcare Managed Medicare	$84.96

2.4MM X 14 GL SCREW

Facility

$144.00

Service Code	HCPCS C1713
Hospital Charge Code	8700304
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of IA Commercial	$129.60
Rate for Payer: Aetna of IA Medical Rental Products	$129.60
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$108.00
Rate for Payer: Medical Associates Commercial	$108.00
Rate for Payer: Midlands Choice Commercial	$100.80
Rate for Payer: United Healthcare Commercial	$129.60

2.4MMX14MM TIGER CANNULATED SCREWS

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8463419
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

2.4MMX14MM TIGER CANNULATED SCREWS

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8463419
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

2.4MM X 16MM CANNULATED SCREW

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8470644
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

Know your out-of-pocket cost for care.

All Charges