Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

clopidogrel 75 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10378951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.39

clopidogrel 75 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10378951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Aetna of IA Medicare	$0.88
Rate for Payer: Amerigroup Medicaid	$0.89
Rate for Payer: Amerigroup Medicare	$0.70
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.69
Rate for Payer: Iowa Total Care Managed Medicaid	$0.88
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Medical Associates Managed Medicare	$0.69
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: Molina Healthcare Managed Medicaid	$0.89
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.39
Rate for Payer: United Healthcare Managed Medicare	$0.91

CLOSED REDUCTION

Professional

Both

$1,621.00

Service Code	CPT 25535
Hospital Charge Code	7982868
Hospital Revenue Code	981
Min. Negotiated Rate	$403.97
Max. Negotiated Rate	$1,215.75
Rate for Payer: Amerigroup Medicaid	$407.93
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Iowa Total Care Managed Medicaid	$403.97
Rate for Payer: Medical Associates Commercial	$1,215.75
Rate for Payer: Midlands Choice Commercial	$1,134.70
Rate for Payer: Molina Healthcare Managed Medicaid	$405.95
Rate for Payer: Partners Health Alliance Commercial	$1,215.75
Rate for Payer: United Healthcare Commercial	$738.56
Rate for Payer: Wellmark IA HMO WHPI	$968.70
Rate for Payer: Wellmark IA PPO	$1,139.60

CLOSED TREATMENT OF CARPAL BONE FX

Professional

Both

$1,464.00

Service Code	CPT 25635
Hospital Charge Code	8822636
Hospital Revenue Code	981
Min. Negotiated Rate	$368.52
Max. Negotiated Rate	$1,098.00
Rate for Payer: Amerigroup Medicaid	$372.13
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Iowa Total Care Managed Medicaid	$368.52
Rate for Payer: Medical Associates Commercial	$1,098.00
Rate for Payer: Midlands Choice Commercial	$1,024.80
Rate for Payer: Molina Healthcare Managed Medicaid	$370.32
Rate for Payer: Partners Health Alliance Commercial	$1,098.00
Rate for Payer: United Healthcare Commercial	$692.03
Rate for Payer: Wellmark IA HMO WHPI	$914.60
Rate for Payer: Wellmark IA PPO	$1,076.00

CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA

Facility

$2,696.01

Service Code	CPT 27252
Hospital Revenue Code	490
Min. Negotiated Rate	$2,447.47
Max. Negotiated Rate	$2,696.01
Rate for Payer: Wellmark IA HMO WHPI	$2,447.47
Rate for Payer: Wellmark IA PPO	$2,696.01

CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA

Facility

$2,009.51

Service Code	CPT 23650
Hospital Revenue Code	490
Min. Negotiated Rate	$1,824.26
Max. Negotiated Rate	$2,009.51
Rate for Payer: Wellmark IA HMO WHPI	$1,824.26
Rate for Payer: Wellmark IA PPO	$2,009.51

Clostridioides difficile Toxin by EIA DMCL

Facility

$58.00

Service Code	CPT 87324
Hospital Charge Code	8728243
Hospital Revenue Code	306
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

Clostridioides difficile Toxin by EIA DMCL

Facility

$58.00

Service Code	CPT 87324
Hospital Charge Code	8728243
Hospital Revenue Code	306
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$33.45
Rate for Payer: Amerigroup Medicare	$26.36
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.10
Rate for Payer: Iowa Total Care Managed Medicaid	$33.13
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$26.10
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$33.62
Rate for Payer: Partners Health Alliance Commercial	$30.02
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

CLOSTRIDIUM DIFFICILE

Facility

$152.00

Service Code	CPT 87493
Hospital Charge Code	4022795
Hospital Revenue Code	306
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Aetna of IA Medicare	$86.64
Rate for Payer: Amerigroup Medicaid	$87.67
Rate for Payer: Amerigroup Medicare	$69.08
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$68.40
Rate for Payer: Iowa Total Care Managed Medicaid	$86.82
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Medical Associates Managed Medicare	$68.40
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: Molina Healthcare Managed Medicaid	$88.10
Rate for Payer: Partners Health Alliance Commercial	$78.66
Rate for Payer: United Healthcare Commercial	$136.80
Rate for Payer: United Healthcare Managed Medicare	$89.68
Rate for Payer: Wellmark IA HMO WHPI	$86.50
Rate for Payer: Wellmark IA PPO	$95.28

CLOSTRIDIUM DIFFICILE

Facility

$152.00

Service Code	CPT 87493
Hospital Charge Code	4022795
Hospital Revenue Code	306
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: United Healthcare Commercial	$136.80

CLOSURE OF SPLIT WOUND

Facility

$579.00

Service Code	CPT 12020
Hospital Charge Code	4863348
Hospital Revenue Code	450
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$1,127.76
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61
Rate for Payer: Wellmark IA HMO WHPI	$1,023.80
Rate for Payer: Wellmark IA PPO	$1,127.76

CLOSURE OF SPLIT WOUND

Facility

$579.00

Service Code	CPT 12020
Hospital Charge Code	4863348
Hospital Revenue Code	450
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: United Healthcare Commercial	$521.10

clotrimazole 10 mg Loz [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10379022
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.41
Rate for Payer: Medical Associates Commercial	$1.41
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: United Healthcare Commercial	$1.70

clotrimazole 10 mg Loz [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10379022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Aetna of IA Medicare	$1.08
Rate for Payer: Amerigroup Medicaid	$1.09
Rate for Payer: Amerigroup Medicare	$0.86
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.41
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.85
Rate for Payer: Iowa Total Care Managed Medicaid	$1.08
Rate for Payer: Medical Associates Commercial	$1.41
Rate for Payer: Medical Associates Managed Medicare	$0.85
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: Molina Healthcare Managed Medicaid	$1.09
Rate for Payer: Partners Health Alliance Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.70
Rate for Payer: United Healthcare Managed Medicare	$1.11

clotrimazole Top 1% Crm 30gm [VDMC]

Facility

$16.20

Service Code	HCPCS A9270
Hospital Charge Code	10434063
Hospital Revenue Code	259
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$14.58
Rate for Payer: Aetna of IA Commercial	$14.58
Rate for Payer: Aetna of IA Medical Rental Products	$14.58
Rate for Payer: Aetna of IA Medicare	$9.23
Rate for Payer: Amerigroup Medicaid	$9.34
Rate for Payer: Amerigroup Medicare	$7.36
Rate for Payer: Cash Price	$12.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$7.29
Rate for Payer: Iowa Total Care Managed Medicaid	$9.25
Rate for Payer: Medical Associates Commercial	$12.15
Rate for Payer: Medical Associates Managed Medicare	$7.29
Rate for Payer: Midlands Choice Commercial	$11.34
Rate for Payer: Molina Healthcare Managed Medicaid	$9.39
Rate for Payer: Partners Health Alliance Commercial	$8.38
Rate for Payer: United Healthcare Commercial	$14.58
Rate for Payer: United Healthcare Managed Medicare	$9.56

clotrimazole Top 1% Crm 30gm [VDMC]

Facility

$16.20

Service Code	HCPCS A9270
Hospital Charge Code	10434063
Hospital Revenue Code	259
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$14.58
Rate for Payer: Aetna of IA Commercial	$14.58
Rate for Payer: Aetna of IA Medical Rental Products	$14.58
Rate for Payer: Cash Price	$12.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.15
Rate for Payer: Medical Associates Commercial	$12.15
Rate for Payer: Midlands Choice Commercial	$11.34
Rate for Payer: United Healthcare Commercial	$14.58

CMPLX RPR E/N/E/L 1.1-2.5 CM

Professional

Both

$1,400.00

Service Code	CPT 13151
Hospital Charge Code	7982819
Hospital Revenue Code	981
Min. Negotiated Rate	$289.84
Max. Negotiated Rate	$1,050.00
Rate for Payer: Amerigroup Medicaid	$292.68
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Iowa Total Care Managed Medicaid	$289.84
Rate for Payer: Medical Associates Commercial	$1,050.00
Rate for Payer: Midlands Choice Commercial	$980.00
Rate for Payer: Molina Healthcare Managed Medicaid	$291.26
Rate for Payer: Partners Health Alliance Commercial	$1,050.00
Rate for Payer: United Healthcare Commercial	$644.37
Rate for Payer: Wellmark IA HMO WHPI	$771.20
Rate for Payer: Wellmark IA PPO	$907.30

CMPLX RPR E/N/E/L 1.1-2.5 CM

Facility

$579.00

Service Code	CPT 13151
Hospital Charge Code	4863434
Hospital Revenue Code	450
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$903.62
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61
Rate for Payer: Wellmark IA HMO WHPI	$820.31
Rate for Payer: Wellmark IA PPO	$903.62

CMPLX RPR E/N/E/L 1.1-2.5 CM

Facility

$579.00

Service Code	CPT 13151
Hospital Charge Code	4863434
Hospital Revenue Code	450
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: United Healthcare Commercial	$521.10

CMPLX RPR E/N/E/L 2.6-7.5 CM

Facility

$1,056.00

Service Code	CPT 13152
Hospital Charge Code	4863435
Hospital Revenue Code	450
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$950.40
Rate for Payer: Aetna of IA Commercial	$950.40
Rate for Payer: Aetna of IA Medical Rental Products	$950.40
Rate for Payer: Aetna of IA Medicare	$601.92
Rate for Payer: Amerigroup Medicaid	$609.10
Rate for Payer: Amerigroup Medicare	$479.95
Rate for Payer: Cash Price	$844.80
Rate for Payer: Cash Price	$844.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$792.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$475.20
Rate for Payer: Iowa Total Care Managed Medicaid	$603.19
Rate for Payer: Medical Associates Commercial	$792.00
Rate for Payer: Medical Associates Managed Medicare	$475.20
Rate for Payer: Midlands Choice Commercial	$739.20
Rate for Payer: Molina Healthcare Managed Medicaid	$612.06
Rate for Payer: Partners Health Alliance Commercial	$546.48
Rate for Payer: United Healthcare Commercial	$950.40
Rate for Payer: United Healthcare Managed Medicare	$623.04
Rate for Payer: Wellmark IA HMO WHPI	$820.31
Rate for Payer: Wellmark IA PPO	$903.62

CMPLX RPR E/N/E/L 2.6-7.5 CM

Facility

$1,056.00

Service Code	CPT 13152
Hospital Charge Code	4863435
Hospital Revenue Code	450
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$950.40
Rate for Payer: Aetna of IA Commercial	$950.40
Rate for Payer: Aetna of IA Medical Rental Products	$950.40
Rate for Payer: Cash Price	$844.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$792.00
Rate for Payer: Medical Associates Commercial	$792.00
Rate for Payer: Midlands Choice Commercial	$739.20
Rate for Payer: United Healthcare Commercial	$950.40

CMPLX RPR F/C/C/M/N/AX/G/H/F

Professional

Both

$1,277.00

Service Code	CPT 13132
Hospital Charge Code	7982820
Hospital Revenue Code	981
Min. Negotiated Rate	$375.53
Max. Negotiated Rate	$1,009.60
Rate for Payer: Amerigroup Medicaid	$379.22
Rate for Payer: Cash Price	$1,021.60
Rate for Payer: Cash Price	$1,021.60
Rate for Payer: Iowa Total Care Managed Medicaid	$375.53
Rate for Payer: Medical Associates Commercial	$957.75
Rate for Payer: Midlands Choice Commercial	$893.90
Rate for Payer: Molina Healthcare Managed Medicaid	$377.37
Rate for Payer: Partners Health Alliance Commercial	$957.75
Rate for Payer: United Healthcare Commercial	$723.20
Rate for Payer: Wellmark IA HMO WHPI	$858.10
Rate for Payer: Wellmark IA PPO	$1,009.60

CMPLX RPR F/C/C/M/N/AX/G/H/F

Facility

$304.00

Service Code	CPT 13131
Hospital Charge Code	4863428
Hospital Revenue Code	450
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$903.62
Rate for Payer: Aetna of IA Commercial	$273.60
Rate for Payer: Aetna of IA Medical Rental Products	$273.60
Rate for Payer: Aetna of IA Medicare	$173.28
Rate for Payer: Amerigroup Medicaid	$175.35
Rate for Payer: Amerigroup Medicare	$138.17
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$228.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$136.80
Rate for Payer: Iowa Total Care Managed Medicaid	$173.64
Rate for Payer: Medical Associates Commercial	$228.00
Rate for Payer: Medical Associates Managed Medicare	$136.80
Rate for Payer: Midlands Choice Commercial	$212.80
Rate for Payer: Molina Healthcare Managed Medicaid	$176.20
Rate for Payer: Partners Health Alliance Commercial	$157.32
Rate for Payer: United Healthcare Commercial	$273.60
Rate for Payer: United Healthcare Managed Medicare	$179.36
Rate for Payer: Wellmark IA HMO WHPI	$820.31
Rate for Payer: Wellmark IA PPO	$903.62

CMPLX RPR F/C/C/M/N/AX/G/H/F

Facility

$304.00

Service Code	CPT 13131
Hospital Charge Code	4863428
Hospital Revenue Code	450
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna of IA Commercial	$273.60
Rate for Payer: Aetna of IA Medical Rental Products	$273.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$228.00
Rate for Payer: Medical Associates Commercial	$228.00
Rate for Payer: Midlands Choice Commercial	$212.80
Rate for Payer: United Healthcare Commercial	$273.60

CMPLX RPR F/C/C/M/N/AX/G/H/F

Facility

$579.00

Service Code	CPT 13133
Hospital Charge Code	4863431
Hospital Revenue Code	450
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$903.62
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61
Rate for Payer: Wellmark IA HMO WHPI	$820.31
Rate for Payer: Wellmark IA PPO	$903.62

Know your out-of-pocket cost for care.

All Charges