Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED

Facility

$2,560.12

Service Code	CPT 64624
Hospital Revenue Code	490
Min. Negotiated Rate	$2,324.10
Max. Negotiated Rate	$2,560.12
Rate for Payer: Wellmark IA HMO WHPI	$2,324.10
Rate for Payer: Wellmark IA PPO	$2,560.12

DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT

Facility

$2,560.12

Service Code	CPT 64635
Hospital Revenue Code	490
Min. Negotiated Rate	$2,324.10
Max. Negotiated Rate	$2,560.12
Rate for Payer: Wellmark IA HMO WHPI	$2,324.10
Rate for Payer: Wellmark IA PPO	$2,560.12

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS

Facility

$333.49

Service Code	CPT 17110
Hospital Revenue Code	360
Min. Negotiated Rate	$302.74
Max. Negotiated Rate	$333.49
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY)

Facility

$4,161.95

Service Code	CPT 46930
Hospital Revenue Code	360
Min. Negotiated Rate	$3,778.26
Max. Negotiated Rate	$4,161.95
Rate for Payer: Wellmark IA HMO WHPI	$3,778.26
Rate for Payer: Wellmark IA PPO	$4,161.95

DESTRUCTION OF LESION(S) VULVA SIMPLE

Professional

Both

$630.00

Service Code	CPT 56501
Hospital Charge Code	8825538
Hospital Revenue Code	975
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$472.50
Rate for Payer: Amerigroup Medicaid	$103.25
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.24
Rate for Payer: Medical Associates Commercial	$472.50
Rate for Payer: Midlands Choice Commercial	$441.00
Rate for Payer: Molina Healthcare Managed Medicaid	$102.75
Rate for Payer: Partners Health Alliance Commercial	$472.50
Rate for Payer: United Healthcare Commercial	$247.42
Rate for Payer: Wellmark IA HMO WHPI	$366.10
Rate for Payer: Wellmark IA PPO	$430.70

DESTRUCTION OF SKIN LESIONS

Facility

$275.00

Service Code	CPT 17281
Hospital Charge Code	7982997
Hospital Revenue Code	450
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$333.49
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

DESTRUCTION OF SKIN LESIONS

Facility

$275.00

Service Code	CPT 17281
Hospital Charge Code	7982997
Hospital Revenue Code	450
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

DESTRUCT PREMALG LES 2-14

Facility

$275.00

Service Code	CPT 17003
Hospital Charge Code	7982995
Hospital Revenue Code	450
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$333.49
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

DESTRUCT PREMALG LES 2-14

Facility

$275.00

Service Code	CPT 17003
Hospital Charge Code	7982995
Hospital Revenue Code	450
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

DESTRUCT PREMALG LESION

Facility

$275.00

Service Code	CPT 17000
Hospital Charge Code	7982996
Hospital Revenue Code	450
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$333.49
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

DESTRUCT PREMALG LESION

Facility

$275.00

Service Code	CPT 17000
Hospital Charge Code	7982996
Hospital Revenue Code	450
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

dexamethasone 0.5 mg Tab [VDMC]

Facility

$1.37

Service Code	HCPCS A9270
Hospital Charge Code	10381637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of IA Commercial	$1.24
Rate for Payer: Aetna of IA Medical Rental Products	$1.24
Rate for Payer: Aetna of IA Medicare	$0.78
Rate for Payer: Amerigroup Medicaid	$0.79
Rate for Payer: Amerigroup Medicare	$0.62
Rate for Payer: Cash Price	$1.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.03
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.62
Rate for Payer: Iowa Total Care Managed Medicaid	$0.79
Rate for Payer: Medical Associates Commercial	$1.03
Rate for Payer: Medical Associates Managed Medicare	$0.62
Rate for Payer: Midlands Choice Commercial	$0.96
Rate for Payer: Molina Healthcare Managed Medicaid	$0.80
Rate for Payer: Partners Health Alliance Commercial	$0.71
Rate for Payer: United Healthcare Commercial	$1.24
Rate for Payer: United Healthcare Managed Medicare	$0.81

dexamethasone 0.5 mg Tab [VDMC]

Facility

$1.37

Service Code	HCPCS A9270
Hospital Charge Code	10381637
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of IA Commercial	$1.24
Rate for Payer: Aetna of IA Medical Rental Products	$1.24
Rate for Payer: Cash Price	$1.10
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.03
Rate for Payer: Medical Associates Commercial	$1.03
Rate for Payer: Midlands Choice Commercial	$0.96
Rate for Payer: United Healthcare Commercial	$1.24

dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj [VDMC]

Facility

$25.37

Service Code	HCPCS J1100
Hospital Charge Code	12738943
Hospital Revenue Code	259
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$22.84
Rate for Payer: Aetna of IA Medical Rental Products	$22.84
Rate for Payer: Aetna of IA Medicare	$14.46
Rate for Payer: Amerigroup Medicaid	$14.64
Rate for Payer: Amerigroup Medicare	$11.53
Rate for Payer: Cash Price	$20.30
Rate for Payer: Cash Price	$20.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.03
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.42
Rate for Payer: Iowa Total Care Managed Medicaid	$14.49
Rate for Payer: Medical Associates Commercial	$19.03
Rate for Payer: Medical Associates Managed Medicare	$11.42
Rate for Payer: Midlands Choice Commercial	$17.76
Rate for Payer: Molina Healthcare Managed Medicaid	$14.71
Rate for Payer: Partners Health Alliance Commercial	$13.13
Rate for Payer: United Healthcare Commercial	$22.84
Rate for Payer: United Healthcare Managed Medicare	$14.97
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj [VDMC]

Facility

$25.37

Service Code	HCPCS J1100
Hospital Charge Code	12738943
Hospital Revenue Code	259
Min. Negotiated Rate	$17.76
Max. Negotiated Rate	$22.84
Rate for Payer: Aetna of IA Commercial	$22.84
Rate for Payer: Aetna of IA Medical Rental Products	$22.84
Rate for Payer: Cash Price	$20.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.03
Rate for Payer: Medical Associates Commercial	$19.03
Rate for Payer: Midlands Choice Commercial	$17.76
Rate for Payer: United Healthcare Commercial	$22.84

dexamethasone 4 mg/mL 5 ml MDV inj [VDMC]

Facility

$23.16

Service Code	HCPCS J1100
Hospital Charge Code	10381834
Hospital Revenue Code	259
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$20.85
Rate for Payer: Aetna of IA Medical Rental Products	$20.85
Rate for Payer: Aetna of IA Medicare	$13.20
Rate for Payer: Amerigroup Medicaid	$13.36
Rate for Payer: Amerigroup Medicare	$10.53
Rate for Payer: Cash Price	$18.53
Rate for Payer: Cash Price	$18.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.37
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.42
Rate for Payer: Iowa Total Care Managed Medicaid	$13.23
Rate for Payer: Medical Associates Commercial	$17.37
Rate for Payer: Medical Associates Managed Medicare	$10.42
Rate for Payer: Midlands Choice Commercial	$16.22
Rate for Payer: Molina Healthcare Managed Medicaid	$13.43
Rate for Payer: Partners Health Alliance Commercial	$11.99
Rate for Payer: United Healthcare Commercial	$20.85
Rate for Payer: United Healthcare Managed Medicare	$13.67
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

dexamethasone 4 mg/mL 5 ml MDV inj [VDMC]

Facility

$23.16

Service Code	HCPCS J1100
Hospital Charge Code	10381834
Hospital Revenue Code	259
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$20.85
Rate for Payer: Aetna of IA Commercial	$20.85
Rate for Payer: Aetna of IA Medical Rental Products	$20.85
Rate for Payer: Cash Price	$18.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.37
Rate for Payer: Medical Associates Commercial	$17.37
Rate for Payer: Midlands Choice Commercial	$16.22
Rate for Payer: United Healthcare Commercial	$20.85

dexamethasone 4 mg Tab [VDMC]

Facility

$4.84

Service Code	HCPCS A9270
Hospital Charge Code	10381765
Hospital Revenue Code	259
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna of IA Commercial	$4.36
Rate for Payer: Aetna of IA Medical Rental Products	$4.36
Rate for Payer: Cash Price	$3.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.63
Rate for Payer: Medical Associates Commercial	$3.63
Rate for Payer: Midlands Choice Commercial	$3.39
Rate for Payer: United Healthcare Commercial	$4.36

dexamethasone 4 mg Tab [VDMC]

Facility

$4.84

Service Code	HCPCS A9270
Hospital Charge Code	10381765
Hospital Revenue Code	259
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna of IA Commercial	$4.36
Rate for Payer: Aetna of IA Medical Rental Products	$4.36
Rate for Payer: Aetna of IA Medicare	$2.76
Rate for Payer: Amerigroup Medicaid	$2.79
Rate for Payer: Amerigroup Medicare	$2.20
Rate for Payer: Cash Price	$3.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.63
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.18
Rate for Payer: Iowa Total Care Managed Medicaid	$2.77
Rate for Payer: Medical Associates Commercial	$3.63
Rate for Payer: Medical Associates Managed Medicare	$2.18
Rate for Payer: Midlands Choice Commercial	$3.39
Rate for Payer: Molina Healthcare Managed Medicaid	$2.81
Rate for Payer: Partners Health Alliance Commercial	$2.51
Rate for Payer: United Healthcare Commercial	$4.36
Rate for Payer: United Healthcare Managed Medicare	$2.86

dexlansoprazole 60 mg Oral DR Cap [VDMC]

Facility

$20.08

Service Code	HCPCS A9270
Hospital Charge Code	27357838
Hospital Revenue Code	259
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$18.08
Rate for Payer: Aetna of IA Commercial	$18.08
Rate for Payer: Aetna of IA Medical Rental Products	$18.08
Rate for Payer: Cash Price	$16.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.06
Rate for Payer: Medical Associates Commercial	$15.06
Rate for Payer: Midlands Choice Commercial	$14.06
Rate for Payer: United Healthcare Commercial	$18.08

dexlansoprazole 60 mg Oral DR Cap [VDMC]

Facility

$20.08

Service Code	HCPCS A9270
Hospital Charge Code	27357838
Hospital Revenue Code	259
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$18.08
Rate for Payer: Aetna of IA Commercial	$18.08
Rate for Payer: Aetna of IA Medical Rental Products	$18.08
Rate for Payer: Aetna of IA Medicare	$11.45
Rate for Payer: Amerigroup Medicaid	$11.58
Rate for Payer: Amerigroup Medicare	$9.13
Rate for Payer: Cash Price	$16.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.04
Rate for Payer: Iowa Total Care Managed Medicaid	$11.47
Rate for Payer: Medical Associates Commercial	$15.06
Rate for Payer: Medical Associates Managed Medicare	$9.04
Rate for Payer: Midlands Choice Commercial	$14.06
Rate for Payer: Molina Healthcare Managed Medicaid	$11.64
Rate for Payer: Partners Health Alliance Commercial	$10.39
Rate for Payer: United Healthcare Commercial	$18.08
Rate for Payer: United Healthcare Managed Medicare	$11.85

dexmedetomidine 100 mcg/mL 2 ml SDV inj [VDMC]

Facility

$26.71

Service Code	HCPCS J3490
Hospital Charge Code	11219809
Hospital Revenue Code	259
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$24.04
Rate for Payer: Aetna of IA Commercial	$24.04
Rate for Payer: Aetna of IA Medical Rental Products	$24.04
Rate for Payer: Aetna of IA Medicare	$15.22
Rate for Payer: Amerigroup Medicaid	$15.41
Rate for Payer: Amerigroup Medicare	$12.14
Rate for Payer: Cash Price	$21.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.03
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.02
Rate for Payer: Iowa Total Care Managed Medicaid	$15.26
Rate for Payer: Medical Associates Commercial	$20.03
Rate for Payer: Medical Associates Managed Medicare	$12.02
Rate for Payer: Midlands Choice Commercial	$18.70
Rate for Payer: Molina Healthcare Managed Medicaid	$15.48
Rate for Payer: Partners Health Alliance Commercial	$13.82
Rate for Payer: United Healthcare Commercial	$24.04
Rate for Payer: United Healthcare Managed Medicare	$15.76

dexmedetomidine 100 mcg/mL 2 ml SDV inj [VDMC]

Facility

$26.71

Service Code	HCPCS J3490
Hospital Charge Code	11219809
Hospital Revenue Code	259
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$24.04
Rate for Payer: Aetna of IA Commercial	$24.04
Rate for Payer: Aetna of IA Medical Rental Products	$24.04
Rate for Payer: Cash Price	$21.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.03
Rate for Payer: Medical Associates Commercial	$20.03
Rate for Payer: Midlands Choice Commercial	$18.70
Rate for Payer: United Healthcare Commercial	$24.04

Dextrose 10% in Water intravenous solution 500 mL [VDMC]

Facility

$69.40

Service Code	HCPCS J7799
Hospital Charge Code	10440241
Hospital Revenue Code	259
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$62.46
Rate for Payer: Aetna of IA Commercial	$62.46
Rate for Payer: Aetna of IA Medical Rental Products	$62.46
Rate for Payer: Aetna of IA Medicare	$39.56
Rate for Payer: Amerigroup Medicaid	$40.03
Rate for Payer: Amerigroup Medicare	$31.54
Rate for Payer: Cash Price	$55.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.05
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.23
Rate for Payer: Iowa Total Care Managed Medicaid	$39.64
Rate for Payer: Medical Associates Commercial	$52.05
Rate for Payer: Medical Associates Managed Medicare	$31.23
Rate for Payer: Midlands Choice Commercial	$48.58
Rate for Payer: Molina Healthcare Managed Medicaid	$40.22
Rate for Payer: Partners Health Alliance Commercial	$35.91
Rate for Payer: United Healthcare Commercial	$62.46
Rate for Payer: United Healthcare Managed Medicare	$40.95

Dextrose 10% in Water intravenous solution 500 mL [VDMC]

Facility

$69.40

Service Code	HCPCS J7799
Hospital Charge Code	10440241
Hospital Revenue Code	259
Min. Negotiated Rate	$48.58
Max. Negotiated Rate	$62.46
Rate for Payer: Aetna of IA Commercial	$62.46
Rate for Payer: Aetna of IA Medical Rental Products	$62.46
Rate for Payer: Cash Price	$55.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.05
Rate for Payer: Medical Associates Commercial	$52.05
Rate for Payer: Midlands Choice Commercial	$48.58
Rate for Payer: United Healthcare Commercial	$62.46

Know your out-of-pocket cost for care.

All Charges