Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

28313 Recontruction angular deformity to toe soft tissue procedures only

Professional

Both

$1,754.00

Service Code	CPT 28313
Hospital Charge Code	8799146
Hospital Revenue Code	975
Min. Negotiated Rate	$332.47
Max. Negotiated Rate	$1,227.80
Rate for Payer: Aetna of IA Medicare	$332.47
Rate for Payer: Amerigroup Medicaid	$343.77
Rate for Payer: Cash Price	$1,403.20
Rate for Payer: Cash Price	$1,403.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$398.96
Rate for Payer: Iowa Total Care Managed Medicaid	$339.12
Rate for Payer: Medical Associates Commercial	$631.69
Rate for Payer: Medical Associates Managed Medicare	$332.47
Rate for Payer: Midlands Choice Commercial	$1,227.80
Rate for Payer: Oscar Health of IA Commercial	$575.17
Rate for Payer: Partners Health Alliance Commercial	$498.70

28415 Open treatment of calcaneal fracture

Professional

Both

$3,751.00

Service Code	CPT 28415
Hospital Charge Code	8799147
Hospital Revenue Code	975
Min. Negotiated Rate	$1,018.66
Max. Negotiated Rate	$2,625.70
Rate for Payer: Aetna of IA Medicare	$1,018.66
Rate for Payer: Amerigroup Medicaid	$1,053.29
Rate for Payer: Cash Price	$3,000.80
Rate for Payer: Cash Price	$3,000.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,222.39
Rate for Payer: Iowa Total Care Managed Medicaid	$1,039.03
Rate for Payer: Medical Associates Commercial	$1,935.45
Rate for Payer: Medical Associates Managed Medicare	$1,018.66
Rate for Payer: Midlands Choice Commercial	$2,625.70
Rate for Payer: Oscar Health of IA Commercial	$1,762.28
Rate for Payer: Partners Health Alliance Commercial	$1,527.99

28485 Open treatment of metatarsal fracture; includes internal fixation

Professional

Both

$1,827.00

Service Code	CPT 28485
Hospital Charge Code	8799148
Hospital Revenue Code	975
Min. Negotiated Rate	$518.97
Max. Negotiated Rate	$1,278.90
Rate for Payer: Aetna of IA Medicare	$518.97
Rate for Payer: Amerigroup Medicaid	$536.61
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$622.76
Rate for Payer: Iowa Total Care Managed Medicaid	$529.35
Rate for Payer: Medical Associates Commercial	$986.04
Rate for Payer: Medical Associates Managed Medicare	$518.97
Rate for Payer: Midlands Choice Commercial	$1,278.90
Rate for Payer: Oscar Health of IA Commercial	$897.82
Rate for Payer: Partners Health Alliance Commercial	$778.46

28740 Arthrodesis midtarsal or tarsometatarsal single joint

Professional

Both

$2,823.00

Service Code	CPT 28740
Hospital Charge Code	8799149
Hospital Revenue Code	975
Min. Negotiated Rate	$565.05
Max. Negotiated Rate	$1,976.10
Rate for Payer: Aetna of IA Medicare	$565.05
Rate for Payer: Amerigroup Medicaid	$584.26
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$678.06
Rate for Payer: Iowa Total Care Managed Medicaid	$576.35
Rate for Payer: Medical Associates Commercial	$1,073.60
Rate for Payer: Medical Associates Managed Medicare	$565.05
Rate for Payer: Midlands Choice Commercial	$1,976.10
Rate for Payer: Oscar Health of IA Commercial	$977.54
Rate for Payer: Partners Health Alliance Commercial	$847.58

28820 Amputate toe metatarsophalangeal joint

Professional

Both

$1,887.00

Service Code	CPT 28820
Hospital Charge Code	8799150
Hospital Revenue Code	975
Min. Negotiated Rate	$162.32
Max. Negotiated Rate	$1,320.90
Rate for Payer: Aetna of IA Medicare	$162.32
Rate for Payer: Amerigroup Medicaid	$167.84
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$194.78
Rate for Payer: Iowa Total Care Managed Medicaid	$165.57
Rate for Payer: Medical Associates Commercial	$308.41
Rate for Payer: Medical Associates Managed Medicare	$162.32
Rate for Payer: Midlands Choice Commercial	$1,320.90
Rate for Payer: Oscar Health of IA Commercial	$280.81
Rate for Payer: Partners Health Alliance Commercial	$243.48

28825 Amputate toe interphalangeal joint

Professional

Both

$1,807.00

Service Code	CPT 28825
Hospital Charge Code	8799151
Hospital Revenue Code	975
Min. Negotiated Rate	$158.30
Max. Negotiated Rate	$1,264.90
Rate for Payer: Aetna of IA Medicare	$158.30
Rate for Payer: Amerigroup Medicaid	$163.68
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.96
Rate for Payer: Iowa Total Care Managed Medicaid	$161.47
Rate for Payer: Medical Associates Commercial	$300.77
Rate for Payer: Medical Associates Managed Medicare	$158.30
Rate for Payer: Midlands Choice Commercial	$1,264.90
Rate for Payer: Oscar Health of IA Commercial	$273.86
Rate for Payer: Partners Health Alliance Commercial	$237.45

29580 APPLICATION OF PASTE BOOT (UNNA)

Professional

Both

$210.00

Service Code	CPT 29580
Hospital Charge Code	8799153
Hospital Revenue Code	975
Min. Negotiated Rate	$23.84
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna of IA Medicare	$23.84
Rate for Payer: Amerigroup Medicaid	$24.65
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$28.61
Rate for Payer: Iowa Total Care Managed Medicaid	$24.32
Rate for Payer: Medical Associates Commercial	$45.30
Rate for Payer: Medical Associates Managed Medicare	$23.84
Rate for Payer: Midlands Choice Commercial	$147.00
Rate for Payer: Oscar Health of IA Commercial	$41.24
Rate for Payer: Partners Health Alliance Commercial	$35.76

29581 COMPRESSION MULTILAYER BELOW KNEE

Professional

Both

$296.00

Service Code	CPT 29581
Hospital Charge Code	8799154
Hospital Revenue Code	975
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna of IA Medicare	$25.18
Rate for Payer: Amerigroup Medicaid	$26.04
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.22
Rate for Payer: Iowa Total Care Managed Medicaid	$25.68
Rate for Payer: Medical Associates Commercial	$47.84
Rate for Payer: Medical Associates Managed Medicare	$25.18
Rate for Payer: Midlands Choice Commercial	$207.20
Rate for Payer: Oscar Health of IA Commercial	$43.56
Rate for Payer: Partners Health Alliance Commercial	$37.77

29807 Arthroscopy shoulder surgical repair of SLAP lesion

Professional

Both

$3,485.00

Service Code	CPT 29807
Hospital Charge Code	8799155
Hospital Revenue Code	975
Min. Negotiated Rate	$932.87
Max. Negotiated Rate	$2,439.50
Rate for Payer: Aetna of IA Medicare	$932.87
Rate for Payer: Amerigroup Medicaid	$964.59
Rate for Payer: Cash Price	$2,788.00
Rate for Payer: Cash Price	$2,788.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,119.44
Rate for Payer: Iowa Total Care Managed Medicaid	$951.53
Rate for Payer: Medical Associates Commercial	$1,772.45
Rate for Payer: Medical Associates Managed Medicare	$932.87
Rate for Payer: Midlands Choice Commercial	$2,439.50
Rate for Payer: Oscar Health of IA Commercial	$1,613.87
Rate for Payer: Partners Health Alliance Commercial	$1,399.30

29826 Arthroscopy shoulder surgical; decompression of subacromial space

Professional

Both

$591.00

Service Code	CPT 29826
Hospital Charge Code	8799156
Hospital Revenue Code	975
Min. Negotiated Rate	$152.35
Max. Negotiated Rate	$413.70
Rate for Payer: Aetna of IA Medicare	$152.35
Rate for Payer: Amerigroup Medicaid	$157.53
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cash Price	$472.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$182.82
Rate for Payer: Iowa Total Care Managed Medicaid	$155.40
Rate for Payer: Medical Associates Commercial	$289.46
Rate for Payer: Medical Associates Managed Medicare	$152.35
Rate for Payer: Midlands Choice Commercial	$413.70
Rate for Payer: Oscar Health of IA Commercial	$263.57
Rate for Payer: Partners Health Alliance Commercial	$228.52

29827 Arthroscopy shoulder surgical; with rotator cuff repair

Professional

Both

$3,542.00

Service Code	CPT 29827
Hospital Charge Code	8799157
Hospital Revenue Code	975
Min. Negotiated Rate	$963.00
Max. Negotiated Rate	$2,280.77
Rate for Payer: Aetna of IA Medicare	$963.00
Rate for Payer: Amerigroup Medicaid	$995.74
Rate for Payer: Cash Price	$2,833.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,155.60
Rate for Payer: Iowa Total Care Managed Medicaid	$982.26
Rate for Payer: Medical Associates Commercial	$1,829.70
Rate for Payer: Medical Associates Managed Medicare	$963.00
Rate for Payer: Midlands Choice Commercial	$2,280.77
Rate for Payer: Oscar Health of IA Commercial	$1,665.99
Rate for Payer: Partners Health Alliance Commercial	$1,444.50

29867 Arthroscopy knee surgical; osteochondral allograft

Professional

Both

$4,311.00

Service Code	CPT 29867
Hospital Charge Code	8799158
Hospital Revenue Code	975
Min. Negotiated Rate	$1,150.36
Max. Negotiated Rate	$3,017.70
Rate for Payer: Aetna of IA Medicare	$1,150.36
Rate for Payer: Amerigroup Medicaid	$1,189.47
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,380.43
Rate for Payer: Iowa Total Care Managed Medicaid	$1,173.37
Rate for Payer: Medical Associates Commercial	$2,185.68
Rate for Payer: Medical Associates Managed Medicare	$1,150.36
Rate for Payer: Midlands Choice Commercial	$3,017.70
Rate for Payer: Oscar Health of IA Commercial	$1,990.12
Rate for Payer: Partners Health Alliance Commercial	$1,725.54

29874 Arthroscopy; knee with removal of loose/foreign body

Professional

Both

$1,801.00

Service Code	CPT 29874
Hospital Charge Code	8799159
Hospital Revenue Code	975
Min. Negotiated Rate	$489.12
Max. Negotiated Rate	$1,260.70
Rate for Payer: Aetna of IA Medicare	$489.12
Rate for Payer: Amerigroup Medicaid	$505.75
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$586.94
Rate for Payer: Iowa Total Care Managed Medicaid	$498.90
Rate for Payer: Medical Associates Commercial	$929.33
Rate for Payer: Medical Associates Managed Medicare	$489.12
Rate for Payer: Midlands Choice Commercial	$1,260.70
Rate for Payer: Oscar Health of IA Commercial	$846.18
Rate for Payer: Partners Health Alliance Commercial	$733.68

29877 Arthroscopy knee w/debridement/shaving of cartilage (chondroplasty)

Professional

Both

$2,087.00

Service Code	CPT 29877
Hospital Charge Code	8799160
Hospital Revenue Code	975
Min. Negotiated Rate	$563.58
Max. Negotiated Rate	$1,460.90
Rate for Payer: Aetna of IA Medicare	$563.58
Rate for Payer: Amerigroup Medicaid	$582.74
Rate for Payer: Cash Price	$1,669.60
Rate for Payer: Cash Price	$1,669.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$676.30
Rate for Payer: Iowa Total Care Managed Medicaid	$574.85
Rate for Payer: Medical Associates Commercial	$1,070.80
Rate for Payer: Medical Associates Managed Medicare	$563.58
Rate for Payer: Midlands Choice Commercial	$1,460.90
Rate for Payer: Oscar Health of IA Commercial	$974.99
Rate for Payer: Partners Health Alliance Commercial	$845.37

29879 Arthroscopy knee surgical; abrasion arthroplasty-drilling/microfracture

Professional

Both

$2,223.00

Service Code	CPT 29879
Hospital Charge Code	8799161
Hospital Revenue Code	975
Min. Negotiated Rate	$600.08
Max. Negotiated Rate	$1,556.10
Rate for Payer: Aetna of IA Medicare	$600.08
Rate for Payer: Amerigroup Medicaid	$620.48
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$720.10
Rate for Payer: Iowa Total Care Managed Medicaid	$612.08
Rate for Payer: Medical Associates Commercial	$1,140.15
Rate for Payer: Medical Associates Managed Medicare	$600.08
Rate for Payer: Midlands Choice Commercial	$1,556.10
Rate for Payer: Oscar Health of IA Commercial	$1,038.14
Rate for Payer: Partners Health Alliance Commercial	$900.12

29880 Arthroscopy; knee with meniscenctomy medial/lateral w/shaving

Professional

Both

$1,885.00

Service Code	CPT 29880
Hospital Charge Code	8799162
Hospital Revenue Code	975
Min. Negotiated Rate	$510.76
Max. Negotiated Rate	$1,319.50
Rate for Payer: Aetna of IA Medicare	$510.76
Rate for Payer: Amerigroup Medicaid	$528.13
Rate for Payer: Cash Price	$1,508.00
Rate for Payer: Cash Price	$1,508.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$612.91
Rate for Payer: Iowa Total Care Managed Medicaid	$520.98
Rate for Payer: Medical Associates Commercial	$970.44
Rate for Payer: Medical Associates Managed Medicare	$510.76
Rate for Payer: Midlands Choice Commercial	$1,319.50
Rate for Payer: Oscar Health of IA Commercial	$883.61
Rate for Payer: Partners Health Alliance Commercial	$766.14

29881 Arthroscopy knee surgical; with meniscectomy (medial OR lateral)

Professional

Both

$1,816.00

Service Code	CPT 29881
Hospital Charge Code	8799163
Hospital Revenue Code	975
Min. Negotiated Rate	$492.40
Max. Negotiated Rate	$1,162.10
Rate for Payer: Aetna of IA Medicare	$492.40
Rate for Payer: Amerigroup Medicaid	$509.14
Rate for Payer: Cash Price	$1,452.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$590.88
Rate for Payer: Iowa Total Care Managed Medicaid	$502.25
Rate for Payer: Medical Associates Commercial	$935.56
Rate for Payer: Medical Associates Managed Medicare	$492.40
Rate for Payer: Midlands Choice Commercial	$1,162.10
Rate for Payer: Oscar Health of IA Commercial	$851.85
Rate for Payer: Partners Health Alliance Commercial	$738.60

29893 Endoscopic plantar fasciotomy

Professional

Both

$2,136.00

Service Code	CPT 29893
Hospital Charge Code	8799164
Hospital Revenue Code	975
Min. Negotiated Rate	$407.25
Max. Negotiated Rate	$1,495.20
Rate for Payer: Aetna of IA Medicare	$407.25
Rate for Payer: Amerigroup Medicaid	$421.10
Rate for Payer: Cash Price	$1,708.80
Rate for Payer: Cash Price	$1,708.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$488.70
Rate for Payer: Iowa Total Care Managed Medicaid	$415.40
Rate for Payer: Medical Associates Commercial	$773.78
Rate for Payer: Medical Associates Managed Medicare	$407.25
Rate for Payer: Midlands Choice Commercial	$1,495.20
Rate for Payer: Oscar Health of IA Commercial	$704.54
Rate for Payer: Partners Health Alliance Commercial	$610.88

2cmx3cm THIN GRAFT

Facility

$2,070.00

Service Code	CPT C1713
Hospital Charge Code	8781513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,449.00
Max. Negotiated Rate	$1,863.00
Rate for Payer: Aetna of IA Commercial	$1,863.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,863.00
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,552.50
Rate for Payer: Medical Associates Commercial	$1,552.50
Rate for Payer: Midlands Choice Commercial	$1,449.00
Rate for Payer: United Healthcare Commercial	$1,863.00

2cmx3cm THIN GRAFT

Facility

$2,070.00

Service Code	CPT C1713
Hospital Charge Code	8781513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,034.59
Max. Negotiated Rate	$1,863.00
Rate for Payer: Aetna of IA Commercial	$1,863.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,863.00
Rate for Payer: Aetna of IA Medicare	$1,179.90
Rate for Payer: Amerigroup Medicaid	$1,044.73
Rate for Payer: Amerigroup Medicare	$1,045.35
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,552.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,035.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,034.59
Rate for Payer: Medical Associates Commercial	$1,552.50
Rate for Payer: Medical Associates Managed Medicare	$1,035.00
Rate for Payer: Midlands Choice Commercial	$1,449.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,050.52
Rate for Payer: Molina Healthcare Managed Medicare	$1,049.90
Rate for Payer: Oscar Health of IA Commercial	$1,552.50
Rate for Payer: Partners Health Alliance Commercial	$1,552.50
Rate for Payer: United Healthcare Commercial	$1,863.00
Rate for Payer: United Healthcare Managed Medicare	$1,221.30

3.0MMX12MM GL LOCKING SCREW

Facility

$342.00

Service Code	CPT C1713
Hospital Charge Code	8463692
Hospital Revenue Code	278
Min. Negotiated Rate	$170.93
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$172.61
Rate for Payer: Amerigroup Medicare	$172.71
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$171.00
Rate for Payer: Iowa Total Care Managed Medicaid	$170.93
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$171.00
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$173.56
Rate for Payer: Molina Healthcare Managed Medicare	$173.46
Rate for Payer: Oscar Health of IA Commercial	$256.50
Rate for Payer: Partners Health Alliance Commercial	$256.50
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0MMX12MM GL LOCKING SCREW

Facility

$342.00

Service Code	CPT C1713
Hospital Charge Code	8463692
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MMX16MM GL LOCKING SCREW

Facility

$342.00

Service Code	CPT C1713
Hospital Charge Code	8463694
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: United Healthcare Commercial	$307.80

3.0MMX16MM GL LOCKING SCREW

Facility

$342.00

Service Code	CPT C1713
Hospital Charge Code	8463694
Hospital Revenue Code	278
Min. Negotiated Rate	$170.93
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of IA Commercial	$307.80
Rate for Payer: Aetna of IA Medical Rental Products	$307.80
Rate for Payer: Aetna of IA Medicare	$194.94
Rate for Payer: Amerigroup Medicaid	$172.61
Rate for Payer: Amerigroup Medicare	$172.71
Rate for Payer: Cash Price	$273.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$256.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$171.00
Rate for Payer: Iowa Total Care Managed Medicaid	$170.93
Rate for Payer: Medical Associates Commercial	$256.50
Rate for Payer: Medical Associates Managed Medicare	$171.00
Rate for Payer: Midlands Choice Commercial	$239.40
Rate for Payer: Molina Healthcare Managed Medicaid	$173.56
Rate for Payer: Molina Healthcare Managed Medicare	$173.46
Rate for Payer: Oscar Health of IA Commercial	$256.50
Rate for Payer: Partners Health Alliance Commercial	$256.50
Rate for Payer: United Healthcare Commercial	$307.80
Rate for Payer: United Healthcare Managed Medicare	$201.78

3.0MM X 16MM GL SCREW

Facility

$171.00

Service Code	CPT C1713
Hospital Charge Code	8463690
Hospital Revenue Code	278
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: United Healthcare Commercial	$153.90

Know your out-of-pocket cost for care.

All Charges