Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

3.5MM X 38MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968474
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 40MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968476
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5MM X 40MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968476
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 42MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968478
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 42MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968478
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5 x 26MM LOCKING SCREW

Facility

$1,215.00

Service Code	HCPCS C1713
Hospital Charge Code	8967717
Hospital Revenue Code	278
Min. Negotiated Rate	$546.75
Max. Negotiated Rate	$1,093.50
Rate for Payer: Aetna of IA Commercial	$1,093.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,093.50
Rate for Payer: Aetna of IA Medicare	$692.55
Rate for Payer: Amerigroup Medicaid	$700.81
Rate for Payer: Amerigroup Medicare	$552.22
Rate for Payer: Cash Price	$972.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$911.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$546.75
Rate for Payer: Iowa Total Care Managed Medicaid	$694.01
Rate for Payer: Medical Associates Commercial	$911.25
Rate for Payer: Medical Associates Managed Medicare	$546.75
Rate for Payer: Midlands Choice Commercial	$850.50
Rate for Payer: Molina Healthcare Managed Medicaid	$704.21
Rate for Payer: Partners Health Alliance Commercial	$628.76
Rate for Payer: United Healthcare Commercial	$1,093.50
Rate for Payer: United Healthcare Managed Medicare	$716.85

3.5 x 26MM LOCKING SCREW

Facility

$1,215.00

Service Code	HCPCS C1713
Hospital Charge Code	8967717
Hospital Revenue Code	278
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$1,093.50
Rate for Payer: Aetna of IA Commercial	$1,093.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,093.50
Rate for Payer: Cash Price	$972.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$911.25
Rate for Payer: Medical Associates Commercial	$911.25
Rate for Payer: Midlands Choice Commercial	$850.50
Rate for Payer: United Healthcare Commercial	$1,093.50

36556 INS NON-TUNNEL CV CATH 5 YRS/>

Professional

Both

$774.00

Service Code	CPT 36556
Hospital Charge Code	8069072
Hospital Revenue Code	975
Min. Negotiated Rate	$245.86
Max. Negotiated Rate	$580.50
Rate for Payer: Amerigroup Medicaid	$248.27
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Iowa Total Care Managed Medicaid	$245.86
Rate for Payer: Medical Associates Commercial	$580.50
Rate for Payer: Midlands Choice Commercial	$541.80
Rate for Payer: Molina Healthcare Managed Medicaid	$247.07
Rate for Payer: Partners Health Alliance Commercial	$580.50
Rate for Payer: United Healthcare Commercial	$321.70
Rate for Payer: Wellmark IA HMO WHPI	$412.90
Rate for Payer: Wellmark IA PPO	$485.80

36561 INS TUNNELED CVAD W PORT AGE 5 YRS/>

Professional

Both

$3,608.00

Service Code	CPT 36561
Hospital Charge Code	8069173
Hospital Revenue Code	975
Min. Negotiated Rate	$1,134.09
Max. Negotiated Rate	$2,706.00
Rate for Payer: Amerigroup Medicaid	$1,145.21
Rate for Payer: Cash Price	$2,886.40
Rate for Payer: Cash Price	$2,886.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,134.09
Rate for Payer: Medical Associates Commercial	$2,706.00
Rate for Payer: Midlands Choice Commercial	$2,525.60
Rate for Payer: Molina Healthcare Managed Medicaid	$1,139.65
Rate for Payer: Partners Health Alliance Commercial	$2,706.00
Rate for Payer: United Healthcare Commercial	$1,608.30
Rate for Payer: Wellmark IA HMO WHPI	$1,868.80
Rate for Payer: Wellmark IA PPO	$2,198.60

36573 Insertion of PICC w/o port including imaging- age 5+

Professional

Both

$651.00

Service Code	CPT 36573
Hospital Charge Code	8799169
Hospital Revenue Code	975
Min. Negotiated Rate	$360.80
Max. Negotiated Rate	$861.40
Rate for Payer: Amerigroup Medicaid	$364.34
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Iowa Total Care Managed Medicaid	$360.80
Rate for Payer: Medical Associates Commercial	$488.25
Rate for Payer: Midlands Choice Commercial	$455.70
Rate for Payer: Molina Healthcare Managed Medicaid	$362.57
Rate for Payer: Partners Health Alliance Commercial	$488.25
Rate for Payer: United Healthcare Commercial	$599.84
Rate for Payer: Wellmark IA HMO WHPI	$732.20
Rate for Payer: Wellmark IA PPO	$861.40

36589 Removal tunneled central venous catheter

Professional

Both

$465.00

Service Code	CPT 36589
Hospital Charge Code	8799170
Hospital Revenue Code	975
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$375.60
Rate for Payer: Amerigroup Medicaid	$150.91
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Iowa Total Care Managed Medicaid	$149.44
Rate for Payer: Medical Associates Commercial	$348.75
Rate for Payer: Midlands Choice Commercial	$325.50
Rate for Payer: Molina Healthcare Managed Medicaid	$150.17
Rate for Payer: Partners Health Alliance Commercial	$348.75
Rate for Payer: United Healthcare Commercial	$252.61
Rate for Payer: Wellmark IA HMO WHPI	$319.30
Rate for Payer: Wellmark IA PPO	$375.60

36590 Removal tunneled VAD w/sub q port/pump central/peripheral

Professional

Both

$741.00

Service Code	CPT 36590
Hospital Charge Code	8799171
Hospital Revenue Code	975
Min. Negotiated Rate	$330.48
Max. Negotiated Rate	$555.75
Rate for Payer: Amerigroup Medicaid	$333.72
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Iowa Total Care Managed Medicaid	$330.48
Rate for Payer: Medical Associates Commercial	$555.75
Rate for Payer: Midlands Choice Commercial	$518.70
Rate for Payer: Molina Healthcare Managed Medicaid	$332.10
Rate for Payer: Partners Health Alliance Commercial	$555.75
Rate for Payer: United Healthcare Commercial	$336.77
Rate for Payer: Wellmark IA HMO WHPI	$431.80
Rate for Payer: Wellmark IA PPO	$508.00

36590 REMOVE TUNNELED CVAD W PORT/PUMP

Professional

Both

$741.00

Service Code	CPT 36590
Hospital Charge Code	8069119
Hospital Revenue Code	975
Min. Negotiated Rate	$330.48
Max. Negotiated Rate	$555.75
Rate for Payer: Amerigroup Medicaid	$333.72
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Iowa Total Care Managed Medicaid	$330.48
Rate for Payer: Medical Associates Commercial	$555.75
Rate for Payer: Midlands Choice Commercial	$518.70
Rate for Payer: Molina Healthcare Managed Medicaid	$332.10
Rate for Payer: Partners Health Alliance Commercial	$555.75
Rate for Payer: United Healthcare Commercial	$336.77
Rate for Payer: Wellmark IA HMO WHPI	$431.80
Rate for Payer: Wellmark IA PPO	$508.00

37785 LIGATE/DIVIDE/EXCISE VEIN 1 LEG

Professional

Both

$1,190.00

Service Code	CPT 37785
Hospital Charge Code	8069149
Hospital Revenue Code	975
Min. Negotiated Rate	$276.20
Max. Negotiated Rate	$892.50
Rate for Payer: Amerigroup Medicaid	$278.90
Rate for Payer: Cash Price	$952.00
Rate for Payer: Cash Price	$952.00
Rate for Payer: Iowa Total Care Managed Medicaid	$276.20
Rate for Payer: Medical Associates Commercial	$892.50
Rate for Payer: Midlands Choice Commercial	$833.00
Rate for Payer: Molina Healthcare Managed Medicaid	$277.55
Rate for Payer: Partners Health Alliance Commercial	$892.50
Rate for Payer: United Healthcare Commercial	$530.50
Rate for Payer: Wellmark IA HMO WHPI	$679.50
Rate for Payer: Wellmark IA PPO	$799.40

38220 Bone marrow; aspiration only

Professional

Both

$556.00

Service Code	CPT 38220
Hospital Charge Code	8799172
Hospital Revenue Code	975
Min. Negotiated Rate	$194.30
Max. Negotiated Rate	$417.00
Rate for Payer: Amerigroup Medicaid	$196.20
Rate for Payer: Cash Price	$444.80
Rate for Payer: Cash Price	$444.80
Rate for Payer: Iowa Total Care Managed Medicaid	$194.30
Rate for Payer: Medical Associates Commercial	$417.00
Rate for Payer: Midlands Choice Commercial	$389.20
Rate for Payer: Molina Healthcare Managed Medicaid	$195.25
Rate for Payer: Partners Health Alliance Commercial	$417.00
Rate for Payer: United Healthcare Commercial	$251.25
Rate for Payer: Wellmark IA HMO WHPI	$300.90
Rate for Payer: Wellmark IA PPO	$354.00

38221 Bone marrow; biopsy needle or trocar- PROFEE

Professional

Both

$556.00

Service Code	CPT 38221
Hospital Charge Code	8799173
Hospital Revenue Code	975
Min. Negotiated Rate	$208.40
Max. Negotiated Rate	$417.00
Rate for Payer: Amerigroup Medicaid	$210.44
Rate for Payer: Cash Price	$444.80
Rate for Payer: Cash Price	$444.80
Rate for Payer: Iowa Total Care Managed Medicaid	$208.40
Rate for Payer: Medical Associates Commercial	$417.00
Rate for Payer: Midlands Choice Commercial	$389.20
Rate for Payer: Molina Healthcare Managed Medicaid	$209.42
Rate for Payer: Partners Health Alliance Commercial	$417.00
Rate for Payer: United Healthcare Commercial	$238.46
Rate for Payer: Wellmark IA HMO WHPI	$311.10
Rate for Payer: Wellmark IA PPO	$366.00

38500 LYMPH NODE BIOSPY/REMOVAL

Professional

Both

$1,107.00

Service Code	CPT 38500
Hospital Charge Code	8069132
Hospital Revenue Code	975
Min. Negotiated Rate	$180.13
Max. Negotiated Rate	$830.25
Rate for Payer: Amerigroup Medicaid	$181.90
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cash Price	$885.60
Rate for Payer: Iowa Total Care Managed Medicaid	$180.13
Rate for Payer: Medical Associates Commercial	$830.25
Rate for Payer: Midlands Choice Commercial	$774.90
Rate for Payer: Molina Healthcare Managed Medicaid	$181.02
Rate for Payer: Partners Health Alliance Commercial	$830.25
Rate for Payer: United Healthcare Commercial	$503.34
Rate for Payer: Wellmark IA HMO WHPI	$647.10
Rate for Payer: Wellmark IA PPO	$761.30

38792 INJ SENTINEL NODE BIOPSY

Professional

Both

$276.00

Service Code	CPT 38792
Hospital Charge Code	8069131
Hospital Revenue Code	975
Min. Negotiated Rate	$25.37
Max. Negotiated Rate	$207.00
Rate for Payer: Amerigroup Medicaid	$25.62
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Iowa Total Care Managed Medicaid	$25.37
Rate for Payer: Medical Associates Commercial	$207.00
Rate for Payer: Midlands Choice Commercial	$193.20
Rate for Payer: Molina Healthcare Managed Medicaid	$25.49
Rate for Payer: Partners Health Alliance Commercial	$207.00
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: Wellmark IA HMO WHPI	$157.50
Rate for Payer: Wellmark IA PPO	$185.30

3D MAX LIGHT-LEFT LARGE

Facility

$364.00

Service Code	HCPCS C1781
Hospital Charge Code	8417552
Hospital Revenue Code	278
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna of IA Commercial	$327.60
Rate for Payer: Aetna of IA Medical Rental Products	$327.60
Rate for Payer: Aetna of IA Medicare	$207.48
Rate for Payer: Amerigroup Medicaid	$209.96
Rate for Payer: Amerigroup Medicare	$165.44
Rate for Payer: Cash Price	$291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$163.80
Rate for Payer: Iowa Total Care Managed Medicaid	$207.92
Rate for Payer: Medical Associates Commercial	$273.00
Rate for Payer: Medical Associates Managed Medicare	$163.80
Rate for Payer: Midlands Choice Commercial	$254.80
Rate for Payer: Molina Healthcare Managed Medicaid	$210.97
Rate for Payer: Partners Health Alliance Commercial	$188.37
Rate for Payer: United Healthcare Commercial	$327.60
Rate for Payer: United Healthcare Managed Medicare	$214.76

3D MAX LIGHT-LEFT LARGE

Facility

$364.00

Service Code	HCPCS C1781
Hospital Charge Code	8417552
Hospital Revenue Code	278
Min. Negotiated Rate	$254.80
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna of IA Commercial	$327.60
Rate for Payer: Aetna of IA Medical Rental Products	$327.60
Rate for Payer: Cash Price	$291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.00
Rate for Payer: Medical Associates Commercial	$273.00
Rate for Payer: Midlands Choice Commercial	$254.80
Rate for Payer: United Healthcare Commercial	$327.60

3D MAX LIGHT RT LRG

Facility

$364.00

Service Code	HCPCS C1781
Hospital Charge Code	8417554
Hospital Revenue Code	278
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna of IA Commercial	$327.60
Rate for Payer: Aetna of IA Medical Rental Products	$327.60
Rate for Payer: Aetna of IA Medicare	$207.48
Rate for Payer: Amerigroup Medicaid	$209.96
Rate for Payer: Amerigroup Medicare	$165.44
Rate for Payer: Cash Price	$291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$163.80
Rate for Payer: Iowa Total Care Managed Medicaid	$207.92
Rate for Payer: Medical Associates Commercial	$273.00
Rate for Payer: Medical Associates Managed Medicare	$163.80
Rate for Payer: Midlands Choice Commercial	$254.80
Rate for Payer: Molina Healthcare Managed Medicaid	$210.97
Rate for Payer: Partners Health Alliance Commercial	$188.37
Rate for Payer: United Healthcare Commercial	$327.60
Rate for Payer: United Healthcare Managed Medicare	$214.76

3D MAX LIGHT RT LRG

Facility

$364.00

Service Code	HCPCS C1781
Hospital Charge Code	8417554
Hospital Revenue Code	278
Min. Negotiated Rate	$254.80
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna of IA Commercial	$327.60
Rate for Payer: Aetna of IA Medical Rental Products	$327.60
Rate for Payer: Cash Price	$291.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.00
Rate for Payer: Medical Associates Commercial	$273.00
Rate for Payer: Midlands Choice Commercial	$254.80
Rate for Payer: United Healthcare Commercial	$327.60

3DMax Mesh, Large Left, 4X6 in

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	8993113
Hospital Revenue Code	278
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna of IA Commercial	$513.00
Rate for Payer: Aetna of IA Medical Rental Products	$513.00
Rate for Payer: Aetna of IA Medicare	$324.90
Rate for Payer: Amerigroup Medicaid	$328.78
Rate for Payer: Amerigroup Medicare	$259.06
Rate for Payer: Cash Price	$456.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$427.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$256.50
Rate for Payer: Iowa Total Care Managed Medicaid	$325.58
Rate for Payer: Medical Associates Commercial	$427.50
Rate for Payer: Medical Associates Managed Medicare	$256.50
Rate for Payer: Midlands Choice Commercial	$399.00
Rate for Payer: Molina Healthcare Managed Medicaid	$330.37
Rate for Payer: Partners Health Alliance Commercial	$294.98
Rate for Payer: United Healthcare Commercial	$513.00
Rate for Payer: United Healthcare Managed Medicare	$336.30

3DMax Mesh, Large Left, 4X6 in

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	8993113
Hospital Revenue Code	278
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna of IA Commercial	$513.00
Rate for Payer: Aetna of IA Medical Rental Products	$513.00
Rate for Payer: Cash Price	$456.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$427.50
Rate for Payer: Medical Associates Commercial	$427.50
Rate for Payer: Midlands Choice Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$513.00

3DMax Mesh, Large Right, 4X6 in

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	8993115
Hospital Revenue Code	278
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna of IA Commercial	$513.00
Rate for Payer: Aetna of IA Medical Rental Products	$513.00
Rate for Payer: Cash Price	$456.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$427.50
Rate for Payer: Medical Associates Commercial	$427.50
Rate for Payer: Midlands Choice Commercial	$399.00
Rate for Payer: United Healthcare Commercial	$513.00

Know your out-of-pocket cost for care.

All Charges