Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

GLUCOSE

Facility

$41.00

Service Code	CPT 82947
Hospital Charge Code	633593
Hospital Revenue Code	301
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Aetna of IA Medicare	$23.37
Rate for Payer: Amerigroup Medicaid	$23.65
Rate for Payer: Amerigroup Medicare	$18.63
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.45
Rate for Payer: Iowa Total Care Managed Medicaid	$23.42
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Medical Associates Managed Medicare	$18.45
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: Molina Healthcare Managed Medicaid	$23.76
Rate for Payer: Partners Health Alliance Commercial	$21.22
Rate for Payer: United Healthcare Commercial	$36.90
Rate for Payer: United Healthcare Managed Medicare	$24.19

GLUCOSE

Facility

$41.00

Service Code	CPT 82947
Hospital Charge Code	4016418
Hospital Revenue Code	301
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: United Healthcare Commercial	$36.90

GLUCOSE

Facility

$41.00

Service Code	CPT 82947
Hospital Charge Code	633593
Hospital Revenue Code	301
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: United Healthcare Commercial	$36.90

GLUCOSE (ACCUCHECK) -POC

Facility

$26.00

Service Code	CPT 82948
Hospital Charge Code	607617
Hospital Revenue Code	301
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$15.00
Rate for Payer: Amerigroup Medicare	$11.82
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.70
Rate for Payer: Iowa Total Care Managed Medicaid	$14.85
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$11.70
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$15.07
Rate for Payer: Partners Health Alliance Commercial	$13.46
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34

GLUCOSE (ACCUCHECK) -POC

Facility

$26.00

Service Code	CPT 82948
Hospital Charge Code	607617
Hospital Revenue Code	301
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

GLUCOSE POST DOSE

Facility

$45.00

Service Code	CPT 82950
Hospital Charge Code	633597
Hospital Revenue Code	301
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Aetna of IA Medicare	$25.65
Rate for Payer: Amerigroup Medicaid	$25.96
Rate for Payer: Amerigroup Medicare	$20.45
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.25
Rate for Payer: Iowa Total Care Managed Medicaid	$25.70
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Medical Associates Managed Medicare	$20.25
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: Molina Healthcare Managed Medicaid	$26.08
Rate for Payer: Partners Health Alliance Commercial	$23.29
Rate for Payer: United Healthcare Commercial	$40.50
Rate for Payer: United Healthcare Managed Medicare	$26.55

GLUCOSE POST DOSE

Facility

$45.00

Service Code	CPT 82950
Hospital Charge Code	633597
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: United Healthcare Commercial	$40.50

Glutamic Acid Decarboxylase Ab DMCL

Facility

$114.00

Service Code	CPT 86341
Hospital Charge Code	8694176
Hospital Revenue Code	301
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

Glutamic Acid Decarboxylase Ab DMCL

Facility

$114.00

Service Code	CPT 86341
Hospital Charge Code	8694176
Hospital Revenue Code	301
Min. Negotiated Rate	$51.30
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	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
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	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$58.99
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26

glyBURIDE 5 mg Tab [VDMC]

Facility

$1.15

Service Code	HCPCS A9270
Hospital Charge Code	10392383
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of IA Commercial	$1.04
Rate for Payer: Aetna of IA Medical Rental Products	$1.04
Rate for Payer: Aetna of IA Medicare	$0.66
Rate for Payer: Amerigroup Medicaid	$0.66
Rate for Payer: Amerigroup Medicare	$0.52
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.52
Rate for Payer: Iowa Total Care Managed Medicaid	$0.66
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Medical Associates Managed Medicare	$0.52
Rate for Payer: Midlands Choice Commercial	$0.81
Rate for Payer: Molina Healthcare Managed Medicaid	$0.67
Rate for Payer: Partners Health Alliance Commercial	$0.60
Rate for Payer: United Healthcare Commercial	$1.04
Rate for Payer: United Healthcare Managed Medicare	$0.68

glyBURIDE 5 mg Tab [VDMC]

Facility

$1.15

Service Code	HCPCS A9270
Hospital Charge Code	10392383
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of IA Commercial	$1.04
Rate for Payer: Aetna of IA Medical Rental Products	$1.04
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Midlands Choice Commercial	$0.81
Rate for Payer: United Healthcare Commercial	$1.04

glyBURIDE micronized 3 mg Tab [VDMC]

Facility

$1.85

Service Code	HCPCS A9270
Hospital Charge Code	10392452
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of IA Commercial	$1.66
Rate for Payer: Aetna of IA Medical Rental Products	$1.66
Rate for Payer: Aetna of IA Medicare	$1.05
Rate for Payer: Amerigroup Medicaid	$1.07
Rate for Payer: Amerigroup Medicare	$0.84
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.83
Rate for Payer: Iowa Total Care Managed Medicaid	$1.06
Rate for Payer: Medical Associates Commercial	$1.39
Rate for Payer: Medical Associates Managed Medicare	$0.83
Rate for Payer: Midlands Choice Commercial	$1.29
Rate for Payer: Molina Healthcare Managed Medicaid	$1.07
Rate for Payer: Partners Health Alliance Commercial	$0.96
Rate for Payer: United Healthcare Commercial	$1.66
Rate for Payer: United Healthcare Managed Medicare	$1.09

glyBURIDE micronized 3 mg Tab [VDMC]

Facility

$1.85

Service Code	HCPCS A9270
Hospital Charge Code	10392452
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of IA Commercial	$1.66
Rate for Payer: Aetna of IA Medical Rental Products	$1.66
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.39
Rate for Payer: Medical Associates Commercial	$1.39
Rate for Payer: Midlands Choice Commercial	$1.29
Rate for Payer: United Healthcare Commercial	$1.66

glycerin pediatric Supp Jar [VDMC]

Facility

$8.00

Service Code	HCPCS A9270
Hospital Charge Code	16842475
Hospital Revenue Code	259
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of IA Commercial	$7.20
Rate for Payer: Aetna of IA Medical Rental Products	$7.20
Rate for Payer: Aetna of IA Medicare	$4.56
Rate for Payer: Amerigroup Medicaid	$4.61
Rate for Payer: Amerigroup Medicare	$3.64
Rate for Payer: Cash Price	$6.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.60
Rate for Payer: Iowa Total Care Managed Medicaid	$4.57
Rate for Payer: Medical Associates Commercial	$6.00
Rate for Payer: Medical Associates Managed Medicare	$3.60
Rate for Payer: Midlands Choice Commercial	$5.60
Rate for Payer: Molina Healthcare Managed Medicaid	$4.64
Rate for Payer: Partners Health Alliance Commercial	$4.14
Rate for Payer: United Healthcare Commercial	$7.20
Rate for Payer: United Healthcare Managed Medicare	$4.72

glycerin pediatric Supp Jar [VDMC]

Facility

$8.00

Service Code	HCPCS A9270
Hospital Charge Code	16842475
Hospital Revenue Code	259
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of IA Commercial	$7.20
Rate for Payer: Aetna of IA Medical Rental Products	$7.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.00
Rate for Payer: Medical Associates Commercial	$6.00
Rate for Payer: Midlands Choice Commercial	$5.60
Rate for Payer: United Healthcare Commercial	$7.20

glycerin pediatric Supp [VDMC]

Facility

$5.66

Service Code	HCPCS A9270
Hospital Charge Code	10392521
Hospital Revenue Code	259
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna of IA Commercial	$5.09
Rate for Payer: Aetna of IA Medical Rental Products	$5.09
Rate for Payer: Cash Price	$4.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.25
Rate for Payer: Medical Associates Commercial	$4.25
Rate for Payer: Midlands Choice Commercial	$3.96
Rate for Payer: United Healthcare Commercial	$5.09

glycerin pediatric Supp [VDMC]

Facility

$5.66

Service Code	HCPCS A9270
Hospital Charge Code	10392521
Hospital Revenue Code	259
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna of IA Commercial	$5.09
Rate for Payer: Aetna of IA Medical Rental Products	$5.09
Rate for Payer: Aetna of IA Medicare	$3.23
Rate for Payer: Amerigroup Medicaid	$3.26
Rate for Payer: Amerigroup Medicare	$2.57
Rate for Payer: Cash Price	$4.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.55
Rate for Payer: Iowa Total Care Managed Medicaid	$3.23
Rate for Payer: Medical Associates Commercial	$4.25
Rate for Payer: Medical Associates Managed Medicare	$2.55
Rate for Payer: Midlands Choice Commercial	$3.96
Rate for Payer: Molina Healthcare Managed Medicaid	$3.28
Rate for Payer: Partners Health Alliance Commercial	$2.93
Rate for Payer: United Healthcare Commercial	$5.09
Rate for Payer: United Healthcare Managed Medicare	$3.34

glycopyrrolate 0.2 mg/mL 2ml SDV Sol [VDMC]

Facility

$24.20

Service Code	HCPCS J1596
Hospital Charge Code	11220054
Hospital Revenue Code	259
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$21.78
Rate for Payer: Aetna of IA Commercial	$21.78
Rate for Payer: Aetna of IA Medical Rental Products	$21.78
Rate for Payer: Cash Price	$19.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.15
Rate for Payer: Medical Associates Commercial	$18.15
Rate for Payer: Midlands Choice Commercial	$16.94
Rate for Payer: United Healthcare Commercial	$21.78

glycopyrrolate 0.2 mg/mL 2ml SDV Sol [VDMC]

Facility

$24.20

Service Code	HCPCS J1596
Hospital Charge Code	11220054
Hospital Revenue Code	259
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$21.78
Rate for Payer: Aetna of IA Commercial	$21.78
Rate for Payer: Aetna of IA Medical Rental Products	$21.78
Rate for Payer: Aetna of IA Medicare	$13.79
Rate for Payer: Amerigroup Medicaid	$13.96
Rate for Payer: Amerigroup Medicare	$11.00
Rate for Payer: Cash Price	$19.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.89
Rate for Payer: Iowa Total Care Managed Medicaid	$13.82
Rate for Payer: Medical Associates Commercial	$18.15
Rate for Payer: Medical Associates Managed Medicare	$10.89
Rate for Payer: Midlands Choice Commercial	$16.94
Rate for Payer: Molina Healthcare Managed Medicaid	$14.02
Rate for Payer: Partners Health Alliance Commercial	$12.52
Rate for Payer: United Healthcare Commercial	$21.78
Rate for Payer: United Healthcare Managed Medicare	$14.28

glycopyrrolate 1 mg Tab [VDMC]

Facility

$4.17

Service Code	HCPCS A9270
Hospital Charge Code	10392657
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna of IA Commercial	$3.75
Rate for Payer: Aetna of IA Medical Rental Products	$3.75
Rate for Payer: Aetna of IA Medicare	$2.38
Rate for Payer: Amerigroup Medicaid	$2.40
Rate for Payer: Amerigroup Medicare	$1.89
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.13
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.88
Rate for Payer: Iowa Total Care Managed Medicaid	$2.38
Rate for Payer: Medical Associates Commercial	$3.13
Rate for Payer: Medical Associates Managed Medicare	$1.88
Rate for Payer: Midlands Choice Commercial	$2.92
Rate for Payer: Molina Healthcare Managed Medicaid	$2.42
Rate for Payer: Partners Health Alliance Commercial	$2.16
Rate for Payer: United Healthcare Commercial	$3.75
Rate for Payer: United Healthcare Managed Medicare	$2.46

glycopyrrolate 1 mg Tab [VDMC]

Facility

$4.17

Service Code	HCPCS A9270
Hospital Charge Code	10392657
Hospital Revenue Code	259
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna of IA Commercial	$3.75
Rate for Payer: Aetna of IA Medical Rental Products	$3.75
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.13
Rate for Payer: Medical Associates Commercial	$3.13
Rate for Payer: Midlands Choice Commercial	$2.92
Rate for Payer: United Healthcare Commercial	$3.75

GRAFT CHIPS STERLING CANCELLOUS 1-4MM 15

Facility

$405.00

Hospital Charge Code	8026570
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

GRAFT CHIPS STERLING CANCELLOUS 1-4MM 15

Facility

$405.00

Hospital Charge Code	8026570
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

GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30

Facility

$630.00

Hospital Charge Code	8026571
Hospital Revenue Code	278
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$567.00
Rate for Payer: Aetna of IA Commercial	$567.00
Rate for Payer: Aetna of IA Medical Rental Products	$567.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$472.50
Rate for Payer: Medical Associates Commercial	$472.50
Rate for Payer: Midlands Choice Commercial	$441.00
Rate for Payer: United Healthcare Commercial	$567.00

GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30

Facility

$630.00

Hospital Charge Code	8026571
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$567.00
Rate for Payer: Aetna of IA Commercial	$567.00
Rate for Payer: Aetna of IA Medical Rental Products	$567.00
Rate for Payer: Aetna of IA Medicare	$359.10
Rate for Payer: Amerigroup Medicaid	$363.38
Rate for Payer: Amerigroup Medicare	$286.33
Rate for Payer: Cash Price	$504.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$472.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$283.50
Rate for Payer: Iowa Total Care Managed Medicaid	$359.86
Rate for Payer: Medical Associates Commercial	$472.50
Rate for Payer: Medical Associates Managed Medicare	$283.50
Rate for Payer: Midlands Choice Commercial	$441.00
Rate for Payer: Molina Healthcare Managed Medicaid	$365.15
Rate for Payer: Partners Health Alliance Commercial	$326.02
Rate for Payer: United Healthcare Commercial	$567.00
Rate for Payer: United Healthcare Managed Medicare	$371.70

Know your out-of-pocket cost for care.

All Charges