Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION

Facility

$4,535.30

Service Code	CPT 66984
Min. Negotiated Rate	$4,123.00
Max. Negotiated Rate	$4,535.30
Rate for Payer: Wellmark IA HMO	$4,123.00
Rate for Payer: Wellmark IA PPO	$4,535.30

Extracranial Procedures With CC

Facility

$12,042.19

Service Code	MS-DRG 038
Hospital Charge Code	727
Min. Negotiated Rate	$11,867.67
Max. Negotiated Rate	$12,042.19
Rate for Payer: Amerigroup Medicaid	$11,984.02
Rate for Payer: Iowa Total Care Managed Medicaid	$11,867.67
Rate for Payer: Molina Healthcare Managed Medicaid	$12,042.19

Extracranial Procedures With MCC

Facility

$20,499.78

Service Code	MS-DRG 037
Hospital Charge Code	726
Min. Negotiated Rate	$20,202.68
Max. Negotiated Rate	$20,499.78
Rate for Payer: Amerigroup Medicaid	$20,400.75
Rate for Payer: Iowa Total Care Managed Medicaid	$20,202.68
Rate for Payer: Molina Healthcare Managed Medicaid	$20,499.78

Extracranial Procedures Without CC/MCC

Facility

$8,014.68

Service Code	MS-DRG 039
Hospital Charge Code	728
Min. Negotiated Rate	$7,898.52
Max. Negotiated Rate	$8,014.68
Rate for Payer: Amerigroup Medicaid	$7,975.96
Rate for Payer: Iowa Total Care Managed Medicaid	$7,898.52
Rate for Payer: Molina Healthcare Managed Medicaid	$8,014.68

Extractable Nuclear Antigen Ab DMCL

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	8037843
Hospital Revenue Code	302
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

Extractable Nuclear Antigen Ab DMCL

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	8037843
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$57.54
Rate for Payer: Amerigroup Medicare	$57.57
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.00
Rate for Payer: Iowa Total Care Managed Medicaid	$56.98
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$57.00
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$57.86
Rate for Payer: Molina Healthcare Managed Medicare	$57.82
Rate for Payer: Oscar Health of IA Commercial	$85.50
Rate for Payer: Partners Health Alliance Commercial	$85.50
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

EXTRACTABLE NUCLEAR ANTIGEN OR ANTIBODY

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	8093932
Hospital Revenue Code	302
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

EXTRACTABLE NUCLEAR ANTIGEN OR ANTIBODY

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	8093932
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$57.54
Rate for Payer: Amerigroup Medicare	$57.57
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.00
Rate for Payer: Iowa Total Care Managed Medicaid	$56.98
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$57.00
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$57.86
Rate for Payer: Molina Healthcare Managed Medicare	$57.82
Rate for Payer: Oscar Health of IA Commercial	$85.50
Rate for Payer: Partners Health Alliance Commercial	$85.50
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Extraocular Procedures Except Orbit

Facility

$11,599.29

Service Code	MS-DRG 115
Hospital Charge Code	7
Min. Negotiated Rate	$11,431.18
Max. Negotiated Rate	$11,599.29
Rate for Payer: Amerigroup Medicaid	$11,543.25
Rate for Payer: Iowa Total Care Managed Medicaid	$11,431.18
Rate for Payer: Molina Healthcare Managed Medicaid	$11,599.29

Extreme Immaturity or Respiratory Distress Syndrome, Neonate

Facility

$37,846.06

Service Code	MS-DRG 790
Hospital Charge Code	532
Min. Negotiated Rate	$37,297.56
Max. Negotiated Rate	$37,846.06
Rate for Payer: Amerigroup Medicaid	$37,663.23
Rate for Payer: Iowa Total Care Managed Medicaid	$37,297.56
Rate for Payer: Molina Healthcare Managed Medicaid	$37,846.06

ezetimibe 10 mg Tab [VDMC]

Facility

$1.49

Service Code	HCPCS A9270
Hospital Charge Code	10387879
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of IA Commercial	$1.34
Rate for Payer: Aetna of IA Medical Rental Products	$1.34
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.12
Rate for Payer: Medical Associates Commercial	$1.12
Rate for Payer: Midlands Choice Commercial	$1.04
Rate for Payer: United Healthcare Commercial	$1.34

ezetimibe 10 mg Tab [VDMC]

Facility

$1.49

Service Code	HCPCS A9270
Hospital Charge Code	10387879
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of IA Commercial	$1.34
Rate for Payer: Aetna of IA Medical Rental Products	$1.34
Rate for Payer: Aetna of IA Medicare	$0.85
Rate for Payer: Amerigroup Medicaid	$0.75
Rate for Payer: Amerigroup Medicare	$0.75
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.12
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.75
Rate for Payer: Iowa Total Care Managed Medicaid	$0.74
Rate for Payer: Medical Associates Commercial	$1.12
Rate for Payer: Medical Associates Managed Medicare	$0.75
Rate for Payer: Midlands Choice Commercial	$1.04
Rate for Payer: Molina Healthcare Managed Medicaid	$0.76
Rate for Payer: Molina Healthcare Managed Medicare	$0.76
Rate for Payer: Oscar Health of IA Commercial	$1.12
Rate for Payer: Partners Health Alliance Commercial	$1.12
Rate for Payer: United Healthcare Commercial	$1.34
Rate for Payer: United Healthcare Managed Medicare	$0.88

Factor V Leiden DMCL

Facility

$220.00

Service Code	CPT 81241
Hospital Charge Code	8037844
Hospital Revenue Code	301
Min. Negotiated Rate	$109.96
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Aetna of IA Medicare	$125.40
Rate for Payer: Amerigroup Medicaid	$111.03
Rate for Payer: Amerigroup Medicare	$111.10
Rate for Payer: Cash Price	$176.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$110.00
Rate for Payer: Iowa Total Care Managed Medicaid	$109.96
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Medical Associates Managed Medicare	$110.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: Molina Healthcare Managed Medicaid	$111.65
Rate for Payer: Molina Healthcare Managed Medicare	$111.58
Rate for Payer: Oscar Health of IA Commercial	$165.00
Rate for Payer: Partners Health Alliance Commercial	$165.00
Rate for Payer: United Healthcare Commercial	$198.00
Rate for Payer: United Healthcare Managed Medicare	$129.80
Rate for Payer: Wellmark IA HMO	$143.22
Rate for Payer: Wellmark IA PPO	$157.54

Factor V Leiden DMCL

Facility

$220.00

Service Code	CPT 81241
Hospital Charge Code	8037844
Hospital Revenue Code	301
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: United Healthcare Commercial	$198.00

Factor X Assay DMCL

Facility

$129.00

Service Code	CPT 85260
Hospital Charge Code	8037845
Hospital Revenue Code	305
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$65.11
Rate for Payer: Amerigroup Medicare	$65.14
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$64.50
Rate for Payer: Iowa Total Care Managed Medicaid	$64.47
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$64.50
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$65.47
Rate for Payer: Molina Healthcare Managed Medicare	$65.43
Rate for Payer: Oscar Health of IA Commercial	$96.75
Rate for Payer: Partners Health Alliance Commercial	$96.75
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11
Rate for Payer: Wellmark IA HMO	$56.42
Rate for Payer: Wellmark IA PPO	$62.06

Factor X Assay DMCL

Facility

$129.00

Service Code	CPT 85260
Hospital Charge Code	8037845
Hospital Revenue Code	305
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

famotidine 10 mg/mL 2 ml IV Sol [VDMC]

Facility

$22.50

Service Code	HCPCS J3490
Hospital Charge Code	10387948
Hospital Revenue Code	259
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of IA Commercial	$20.25
Rate for Payer: Aetna of IA Medical Rental Products	$20.25
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.88
Rate for Payer: Medical Associates Commercial	$16.88
Rate for Payer: Midlands Choice Commercial	$15.75
Rate for Payer: United Healthcare Commercial	$20.25

famotidine 10 mg/mL 2 ml IV Sol [VDMC]

Facility

$22.50

Service Code	HCPCS J3490
Hospital Charge Code	10387948
Hospital Revenue Code	259
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of IA Commercial	$20.25
Rate for Payer: Aetna of IA Medical Rental Products	$20.25
Rate for Payer: Aetna of IA Medicare	$12.82
Rate for Payer: Amerigroup Medicaid	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.25
Rate for Payer: Iowa Total Care Managed Medicaid	$11.25
Rate for Payer: Medical Associates Commercial	$16.88
Rate for Payer: Medical Associates Managed Medicare	$11.25
Rate for Payer: Midlands Choice Commercial	$15.75
Rate for Payer: Molina Healthcare Managed Medicaid	$11.42
Rate for Payer: Molina Healthcare Managed Medicare	$11.41
Rate for Payer: Oscar Health of IA Commercial	$16.88
Rate for Payer: Partners Health Alliance Commercial	$16.88
Rate for Payer: United Healthcare Commercial	$20.25
Rate for Payer: United Healthcare Managed Medicare	$13.28

famotidine 20 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10388019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

famotidine 20 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10388019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Aetna of IA Medicare	$0.74
Rate for Payer: Amerigroup Medicaid	$0.65
Rate for Payer: Amerigroup Medicare	$0.65
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.65
Rate for Payer: Iowa Total Care Managed Medicaid	$0.64
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: Molina Healthcare Managed Medicaid	$0.65
Rate for Payer: Molina Healthcare Managed Medicare	$0.65
Rate for Payer: Oscar Health of IA Commercial	$0.97
Rate for Payer: Partners Health Alliance Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.16
Rate for Payer: United Healthcare Managed Medicare	$0.76

Fat Emul, 20% IV 250 mL [VDMC]

Facility

$102.11

Service Code	NDC 65219-0533-25
Hospital Charge Code	10434518
Hospital Revenue Code	259
Min. Negotiated Rate	$51.03
Max. Negotiated Rate	$91.90
Rate for Payer: Aetna of IA Commercial	$91.90
Rate for Payer: Aetna of IA Medical Rental Products	$91.90
Rate for Payer: Aetna of IA Medicare	$58.20
Rate for Payer: Amerigroup Medicaid	$51.53
Rate for Payer: Amerigroup Medicare	$51.57
Rate for Payer: Cash Price	$81.69
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.06
Rate for Payer: Iowa Total Care Managed Medicaid	$51.03
Rate for Payer: Medical Associates Commercial	$76.58
Rate for Payer: Medical Associates Managed Medicare	$51.06
Rate for Payer: Midlands Choice Commercial	$71.48
Rate for Payer: Molina Healthcare Managed Medicaid	$51.82
Rate for Payer: Molina Healthcare Managed Medicare	$51.79
Rate for Payer: Oscar Health of IA Commercial	$76.58
Rate for Payer: Partners Health Alliance Commercial	$76.58
Rate for Payer: United Healthcare Commercial	$91.90
Rate for Payer: United Healthcare Managed Medicare	$60.24

Fat Emul, 20% IV 250 mL [VDMC]

Facility

$102.11

Service Code	NDC 65219-0533-25
Hospital Charge Code	10434518
Hospital Revenue Code	259
Min. Negotiated Rate	$71.48
Max. Negotiated Rate	$91.90
Rate for Payer: Aetna of IA Commercial	$91.90
Rate for Payer: Aetna of IA Medical Rental Products	$91.90
Rate for Payer: Cash Price	$81.69
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.58
Rate for Payer: Medical Associates Commercial	$76.58
Rate for Payer: Midlands Choice Commercial	$71.48
Rate for Payer: United Healthcare Commercial	$91.90

febuxostat 40 mg Tab [VDMC]

Facility

$2.68

Service Code	HCPCS A9270
Hospital Charge Code	10388088
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna of IA Commercial	$2.41
Rate for Payer: Aetna of IA Medical Rental Products	$2.41
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.01
Rate for Payer: Medical Associates Commercial	$2.01
Rate for Payer: Midlands Choice Commercial	$1.88
Rate for Payer: United Healthcare Commercial	$2.41

febuxostat 40 mg Tab [VDMC]

Facility

$2.68

Service Code	HCPCS A9270
Hospital Charge Code	10388088
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna of IA Commercial	$2.41
Rate for Payer: Aetna of IA Medical Rental Products	$2.41
Rate for Payer: Aetna of IA Medicare	$1.53
Rate for Payer: Amerigroup Medicaid	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.01
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.34
Rate for Payer: Iowa Total Care Managed Medicaid	$1.34
Rate for Payer: Medical Associates Commercial	$2.01
Rate for Payer: Medical Associates Managed Medicare	$1.34
Rate for Payer: Midlands Choice Commercial	$1.88
Rate for Payer: Molina Healthcare Managed Medicaid	$1.36
Rate for Payer: Molina Healthcare Managed Medicare	$1.36
Rate for Payer: Oscar Health of IA Commercial	$2.01
Rate for Payer: Partners Health Alliance Commercial	$2.01
Rate for Payer: United Healthcare Commercial	$2.41
Rate for Payer: United Healthcare Managed Medicare	$1.58

felodipine 5 mg ER Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10388157
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of IA Commercial	$1.30
Rate for Payer: Aetna of IA Medical Rental Products	$1.30
Rate for Payer: Aetna of IA Medicare	$0.82
Rate for Payer: Amerigroup Medicaid	$0.73
Rate for Payer: Amerigroup Medicare	$0.73
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.72
Rate for Payer: Iowa Total Care Managed Medicaid	$0.72
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Medical Associates Managed Medicare	$0.72
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: Molina Healthcare Managed Medicaid	$0.73
Rate for Payer: Molina Healthcare Managed Medicare	$0.73
Rate for Payer: Oscar Health of IA Commercial	$1.08
Rate for Payer: Partners Health Alliance Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.30
Rate for Payer: United Healthcare Managed Medicare	$0.85

Know your out-of-pocket cost for care.

All Charges