Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

esketamine 84 mg/3 nasal spray [VDMC]

Facility

$4,758.00

Service Code	HCPCS S0013
Hospital Charge Code	18384750
Hospital Revenue Code	259
Min. Negotiated Rate	$2,141.10
Max. Negotiated Rate	$4,282.20
Rate for Payer: Aetna of IA Commercial	$4,282.20
Rate for Payer: Aetna of IA Medical Rental Products	$4,282.20
Rate for Payer: Aetna of IA Medicare	$2,712.06
Rate for Payer: Amerigroup Medicaid	$2,744.41
Rate for Payer: Amerigroup Medicare	$2,162.51
Rate for Payer: Cash Price	$3,806.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,568.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,141.10
Rate for Payer: Iowa Total Care Managed Medicaid	$2,717.77
Rate for Payer: Medical Associates Commercial	$3,568.50
Rate for Payer: Medical Associates Managed Medicare	$2,141.10
Rate for Payer: Midlands Choice Commercial	$3,330.60
Rate for Payer: Molina Healthcare Managed Medicaid	$2,757.74
Rate for Payer: Partners Health Alliance Commercial	$2,462.26
Rate for Payer: United Healthcare Commercial	$4,282.20
Rate for Payer: United Healthcare Managed Medicare	$2,807.22

esketamine 84 mg/3 nasal spray [VDMC]

Facility

$4,758.00

Service Code	HCPCS S0013
Hospital Charge Code	18384750
Hospital Revenue Code	259
Min. Negotiated Rate	$3,330.60
Max. Negotiated Rate	$4,282.20
Rate for Payer: Aetna of IA Commercial	$4,282.20
Rate for Payer: Aetna of IA Medical Rental Products	$4,282.20
Rate for Payer: Cash Price	$3,806.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,568.50
Rate for Payer: Medical Associates Commercial	$3,568.50
Rate for Payer: Midlands Choice Commercial	$3,330.60
Rate for Payer: United Healthcare Commercial	$4,282.20

esmolol 10 mg/mL 10 ml SDV Vial [VDMC]

Facility

$27.14

Service Code	HCPCS J1805
Hospital Charge Code	10431703
Hospital Revenue Code	259
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$24.42
Rate for Payer: Aetna of IA Commercial	$24.42
Rate for Payer: Aetna of IA Medical Rental Products	$24.42
Rate for Payer: Aetna of IA Medicare	$15.47
Rate for Payer: Amerigroup Medicaid	$15.65
Rate for Payer: Amerigroup Medicare	$12.33
Rate for Payer: Cash Price	$21.71
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.35
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.21
Rate for Payer: Iowa Total Care Managed Medicaid	$15.50
Rate for Payer: Medical Associates Commercial	$20.35
Rate for Payer: Medical Associates Managed Medicare	$12.21
Rate for Payer: Midlands Choice Commercial	$19.00
Rate for Payer: Molina Healthcare Managed Medicaid	$15.73
Rate for Payer: Partners Health Alliance Commercial	$14.04
Rate for Payer: United Healthcare Commercial	$24.42
Rate for Payer: United Healthcare Managed Medicare	$16.01

esmolol 10 mg/mL 10 ml SDV Vial [VDMC]

Facility

$27.14

Service Code	HCPCS J1805
Hospital Charge Code	10431703
Hospital Revenue Code	259
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$24.42
Rate for Payer: Aetna of IA Commercial	$24.42
Rate for Payer: Aetna of IA Medical Rental Products	$24.42
Rate for Payer: Cash Price	$21.71
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.35
Rate for Payer: Medical Associates Commercial	$20.35
Rate for Payer: Midlands Choice Commercial	$19.00
Rate for Payer: United Healthcare Commercial	$24.42

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$11,648.23

Service Code	MSDRG 391
Min. Negotiated Rate	$11,479.41
Max. Negotiated Rate	$11,648.23
Rate for Payer: Amerigroup Medicaid	$11,591.96
Rate for Payer: Iowa Total Care Managed Medicaid	$11,479.41
Rate for Payer: Molina Healthcare Managed Medicaid	$11,648.23

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$7,188.24

Service Code	MSDRG 392
Min. Negotiated Rate	$7,084.06
Max. Negotiated Rate	$7,188.24
Rate for Payer: Amerigroup Medicaid	$7,153.51
Rate for Payer: Iowa Total Care Managed Medicaid	$7,084.06
Rate for Payer: Molina Healthcare Managed Medicaid	$7,188.24

ESSURE TUBAL OCCLUSION

Facility

$1,577.00

Hospital Charge Code	8025903
Hospital Revenue Code	272
Min. Negotiated Rate	$709.65
Max. Negotiated Rate	$1,419.30
Rate for Payer: Aetna of IA Commercial	$1,419.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,419.30
Rate for Payer: Aetna of IA Medicare	$898.89
Rate for Payer: Amerigroup Medicaid	$909.61
Rate for Payer: Amerigroup Medicare	$716.75
Rate for Payer: Cash Price	$1,261.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,182.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$709.65
Rate for Payer: Iowa Total Care Managed Medicaid	$900.78
Rate for Payer: Medical Associates Commercial	$1,182.75
Rate for Payer: Medical Associates Managed Medicare	$709.65
Rate for Payer: Midlands Choice Commercial	$1,103.90
Rate for Payer: Molina Healthcare Managed Medicaid	$914.03
Rate for Payer: Partners Health Alliance Commercial	$816.10
Rate for Payer: United Healthcare Commercial	$1,419.30
Rate for Payer: United Healthcare Managed Medicare	$930.43

ESSURE TUBAL OCCLUSION

Facility

$1,577.00

Hospital Charge Code	8025903
Hospital Revenue Code	272
Min. Negotiated Rate	$1,103.90
Max. Negotiated Rate	$1,419.30
Rate for Payer: Aetna of IA Commercial	$1,419.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,419.30
Rate for Payer: Cash Price	$1,261.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,182.75
Rate for Payer: Medical Associates Commercial	$1,182.75
Rate for Payer: Midlands Choice Commercial	$1,103.90
Rate for Payer: United Healthcare Commercial	$1,419.30

ESTABLISHED PATIENT NURSE ONLY CHARGE

Facility

$30.00

Service Code	CPT 99211
Hospital Charge Code	8068920
Hospital Revenue Code	510
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Aetna of IA Medicare	$17.10
Rate for Payer: Amerigroup Medicaid	$17.30
Rate for Payer: Amerigroup Medicare	$13.64
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.50
Rate for Payer: Iowa Total Care Managed Medicaid	$17.14
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Medical Associates Managed Medicare	$13.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: Molina Healthcare Managed Medicaid	$17.39
Rate for Payer: Partners Health Alliance Commercial	$15.52
Rate for Payer: United Healthcare Commercial	$27.00
Rate for Payer: United Healthcare Managed Medicare	$17.70

ESTABLISHED PATIENT NURSE ONLY CHARGE

Professional

Both

$30.00

Service Code	CPT 99211
Hospital Charge Code	8068920
Hospital Revenue Code	983
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$33.30
Rate for Payer: Amerigroup Medicaid	$18.64
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Iowa Total Care Managed Medicaid	$18.46
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$22.50
Rate for Payer: United Healthcare Commercial	$24.97
Rate for Payer: Wellmark IA HMO WHPI	$33.30
Rate for Payer: Wellmark IA PPO	$33.30

ESTABLISHED PATIENT NURSE ONLY CHARGE

Facility

$30.00

Service Code	CPT 99211
Hospital Charge Code	8068920
Hospital Revenue Code	510
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: United Healthcare Commercial	$27.00

ESTAB PATIENT DETAILED

Professional

Both

$357.00

Service Code	CPT 99214
Hospital Charge Code	8101317
Hospital Revenue Code	983
Min. Negotiated Rate	$68.14
Max. Negotiated Rate	$267.75
Rate for Payer: Amerigroup Medicaid	$68.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Iowa Total Care Managed Medicaid	$68.14
Rate for Payer: Medical Associates Commercial	$267.75
Rate for Payer: Midlands Choice Commercial	$249.90
Rate for Payer: Molina Healthcare Managed Medicaid	$68.47
Rate for Payer: Partners Health Alliance Commercial	$267.75
Rate for Payer: United Healthcare Commercial	$118.77
Rate for Payer: Wellmark IA HMO WHPI	$183.30
Rate for Payer: Wellmark IA PPO	$183.30

ESTAB PATIENT EXPANDED

Professional

Both

$244.00

Service Code	CPT 99213
Hospital Charge Code	8101316
Hospital Revenue Code	983
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$183.00
Rate for Payer: Amerigroup Medicaid	$44.53
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Iowa Total Care Managed Medicaid	$44.09
Rate for Payer: Medical Associates Commercial	$183.00
Rate for Payer: Midlands Choice Commercial	$170.80
Rate for Payer: Molina Healthcare Managed Medicaid	$44.31
Rate for Payer: Partners Health Alliance Commercial	$183.00
Rate for Payer: United Healthcare Commercial	$81.57
Rate for Payer: Wellmark IA HMO WHPI	$129.90
Rate for Payer: Wellmark IA PPO	$129.90

ESTAB PATIENT FOCUSED

Professional

Both

$148.00

Service Code	CPT 99212
Hospital Charge Code	8101315
Hospital Revenue Code	983
Min. Negotiated Rate	$31.99
Max. Negotiated Rate	$111.00
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$111.00
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: Molina Healthcare Managed Medicaid	$32.14
Rate for Payer: Partners Health Alliance Commercial	$111.00
Rate for Payer: United Healthcare Commercial	$49.04
Rate for Payer: Wellmark IA HMO WHPI	$80.90
Rate for Payer: Wellmark IA PPO	$80.90

ESTAB PATIENT NURSE ONLY

Facility

$36.00

Service Code	CPT 99211
Hospital Charge Code	4734797
Hospital Revenue Code	760
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

ESTAB PATIENT NURSE ONLY

Facility

$36.00

Service Code	CPT 99211
Hospital Charge Code	4734797
Hospital Revenue Code	760
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

estradiol 1 mg Tab [VDMC]

Facility

$1.49

Service Code	HCPCS A9270
Hospital Charge Code	10387396
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

estradiol 1 mg Tab [VDMC]

Facility

$1.49

Service Code	HCPCS A9270
Hospital Charge Code	10387396
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
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	$0.86
Rate for Payer: Amerigroup Medicare	$0.68
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	$0.67
Rate for Payer: Iowa Total Care Managed Medicaid	$0.85
Rate for Payer: Medical Associates Commercial	$1.12
Rate for Payer: Medical Associates Managed Medicare	$0.67
Rate for Payer: Midlands Choice Commercial	$1.04
Rate for Payer: Molina Healthcare Managed Medicaid	$0.86
Rate for Payer: Partners Health Alliance Commercial	$0.77
Rate for Payer: United Healthcare Commercial	$1.34
Rate for Payer: United Healthcare Managed Medicare	$0.88

Estradiol Level DMCL

Facility

$190.00

Service Code	CPT 82670
Hospital Charge Code	8037841
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of IA Commercial	$171.00
Rate for Payer: Aetna of IA Medical Rental Products	$171.00
Rate for Payer: Aetna of IA Medicare	$108.30
Rate for Payer: Amerigroup Medicaid	$109.59
Rate for Payer: Amerigroup Medicare	$86.36
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$142.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$85.50
Rate for Payer: Iowa Total Care Managed Medicaid	$108.53
Rate for Payer: Medical Associates Commercial	$142.50
Rate for Payer: Medical Associates Managed Medicare	$85.50
Rate for Payer: Midlands Choice Commercial	$133.00
Rate for Payer: Molina Healthcare Managed Medicaid	$110.12
Rate for Payer: Partners Health Alliance Commercial	$98.32
Rate for Payer: United Healthcare Commercial	$171.00
Rate for Payer: United Healthcare Managed Medicare	$112.10
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Estradiol Level DMCL

Facility

$190.00

Service Code	CPT 82670
Hospital Charge Code	8037841
Hospital Revenue Code	301
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of IA Commercial	$171.00
Rate for Payer: Aetna of IA Medical Rental Products	$171.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$142.50
Rate for Payer: Medical Associates Commercial	$142.50
Rate for Payer: Midlands Choice Commercial	$133.00
Rate for Payer: United Healthcare Commercial	$171.00

ESTRIOL UNCONJUGATED

Facility

$146.00

Service Code	CPT 82677
Hospital Charge Code	8037490
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Aetna of IA Medicare	$83.22
Rate for Payer: Amerigroup Medicaid	$84.21
Rate for Payer: Amerigroup Medicare	$66.36
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$65.70
Rate for Payer: Iowa Total Care Managed Medicaid	$83.40
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Medical Associates Managed Medicare	$65.70
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: Molina Healthcare Managed Medicaid	$84.62
Rate for Payer: Partners Health Alliance Commercial	$75.56
Rate for Payer: United Healthcare Commercial	$131.40
Rate for Payer: United Healthcare Managed Medicare	$86.14
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

ESTRIOL UNCONJUGATED

Facility

$146.00

Service Code	CPT 82677
Hospital Charge Code	8037490
Hospital Revenue Code	301
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of IA Commercial	$131.40
Rate for Payer: Aetna of IA Medical Rental Products	$131.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$109.50
Rate for Payer: Medical Associates Commercial	$109.50
Rate for Payer: Midlands Choice Commercial	$102.20
Rate for Payer: United Healthcare Commercial	$131.40

Estrogens Fractionated (E1 and E2) DMCL

Facility

$190.00

Service Code	CPT 82671
Hospital Charge Code	8037842
Hospital Revenue Code	301
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of IA Commercial	$171.00
Rate for Payer: Aetna of IA Medical Rental Products	$171.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$142.50
Rate for Payer: Medical Associates Commercial	$142.50
Rate for Payer: Midlands Choice Commercial	$133.00
Rate for Payer: United Healthcare Commercial	$171.00

Estrogens Fractionated (E1 and E2) DMCL

Facility

$190.00

Service Code	CPT 82671
Hospital Charge Code	8037842
Hospital Revenue Code	301
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of IA Commercial	$171.00
Rate for Payer: Aetna of IA Medical Rental Products	$171.00
Rate for Payer: Aetna of IA Medicare	$108.30
Rate for Payer: Amerigroup Medicaid	$109.59
Rate for Payer: Amerigroup Medicare	$86.36
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$142.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$85.50
Rate for Payer: Iowa Total Care Managed Medicaid	$108.53
Rate for Payer: Medical Associates Commercial	$142.50
Rate for Payer: Medical Associates Managed Medicare	$85.50
Rate for Payer: Midlands Choice Commercial	$133.00
Rate for Payer: Molina Healthcare Managed Medicaid	$110.12
Rate for Payer: Partners Health Alliance Commercial	$98.32
Rate for Payer: United Healthcare Commercial	$171.00
Rate for Payer: United Healthcare Managed Medicare	$112.10
Rate for Payer: Wellmark IA HMO WHPI	$82.95
Rate for Payer: Wellmark IA PPO	$91.38

ETHICON ENDO GIA GUN

Facility

$480.00

Hospital Charge Code	8026300
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of IA Commercial	$432.00
Rate for Payer: Aetna of IA Medical Rental Products	$432.00
Rate for Payer: Aetna of IA Medicare	$273.60
Rate for Payer: Amerigroup Medicaid	$276.86
Rate for Payer: Amerigroup Medicare	$218.16
Rate for Payer: Cash Price	$384.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$360.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$216.00
Rate for Payer: Iowa Total Care Managed Medicaid	$274.18
Rate for Payer: Medical Associates Commercial	$360.00
Rate for Payer: Medical Associates Managed Medicare	$216.00
Rate for Payer: Midlands Choice Commercial	$336.00
Rate for Payer: Molina Healthcare Managed Medicaid	$278.21
Rate for Payer: Partners Health Alliance Commercial	$248.40
Rate for Payer: United Healthcare Commercial	$432.00
Rate for Payer: United Healthcare Managed Medicare	$283.20

Know your out-of-pocket cost for care.

All Charges