Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

GENERAL ANESTHESIA I

Facility

$926.00

Hospital Charge Code	8059074
Hospital Revenue Code	370
Min. Negotiated Rate	$648.20
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of IA Commercial	$833.40
Rate for Payer: Aetna of IA Medical Rental Products	$833.40
Rate for Payer: Cash Price	$740.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$694.50
Rate for Payer: Medical Associates Commercial	$694.50
Rate for Payer: Midlands Choice Commercial	$648.20
Rate for Payer: United Healthcare Commercial	$833.40

GENERAL ANESTHESIA I

Facility

$926.00

Hospital Charge Code	8059074
Hospital Revenue Code	370
Min. Negotiated Rate	$416.70
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of IA Commercial	$833.40
Rate for Payer: Aetna of IA Medical Rental Products	$833.40
Rate for Payer: Aetna of IA Medicare	$527.82
Rate for Payer: Amerigroup Medicaid	$534.12
Rate for Payer: Amerigroup Medicare	$420.87
Rate for Payer: Cash Price	$740.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$694.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$416.70
Rate for Payer: Iowa Total Care Managed Medicaid	$528.93
Rate for Payer: Medical Associates Commercial	$694.50
Rate for Payer: Medical Associates Managed Medicare	$416.70
Rate for Payer: Midlands Choice Commercial	$648.20
Rate for Payer: Molina Healthcare Managed Medicaid	$536.71
Rate for Payer: Partners Health Alliance Commercial	$479.20
Rate for Payer: United Healthcare Commercial	$833.40
Rate for Payer: United Healthcare Managed Medicare	$546.34

GENERAL ANESTHESIA II

Facility

$795.00

Hospital Charge Code	8059075
Hospital Revenue Code	370
Min. Negotiated Rate	$556.50
Max. Negotiated Rate	$715.50
Rate for Payer: Aetna of IA Commercial	$715.50
Rate for Payer: Aetna of IA Medical Rental Products	$715.50
Rate for Payer: Cash Price	$636.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$596.25
Rate for Payer: Medical Associates Commercial	$596.25
Rate for Payer: Midlands Choice Commercial	$556.50
Rate for Payer: United Healthcare Commercial	$715.50

GENERAL ANESTHESIA II

Facility

$795.00

Hospital Charge Code	8059075
Hospital Revenue Code	370
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$715.50
Rate for Payer: Aetna of IA Commercial	$715.50
Rate for Payer: Aetna of IA Medical Rental Products	$715.50
Rate for Payer: Aetna of IA Medicare	$453.15
Rate for Payer: Amerigroup Medicaid	$458.56
Rate for Payer: Amerigroup Medicare	$361.33
Rate for Payer: Cash Price	$636.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$596.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$357.75
Rate for Payer: Iowa Total Care Managed Medicaid	$454.10
Rate for Payer: Medical Associates Commercial	$596.25
Rate for Payer: Medical Associates Managed Medicare	$357.75
Rate for Payer: Midlands Choice Commercial	$556.50
Rate for Payer: Molina Healthcare Managed Medicaid	$460.78
Rate for Payer: Partners Health Alliance Commercial	$411.41
Rate for Payer: United Healthcare Commercial	$715.50
Rate for Payer: United Healthcare Managed Medicare	$469.05

GENERAL ANESTHESIA III

Facility

$888.00

Hospital Charge Code	8059591
Hospital Revenue Code	370
Min. Negotiated Rate	$399.60
Max. Negotiated Rate	$799.20
Rate for Payer: Aetna of IA Commercial	$799.20
Rate for Payer: Aetna of IA Medical Rental Products	$799.20
Rate for Payer: Aetna of IA Medicare	$506.16
Rate for Payer: Amerigroup Medicaid	$512.20
Rate for Payer: Amerigroup Medicare	$403.60
Rate for Payer: Cash Price	$710.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$666.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$399.60
Rate for Payer: Iowa Total Care Managed Medicaid	$507.23
Rate for Payer: Medical Associates Commercial	$666.00
Rate for Payer: Medical Associates Managed Medicare	$399.60
Rate for Payer: Midlands Choice Commercial	$621.60
Rate for Payer: Molina Healthcare Managed Medicaid	$514.68
Rate for Payer: Partners Health Alliance Commercial	$459.54
Rate for Payer: United Healthcare Commercial	$799.20
Rate for Payer: United Healthcare Managed Medicare	$523.92

GENERAL ANESTHESIA III

Facility

$888.00

Hospital Charge Code	8059591
Hospital Revenue Code	370
Min. Negotiated Rate	$621.60
Max. Negotiated Rate	$799.20
Rate for Payer: Aetna of IA Commercial	$799.20
Rate for Payer: Aetna of IA Medical Rental Products	$799.20
Rate for Payer: Cash Price	$710.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$666.00
Rate for Payer: Medical Associates Commercial	$666.00
Rate for Payer: Midlands Choice Commercial	$621.60
Rate for Payer: United Healthcare Commercial	$799.20

GENERAL ANESTHESIA IV

Facility

$712.00

Hospital Charge Code	8059076
Hospital Revenue Code	370
Min. Negotiated Rate	$498.40
Max. Negotiated Rate	$640.80
Rate for Payer: Aetna of IA Commercial	$640.80
Rate for Payer: Aetna of IA Medical Rental Products	$640.80
Rate for Payer: Cash Price	$569.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$534.00
Rate for Payer: Medical Associates Commercial	$534.00
Rate for Payer: Midlands Choice Commercial	$498.40
Rate for Payer: United Healthcare Commercial	$640.80

GENERAL ANESTHESIA IV

Facility

$712.00

Hospital Charge Code	8059076
Hospital Revenue Code	370
Min. Negotiated Rate	$320.40
Max. Negotiated Rate	$640.80
Rate for Payer: Aetna of IA Commercial	$640.80
Rate for Payer: Aetna of IA Medical Rental Products	$640.80
Rate for Payer: Aetna of IA Medicare	$405.84
Rate for Payer: Amerigroup Medicaid	$410.68
Rate for Payer: Amerigroup Medicare	$323.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$534.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$320.40
Rate for Payer: Iowa Total Care Managed Medicaid	$406.69
Rate for Payer: Medical Associates Commercial	$534.00
Rate for Payer: Medical Associates Managed Medicare	$320.40
Rate for Payer: Midlands Choice Commercial	$498.40
Rate for Payer: Molina Healthcare Managed Medicaid	$412.68
Rate for Payer: Partners Health Alliance Commercial	$368.46
Rate for Payer: United Healthcare Commercial	$640.80
Rate for Payer: United Healthcare Managed Medicare	$420.08

GENERAL HEALTH PANEL

Facility

$344.00

Service Code	CPT 80050
Hospital Charge Code	7805074
Hospital Revenue Code	300
Min. Negotiated Rate	$240.80
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of IA Commercial	$309.60
Rate for Payer: Aetna of IA Medical Rental Products	$309.60
Rate for Payer: Cash Price	$275.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$258.00
Rate for Payer: Medical Associates Commercial	$258.00
Rate for Payer: Midlands Choice Commercial	$240.80
Rate for Payer: United Healthcare Commercial	$309.60

GENERAL HEALTH PANEL

Facility

$344.00

Service Code	CPT 80050
Hospital Charge Code	7805074
Hospital Revenue Code	300
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of IA Commercial	$309.60
Rate for Payer: Aetna of IA Medical Rental Products	$309.60
Rate for Payer: Aetna of IA Medicare	$196.08
Rate for Payer: Amerigroup Medicaid	$198.42
Rate for Payer: Amerigroup Medicare	$156.35
Rate for Payer: Cash Price	$275.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$258.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$154.80
Rate for Payer: Iowa Total Care Managed Medicaid	$196.49
Rate for Payer: Medical Associates Commercial	$258.00
Rate for Payer: Medical Associates Managed Medicare	$154.80
Rate for Payer: Midlands Choice Commercial	$240.80
Rate for Payer: Molina Healthcare Managed Medicaid	$199.38
Rate for Payer: Partners Health Alliance Commercial	$178.02
Rate for Payer: United Healthcare Commercial	$309.60
Rate for Payer: United Healthcare Managed Medicare	$202.96

GENERAL PHYSICAL

Facility

$70.00

Service Code	CPT 99212
Hospital Charge Code	8015871
Hospital Revenue Code	983
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: United Healthcare Commercial	$63.00

GENERAL PHYSICAL

Facility

$70.00

Service Code	CPT 99212
Hospital Charge Code	8015871
Hospital Revenue Code	983
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of IA Commercial	$63.00
Rate for Payer: Aetna of IA Medical Rental Products	$63.00
Rate for Payer: Aetna of IA Medicare	$39.90
Rate for Payer: Amerigroup Medicaid	$40.38
Rate for Payer: Amerigroup Medicare	$31.82
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.50
Rate for Payer: Iowa Total Care Managed Medicaid	$39.98
Rate for Payer: Medical Associates Commercial	$52.50
Rate for Payer: Medical Associates Managed Medicare	$31.50
Rate for Payer: Midlands Choice Commercial	$49.00
Rate for Payer: Molina Healthcare Managed Medicaid	$40.57
Rate for Payer: Partners Health Alliance Commercial	$36.23
Rate for Payer: United Healthcare Commercial	$63.00

gentamicin 0.1% cream 15gm Tube [VDMC]

Facility

$33.68

Service Code	HCPCS A9270
Hospital Charge Code	10434715
Hospital Revenue Code	259
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$30.31
Rate for Payer: Aetna of IA Commercial	$30.31
Rate for Payer: Aetna of IA Medical Rental Products	$30.31
Rate for Payer: Aetna of IA Medicare	$19.20
Rate for Payer: Amerigroup Medicaid	$19.43
Rate for Payer: Amerigroup Medicare	$15.31
Rate for Payer: Cash Price	$26.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.26
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.16
Rate for Payer: Iowa Total Care Managed Medicaid	$19.24
Rate for Payer: Medical Associates Commercial	$25.26
Rate for Payer: Medical Associates Managed Medicare	$15.16
Rate for Payer: Midlands Choice Commercial	$23.58
Rate for Payer: Molina Healthcare Managed Medicaid	$19.52
Rate for Payer: Partners Health Alliance Commercial	$17.43
Rate for Payer: United Healthcare Commercial	$30.31
Rate for Payer: United Healthcare Managed Medicare	$19.87

gentamicin 0.1% cream 15gm Tube [VDMC]

Facility

$33.68

Service Code	HCPCS A9270
Hospital Charge Code	10434715
Hospital Revenue Code	259
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$30.31
Rate for Payer: Aetna of IA Commercial	$30.31
Rate for Payer: Aetna of IA Medical Rental Products	$30.31
Rate for Payer: Cash Price	$26.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.26
Rate for Payer: Medical Associates Commercial	$25.26
Rate for Payer: Midlands Choice Commercial	$23.58
Rate for Payer: United Healthcare Commercial	$30.31

gentamicin 10 mg/mL 2ml [VDMC]

Facility

$27.58

Service Code	HCPCS J1580
Hospital Charge Code	10391689
Hospital Revenue Code	259
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$24.82
Rate for Payer: Aetna of IA Commercial	$24.82
Rate for Payer: Aetna of IA Medical Rental Products	$24.82
Rate for Payer: Aetna of IA Medicare	$15.72
Rate for Payer: Amerigroup Medicaid	$15.91
Rate for Payer: Amerigroup Medicare	$12.53
Rate for Payer: Cash Price	$22.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.68
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.41
Rate for Payer: Iowa Total Care Managed Medicaid	$15.75
Rate for Payer: Medical Associates Commercial	$20.68
Rate for Payer: Medical Associates Managed Medicare	$12.41
Rate for Payer: Midlands Choice Commercial	$19.31
Rate for Payer: Molina Healthcare Managed Medicaid	$15.98
Rate for Payer: Partners Health Alliance Commercial	$14.27
Rate for Payer: United Healthcare Commercial	$24.82
Rate for Payer: United Healthcare Managed Medicare	$16.27

gentamicin 10 mg/mL 2ml [VDMC]

Facility

$27.58

Service Code	HCPCS J1580
Hospital Charge Code	10391689
Hospital Revenue Code	259
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$24.82
Rate for Payer: Aetna of IA Commercial	$24.82
Rate for Payer: Aetna of IA Medical Rental Products	$24.82
Rate for Payer: Cash Price	$22.06
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.68
Rate for Payer: Medical Associates Commercial	$20.68
Rate for Payer: Midlands Choice Commercial	$19.31
Rate for Payer: United Healthcare Commercial	$24.82

gentamicin 40 mg/mL 20ml Inj Sol [VDMC]

Facility

$110.91

Service Code	HCPCS J1580
Hospital Charge Code	10391760
Hospital Revenue Code	259
Min. Negotiated Rate	$49.91
Max. Negotiated Rate	$99.82
Rate for Payer: Aetna of IA Commercial	$99.82
Rate for Payer: Aetna of IA Medical Rental Products	$99.82
Rate for Payer: Aetna of IA Medicare	$63.22
Rate for Payer: Amerigroup Medicaid	$63.97
Rate for Payer: Amerigroup Medicare	$50.41
Rate for Payer: Cash Price	$88.73
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.19
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$49.91
Rate for Payer: Iowa Total Care Managed Medicaid	$63.35
Rate for Payer: Medical Associates Commercial	$83.19
Rate for Payer: Medical Associates Managed Medicare	$49.91
Rate for Payer: Midlands Choice Commercial	$77.64
Rate for Payer: Molina Healthcare Managed Medicaid	$64.29
Rate for Payer: Partners Health Alliance Commercial	$57.40
Rate for Payer: United Healthcare Commercial	$99.82
Rate for Payer: United Healthcare Managed Medicare	$65.44

gentamicin 40 mg/mL 20ml Inj Sol [VDMC]

Facility

$110.91

Service Code	HCPCS J1580
Hospital Charge Code	10391760
Hospital Revenue Code	259
Min. Negotiated Rate	$77.64
Max. Negotiated Rate	$99.82
Rate for Payer: Aetna of IA Commercial	$99.82
Rate for Payer: Aetna of IA Medical Rental Products	$99.82
Rate for Payer: Cash Price	$88.73
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.19
Rate for Payer: Medical Associates Commercial	$83.19
Rate for Payer: Midlands Choice Commercial	$77.64
Rate for Payer: United Healthcare Commercial	$99.82

gentamicin 80 mg/100 mL-NS IV Sol [VDMC]

Facility

$57.33

Service Code	HCPCS J1580
Hospital Charge Code	10391831
Hospital Revenue Code	259
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$51.60
Rate for Payer: Aetna of IA Commercial	$51.60
Rate for Payer: Aetna of IA Medical Rental Products	$51.60
Rate for Payer: Aetna of IA Medicare	$32.68
Rate for Payer: Amerigroup Medicaid	$33.07
Rate for Payer: Amerigroup Medicare	$26.06
Rate for Payer: Cash Price	$45.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.80
Rate for Payer: Iowa Total Care Managed Medicaid	$32.75
Rate for Payer: Medical Associates Commercial	$43.00
Rate for Payer: Medical Associates Managed Medicare	$25.80
Rate for Payer: Midlands Choice Commercial	$40.13
Rate for Payer: Molina Healthcare Managed Medicaid	$33.23
Rate for Payer: Partners Health Alliance Commercial	$29.67
Rate for Payer: United Healthcare Commercial	$51.60
Rate for Payer: United Healthcare Managed Medicare	$33.83

gentamicin 80 mg/100 mL-NS IV Sol [VDMC]

Facility

$57.33

Service Code	HCPCS J1580
Hospital Charge Code	10391831
Hospital Revenue Code	259
Min. Negotiated Rate	$40.13
Max. Negotiated Rate	$51.60
Rate for Payer: Aetna of IA Commercial	$51.60
Rate for Payer: Aetna of IA Medical Rental Products	$51.60
Rate for Payer: Cash Price	$45.87
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.00
Rate for Payer: Medical Associates Commercial	$43.00
Rate for Payer: Midlands Choice Commercial	$40.13
Rate for Payer: United Healthcare Commercial	$51.60

gentamicin Ophth 0.3% Sol 5ml Bottle [VDMC]

Facility

$27.48

Service Code	HCPCS A9270
Hospital Charge Code	10434650
Hospital Revenue Code	259
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$24.73
Rate for Payer: Aetna of IA Commercial	$24.73
Rate for Payer: Aetna of IA Medical Rental Products	$24.73
Rate for Payer: Cash Price	$21.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.61
Rate for Payer: Medical Associates Commercial	$20.61
Rate for Payer: Midlands Choice Commercial	$19.24
Rate for Payer: United Healthcare Commercial	$24.73

gentamicin Ophth 0.3% Sol 5ml Bottle [VDMC]

Facility

$27.48

Service Code	HCPCS A9270
Hospital Charge Code	10434650
Hospital Revenue Code	259
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$24.73
Rate for Payer: United Healthcare Managed Medicare	$16.21
Rate for Payer: Aetna of IA Commercial	$24.73
Rate for Payer: Aetna of IA Medical Rental Products	$24.73
Rate for Payer: Aetna of IA Medicare	$15.66
Rate for Payer: Amerigroup Medicaid	$15.85
Rate for Payer: Amerigroup Medicare	$12.49
Rate for Payer: Cash Price	$21.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.61
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.37
Rate for Payer: Iowa Total Care Managed Medicaid	$15.70
Rate for Payer: Medical Associates Commercial	$20.61
Rate for Payer: Medical Associates Managed Medicare	$12.37
Rate for Payer: Midlands Choice Commercial	$19.24
Rate for Payer: Molina Healthcare Managed Medicaid	$15.93
Rate for Payer: Partners Health Alliance Commercial	$14.22
Rate for Payer: United Healthcare Commercial	$24.73

GENTAMYCIN LEVEL

Facility

$112.00

Service Code	CPT 80170
Hospital Charge Code	633735
Hospital Revenue Code	301
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of IA Commercial	$100.80
Rate for Payer: Aetna of IA Medical Rental Products	$100.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$84.00
Rate for Payer: Medical Associates Commercial	$84.00
Rate for Payer: Midlands Choice Commercial	$78.40
Rate for Payer: United Healthcare Commercial	$100.80

GENTAMYCIN LEVEL

Facility

$112.00

Service Code	CPT 80170
Hospital Charge Code	633736
Hospital Revenue Code	301
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of IA Commercial	$100.80
Rate for Payer: Aetna of IA Medical Rental Products	$100.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$84.00
Rate for Payer: Medical Associates Commercial	$84.00
Rate for Payer: Midlands Choice Commercial	$78.40
Rate for Payer: United Healthcare Commercial	$100.80

GENTAMYCIN LEVEL

Facility

$112.00

Service Code	CPT 80170
Hospital Charge Code	633736
Hospital Revenue Code	301
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of IA Commercial	$100.80
Rate for Payer: Aetna of IA Medical Rental Products	$100.80
Rate for Payer: Aetna of IA Medicare	$63.84
Rate for Payer: Amerigroup Medicaid	$64.60
Rate for Payer: Amerigroup Medicare	$50.90
Rate for Payer: Cash Price	$89.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$84.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$50.40
Rate for Payer: Iowa Total Care Managed Medicaid	$63.97
Rate for Payer: Medical Associates Commercial	$84.00
Rate for Payer: Medical Associates Managed Medicare	$50.40
Rate for Payer: Midlands Choice Commercial	$78.40
Rate for Payer: Molina Healthcare Managed Medicaid	$64.92
Rate for Payer: Partners Health Alliance Commercial	$57.96
Rate for Payer: United Healthcare Commercial	$100.80
Rate for Payer: United Healthcare Managed Medicare	$66.08

Know your out-of-pocket cost for care.

All Charges