Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ENDO CLIP CARTRIDGE

Facility

$94.00

Hospital Charge Code	8026309
Hospital Revenue Code	272
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of IA Commercial	$84.60
Rate for Payer: Aetna of IA Medical Rental Products	$84.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$70.50
Rate for Payer: Medical Associates Commercial	$70.50
Rate for Payer: Midlands Choice Commercial	$65.80
Rate for Payer: United Healthcare Commercial	$84.60

ENDO GIA 30 2.5 (SULU) LOADING UNIT

Facility

$1,141.00

Hospital Charge Code	8047001
Hospital Revenue Code	272
Min. Negotiated Rate	$798.70
Max. Negotiated Rate	$1,026.90
Rate for Payer: Aetna of IA Commercial	$1,026.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,026.90
Rate for Payer: Cash Price	$912.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$855.75
Rate for Payer: Medical Associates Commercial	$855.75
Rate for Payer: Midlands Choice Commercial	$798.70
Rate for Payer: United Healthcare Commercial	$1,026.90

ENDO GIA 30 2.5 (SULU) LOADING UNIT

Facility

$1,141.00

Hospital Charge Code	8047001
Hospital Revenue Code	272
Min. Negotiated Rate	$513.45
Max. Negotiated Rate	$1,026.90
Rate for Payer: Aetna of IA Commercial	$1,026.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,026.90
Rate for Payer: Aetna of IA Medicare	$650.37
Rate for Payer: Amerigroup Medicaid	$658.13
Rate for Payer: Amerigroup Medicare	$518.58
Rate for Payer: Cash Price	$912.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$855.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$513.45
Rate for Payer: Iowa Total Care Managed Medicaid	$651.74
Rate for Payer: Medical Associates Commercial	$855.75
Rate for Payer: Medical Associates Managed Medicare	$513.45
Rate for Payer: Midlands Choice Commercial	$798.70
Rate for Payer: Molina Healthcare Managed Medicaid	$661.32
Rate for Payer: Partners Health Alliance Commercial	$590.47
Rate for Payer: United Healthcare Commercial	$1,026.90
Rate for Payer: United Healthcare Managed Medicare	$673.19

ENDO GIA 30 3.5 LOAD

Facility

$603.00

Hospital Charge Code	8025853
Hospital Revenue Code	272
Min. Negotiated Rate	$422.10
Max. Negotiated Rate	$542.70
Rate for Payer: Aetna of IA Commercial	$542.70
Rate for Payer: Aetna of IA Medical Rental Products	$542.70
Rate for Payer: Cash Price	$482.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$452.25
Rate for Payer: Medical Associates Commercial	$452.25
Rate for Payer: Midlands Choice Commercial	$422.10
Rate for Payer: United Healthcare Commercial	$542.70

ENDO GIA 30 3.5 LOAD

Facility

$603.00

Hospital Charge Code	8025853
Hospital Revenue Code	272
Min. Negotiated Rate	$271.35
Max. Negotiated Rate	$542.70
Rate for Payer: Aetna of IA Commercial	$542.70
Rate for Payer: Aetna of IA Medical Rental Products	$542.70
Rate for Payer: Aetna of IA Medicare	$343.71
Rate for Payer: Amerigroup Medicaid	$347.81
Rate for Payer: Amerigroup Medicare	$274.06
Rate for Payer: Cash Price	$482.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$452.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$271.35
Rate for Payer: Iowa Total Care Managed Medicaid	$344.43
Rate for Payer: Medical Associates Commercial	$452.25
Rate for Payer: Medical Associates Managed Medicare	$271.35
Rate for Payer: Midlands Choice Commercial	$422.10
Rate for Payer: Molina Healthcare Managed Medicaid	$349.50
Rate for Payer: Partners Health Alliance Commercial	$312.05
Rate for Payer: United Healthcare Commercial	$542.70
Rate for Payer: United Healthcare Managed Medicare	$355.77

Endomysial IgA Antibody DMCL

Facility

$115.00

Service Code	CPT 83516
Hospital Charge Code	8037839
Hospital Revenue Code	302
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of IA Commercial	$103.50
Rate for Payer: Aetna of IA Medical Rental Products	$103.50
Rate for Payer: Cash Price	$92.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$86.25
Rate for Payer: Medical Associates Commercial	$86.25
Rate for Payer: Midlands Choice Commercial	$80.50
Rate for Payer: United Healthcare Commercial	$103.50

Endomysial IgA Antibody DMCL

Facility

$115.00

Service Code	CPT 83516
Hospital Charge Code	8037839
Hospital Revenue Code	302
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of IA Commercial	$103.50
Rate for Payer: Aetna of IA Medical Rental Products	$103.50
Rate for Payer: Aetna of IA Medicare	$65.55
Rate for Payer: Amerigroup Medicaid	$66.33
Rate for Payer: Amerigroup Medicare	$52.27
Rate for Payer: Cash Price	$92.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$86.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.75
Rate for Payer: Iowa Total Care Managed Medicaid	$65.69
Rate for Payer: Medical Associates Commercial	$86.25
Rate for Payer: Medical Associates Managed Medicare	$51.75
Rate for Payer: Midlands Choice Commercial	$80.50
Rate for Payer: Molina Healthcare Managed Medicaid	$66.65
Rate for Payer: Partners Health Alliance Commercial	$59.51
Rate for Payer: United Healthcare Commercial	$103.50
Rate for Payer: United Healthcare Managed Medicare	$67.85

enoxaparin 100 mg/mL 1ml SDV syringe [VDMC]

Facility

$51.20

Service Code	HCPCS J1650
Hospital Charge Code	10385695
Hospital Revenue Code	259
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$46.08
Rate for Payer: Aetna of IA Commercial	$46.08
Rate for Payer: Aetna of IA Medical Rental Products	$46.08
Rate for Payer: Aetna of IA Medicare	$29.18
Rate for Payer: Amerigroup Medicaid	$29.53
Rate for Payer: Amerigroup Medicare	$23.27
Rate for Payer: Cash Price	$40.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.04
Rate for Payer: Iowa Total Care Managed Medicaid	$29.25
Rate for Payer: Medical Associates Commercial	$38.40
Rate for Payer: Medical Associates Managed Medicare	$23.04
Rate for Payer: Midlands Choice Commercial	$35.84
Rate for Payer: Molina Healthcare Managed Medicaid	$29.68
Rate for Payer: Partners Health Alliance Commercial	$26.50
Rate for Payer: United Healthcare Commercial	$46.08
Rate for Payer: United Healthcare Managed Medicare	$30.21

enoxaparin 100 mg/mL 1ml SDV syringe [VDMC]

Facility

$51.20

Service Code	HCPCS J1650
Hospital Charge Code	10385695
Hospital Revenue Code	259
Min. Negotiated Rate	$35.84
Max. Negotiated Rate	$46.08
Rate for Payer: Aetna of IA Commercial	$46.08
Rate for Payer: Aetna of IA Medical Rental Products	$46.08
Rate for Payer: Cash Price	$40.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$38.40
Rate for Payer: Medical Associates Commercial	$38.40
Rate for Payer: Midlands Choice Commercial	$35.84
Rate for Payer: United Healthcare Commercial	$46.08

enoxaparin 30 mg/0.3 ml SDV syringe [VDMC]

Facility

$26.50

Service Code	HCPCS J1650
Hospital Charge Code	10607521
Hospital Revenue Code	259
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna of IA Commercial	$23.85
Rate for Payer: Aetna of IA Medical Rental Products	$23.85
Rate for Payer: Cash Price	$21.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.87
Rate for Payer: Medical Associates Commercial	$19.87
Rate for Payer: Midlands Choice Commercial	$18.55
Rate for Payer: United Healthcare Commercial	$23.85

enoxaparin 30 mg/0.3 ml SDV syringe [VDMC]

Facility

$26.50

Service Code	HCPCS J1650
Hospital Charge Code	10607521
Hospital Revenue Code	259
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna of IA Commercial	$23.85
Rate for Payer: Aetna of IA Medical Rental Products	$23.85
Rate for Payer: Aetna of IA Medicare	$15.10
Rate for Payer: Amerigroup Medicaid	$15.28
Rate for Payer: Amerigroup Medicare	$12.04
Rate for Payer: Cash Price	$21.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.87
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.92
Rate for Payer: Iowa Total Care Managed Medicaid	$15.13
Rate for Payer: Medical Associates Commercial	$19.87
Rate for Payer: Medical Associates Managed Medicare	$11.92
Rate for Payer: Midlands Choice Commercial	$18.55
Rate for Payer: Molina Healthcare Managed Medicaid	$15.36
Rate for Payer: Partners Health Alliance Commercial	$13.71
Rate for Payer: United Healthcare Commercial	$23.85
Rate for Payer: United Healthcare Managed Medicare	$15.63

enoxaparin 40 mg/0.4 mL SDV syringe [VDMC]

Facility

$28.21

Service Code	HCPCS J1650
Hospital Charge Code	10385764
Hospital Revenue Code	259
Min. Negotiated Rate	$19.75
Max. Negotiated Rate	$25.39
Rate for Payer: Aetna of IA Commercial	$25.39
Rate for Payer: Aetna of IA Medical Rental Products	$25.39
Rate for Payer: Cash Price	$22.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.16
Rate for Payer: Medical Associates Commercial	$21.16
Rate for Payer: Midlands Choice Commercial	$19.75
Rate for Payer: United Healthcare Commercial	$25.39

enoxaparin 40 mg/0.4 mL SDV syringe [VDMC]

Facility

$28.21

Service Code	HCPCS J1650
Hospital Charge Code	10385764
Hospital Revenue Code	259
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$25.39
Rate for Payer: Aetna of IA Commercial	$25.39
Rate for Payer: Aetna of IA Medical Rental Products	$25.39
Rate for Payer: Aetna of IA Medicare	$16.08
Rate for Payer: Amerigroup Medicaid	$16.27
Rate for Payer: Amerigroup Medicare	$12.82
Rate for Payer: Cash Price	$22.57
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.69
Rate for Payer: Iowa Total Care Managed Medicaid	$16.11
Rate for Payer: Medical Associates Commercial	$21.16
Rate for Payer: Medical Associates Managed Medicare	$12.69
Rate for Payer: Midlands Choice Commercial	$19.75
Rate for Payer: Molina Healthcare Managed Medicaid	$16.35
Rate for Payer: Partners Health Alliance Commercial	$14.60
Rate for Payer: United Healthcare Commercial	$25.39
Rate for Payer: United Healthcare Managed Medicare	$16.64

enoxaparin 60 mg/0.6 mL SDV syringe [VDMC]

Facility

$31.85

Service Code	HCPCS J1650
Hospital Charge Code	10385835
Hospital Revenue Code	259
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna of IA Commercial	$28.66
Rate for Payer: Aetna of IA Medical Rental Products	$28.66
Rate for Payer: Aetna of IA Medicare	$18.15
Rate for Payer: Amerigroup Medicaid	$18.37
Rate for Payer: Amerigroup Medicare	$14.47
Rate for Payer: Cash Price	$25.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.89
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.33
Rate for Payer: Iowa Total Care Managed Medicaid	$18.19
Rate for Payer: Medical Associates Commercial	$23.89
Rate for Payer: Medical Associates Managed Medicare	$14.33
Rate for Payer: Midlands Choice Commercial	$22.29
Rate for Payer: Molina Healthcare Managed Medicaid	$18.46
Rate for Payer: Partners Health Alliance Commercial	$16.48
Rate for Payer: United Healthcare Commercial	$28.66
Rate for Payer: United Healthcare Managed Medicare	$18.79

enoxaparin 60 mg/0.6 mL SDV syringe [VDMC]

Facility

$31.85

Service Code	HCPCS J1650
Hospital Charge Code	10385835
Hospital Revenue Code	259
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna of IA Commercial	$28.66
Rate for Payer: Aetna of IA Medical Rental Products	$28.66
Rate for Payer: Cash Price	$25.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.89
Rate for Payer: Medical Associates Commercial	$23.89
Rate for Payer: Midlands Choice Commercial	$22.29
Rate for Payer: United Healthcare Commercial	$28.66

enoxaparin 80 mg/0.8 mL SDV syringe [VDMC]

Facility

$36.35

Service Code	HCPCS J1650
Hospital Charge Code	10385906
Hospital Revenue Code	259
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$32.71
Rate for Payer: Aetna of IA Commercial	$32.71
Rate for Payer: Aetna of IA Medical Rental Products	$32.71
Rate for Payer: Cash Price	$29.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.26
Rate for Payer: Medical Associates Commercial	$27.26
Rate for Payer: Midlands Choice Commercial	$25.44
Rate for Payer: United Healthcare Commercial	$32.71

enoxaparin 80 mg/0.8 mL SDV syringe [VDMC]

Facility

$36.35

Service Code	HCPCS J1650
Hospital Charge Code	10385906
Hospital Revenue Code	259
Min. Negotiated Rate	$16.36
Max. Negotiated Rate	$32.71
Rate for Payer: Aetna of IA Commercial	$32.71
Rate for Payer: Aetna of IA Medical Rental Products	$32.71
Rate for Payer: Aetna of IA Medicare	$20.72
Rate for Payer: Amerigroup Medicaid	$20.97
Rate for Payer: Amerigroup Medicare	$16.52
Rate for Payer: Cash Price	$29.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.26
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.36
Rate for Payer: Iowa Total Care Managed Medicaid	$20.76
Rate for Payer: Medical Associates Commercial	$27.26
Rate for Payer: Medical Associates Managed Medicare	$16.36
Rate for Payer: Midlands Choice Commercial	$25.44
Rate for Payer: Molina Healthcare Managed Medicaid	$21.07
Rate for Payer: Partners Health Alliance Commercial	$18.81
Rate for Payer: United Healthcare Commercial	$32.71
Rate for Payer: United Healthcare Managed Medicare	$21.45

Enterovirus Detection PCR DMCL

Facility

$198.00

Service Code	CPT 87498
Hospital Charge Code	8037855
Hospital Revenue Code	306
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.47
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

Enterovirus Detection PCR DMCL

Facility

$198.00

Service Code	CPT 87498
Hospital Charge Code	8037855
Hospital Revenue Code	306
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

ePHEDrine 50 mg/mL 1ml SDV [VDMC]

Facility

$46.49

Service Code	HCPCS J3490
Hospital Charge Code	15873673
Hospital Revenue Code	259
Min. Negotiated Rate	$32.54
Max. Negotiated Rate	$41.84
Rate for Payer: Aetna of IA Commercial	$41.84
Rate for Payer: Aetna of IA Medical Rental Products	$41.84
Rate for Payer: Cash Price	$37.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.87
Rate for Payer: Medical Associates Commercial	$34.87
Rate for Payer: Midlands Choice Commercial	$32.54
Rate for Payer: United Healthcare Commercial	$41.84

ePHEDrine 50 mg/mL 1ml SDV [VDMC]

Facility

$46.49

Service Code	HCPCS J3490
Hospital Charge Code	15873673
Hospital Revenue Code	259
Min. Negotiated Rate	$20.92
Max. Negotiated Rate	$41.84
Rate for Payer: Aetna of IA Commercial	$41.84
Rate for Payer: Aetna of IA Medical Rental Products	$41.84
Rate for Payer: Aetna of IA Medicare	$26.50
Rate for Payer: Amerigroup Medicaid	$26.82
Rate for Payer: Amerigroup Medicare	$21.13
Rate for Payer: Cash Price	$37.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.87
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.92
Rate for Payer: Iowa Total Care Managed Medicaid	$26.56
Rate for Payer: Medical Associates Commercial	$34.87
Rate for Payer: Medical Associates Managed Medicare	$20.92
Rate for Payer: Midlands Choice Commercial	$32.54
Rate for Payer: Molina Healthcare Managed Medicaid	$26.95
Rate for Payer: Partners Health Alliance Commercial	$24.06
Rate for Payer: United Healthcare Commercial	$41.84
Rate for Payer: United Healthcare Managed Medicare	$27.43

EPID INJECTION OF BLOOD PATCH

Facility

$442.00

Service Code	CPT 62273
Hospital Charge Code	8059063
Hospital Revenue Code	964
Min. Negotiated Rate	$309.40
Max. Negotiated Rate	$397.80
Rate for Payer: Aetna of IA Commercial	$397.80
Rate for Payer: Aetna of IA Medical Rental Products	$397.80
Rate for Payer: Cash Price	$353.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$331.50
Rate for Payer: Medical Associates Commercial	$331.50
Rate for Payer: Midlands Choice Commercial	$309.40
Rate for Payer: United Healthcare Commercial	$397.80

EPID INJECTION OF BLOOD PATCH

Facility

$442.00

Service Code	CPT 62273
Hospital Charge Code	8059063
Hospital Revenue Code	964
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$397.80
Rate for Payer: Aetna of IA Commercial	$397.80
Rate for Payer: Aetna of IA Medical Rental Products	$397.80
Rate for Payer: Aetna of IA Medicare	$251.94
Rate for Payer: Amerigroup Medicaid	$254.95
Rate for Payer: Amerigroup Medicare	$200.89
Rate for Payer: Cash Price	$353.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$331.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$198.90
Rate for Payer: Iowa Total Care Managed Medicaid	$252.47
Rate for Payer: Medical Associates Commercial	$331.50
Rate for Payer: Medical Associates Managed Medicare	$198.90
Rate for Payer: Midlands Choice Commercial	$309.40
Rate for Payer: Molina Healthcare Managed Medicaid	$256.18
Rate for Payer: Partners Health Alliance Commercial	$228.74
Rate for Payer: United Healthcare Commercial	$397.80

EPID INJECTION OF BLOOD PATCH

Professional

Both

$572.00

Service Code	CPT 62273
Hospital Charge Code	8059063
Hospital Revenue Code	975
Min. Negotiated Rate	$262.88
Max. Negotiated Rate	$429.00
Rate for Payer: Cash Price	$457.60
Rate for Payer: Cash Price	$457.60
Rate for Payer: Medical Associates Commercial	$429.00
Rate for Payer: Midlands Choice Commercial	$400.40
Rate for Payer: Partners Health Alliance Commercial	$429.00
Rate for Payer: United Healthcare Commercial	$262.88

EPIDRM A-GRFT FACE/NCK/HF/G

Facility

$1,408.00

Service Code	CPT 15115
Hospital Charge Code	7982937
Hospital Revenue Code	450
Min. Negotiated Rate	$633.60
Max. Negotiated Rate	$1,267.20
Rate for Payer: Aetna of IA Commercial	$1,267.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,267.20
Rate for Payer: Aetna of IA Medicare	$802.56
Rate for Payer: Amerigroup Medicaid	$812.13
Rate for Payer: Amerigroup Medicare	$639.94
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,056.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$633.60
Rate for Payer: Iowa Total Care Managed Medicaid	$804.25
Rate for Payer: Medical Associates Commercial	$1,056.00
Rate for Payer: Medical Associates Managed Medicare	$633.60
Rate for Payer: Midlands Choice Commercial	$985.60
Rate for Payer: Molina Healthcare Managed Medicaid	$816.08
Rate for Payer: Partners Health Alliance Commercial	$728.64
Rate for Payer: United Healthcare Commercial	$1,267.20
Rate for Payer: United Healthcare Managed Medicare	$830.72

Know your out-of-pocket cost for care.

All Charges