Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE

Facility

$1,755.00

Service Code	HCPCS C1713
Hospital Charge Code	8784972
Hospital Revenue Code	278
Min. Negotiated Rate	$789.75
Max. Negotiated Rate	$1,579.50
Rate for Payer: Aetna of IA Commercial	$1,579.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,579.50
Rate for Payer: Aetna of IA Medicare	$1,000.35
Rate for Payer: Amerigroup Medicaid	$1,012.28
Rate for Payer: Amerigroup Medicare	$797.65
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,316.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$789.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,002.46
Rate for Payer: Medical Associates Commercial	$1,316.25
Rate for Payer: Medical Associates Managed Medicare	$789.75
Rate for Payer: Midlands Choice Commercial	$1,228.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,017.20
Rate for Payer: Partners Health Alliance Commercial	$908.21
Rate for Payer: United Healthcare Commercial	$1,579.50
Rate for Payer: United Healthcare Managed Medicare	$1,035.45

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$9,611.34

Service Code	MSDRG 642
Min. Negotiated Rate	$9,472.04
Max. Negotiated Rate	$9,611.34
Rate for Payer: Amerigroup Medicaid	$9,564.90
Rate for Payer: Iowa Total Care Managed Medicaid	$9,472.04
Rate for Payer: Molina Healthcare Managed Medicaid	$9,611.34

INCISE EXTERNAL HEMORRHOID

Facility

$528.00

Service Code	CPT 46083
Hospital Charge Code	4864972
Hospital Revenue Code	450
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$4,161.95
Rate for Payer: Aetna of IA Commercial	$475.20
Rate for Payer: Aetna of IA Medical Rental Products	$475.20
Rate for Payer: Aetna of IA Medicare	$300.96
Rate for Payer: Amerigroup Medicaid	$304.55
Rate for Payer: Amerigroup Medicare	$239.98
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$396.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$237.60
Rate for Payer: Iowa Total Care Managed Medicaid	$301.59
Rate for Payer: Medical Associates Commercial	$396.00
Rate for Payer: Medical Associates Managed Medicare	$237.60
Rate for Payer: Midlands Choice Commercial	$369.60
Rate for Payer: Molina Healthcare Managed Medicaid	$306.03
Rate for Payer: Partners Health Alliance Commercial	$273.24
Rate for Payer: United Healthcare Commercial	$475.20
Rate for Payer: United Healthcare Managed Medicare	$311.52
Rate for Payer: Wellmark IA HMO WHPI	$3,778.26
Rate for Payer: Wellmark IA PPO	$4,161.95

INCISE EXTERNAL HEMORRHOID

Facility

$528.00

Service Code	CPT 46083
Hospital Charge Code	4864972
Hospital Revenue Code	450
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of IA Commercial	$475.20
Rate for Payer: Aetna of IA Medical Rental Products	$475.20
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$396.00
Rate for Payer: Medical Associates Commercial	$396.00
Rate for Payer: Midlands Choice Commercial	$369.60
Rate for Payer: United Healthcare Commercial	$475.20

INCISE EXTERNAL HEMORRHOID

Professional

Both

$588.00

Service Code	CPT 46083
Hospital Charge Code	7982770
Hospital Revenue Code	981
Min. Negotiated Rate	$136.05
Max. Negotiated Rate	$472.80
Rate for Payer: Amerigroup Medicaid	$137.38
Rate for Payer: Cash Price	$470.40
Rate for Payer: Cash Price	$470.40
Rate for Payer: Iowa Total Care Managed Medicaid	$136.05
Rate for Payer: Medical Associates Commercial	$441.00
Rate for Payer: Midlands Choice Commercial	$411.60
Rate for Payer: Molina Healthcare Managed Medicaid	$136.71
Rate for Payer: Partners Health Alliance Commercial	$441.00
Rate for Payer: United Healthcare Commercial	$289.36
Rate for Payer: Wellmark IA HMO WHPI	$401.80
Rate for Payer: Wellmark IA PPO	$472.80

INCISION AND DRAINAGE

Professional

Both

$304.00

Service Code	CPT 10060
Hospital Charge Code	7982860
Hospital Revenue Code	981
Min. Negotiated Rate	$72.26
Max. Negotiated Rate	$273.80
Rate for Payer: Amerigroup Medicaid	$72.97
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Iowa Total Care Managed Medicaid	$72.26
Rate for Payer: Medical Associates Commercial	$228.00
Rate for Payer: Midlands Choice Commercial	$212.80
Rate for Payer: Molina Healthcare Managed Medicaid	$72.61
Rate for Payer: Partners Health Alliance Commercial	$228.00
Rate for Payer: United Healthcare Commercial	$183.09
Rate for Payer: Wellmark IA HMO WHPI	$232.80
Rate for Payer: Wellmark IA PPO	$273.80

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$333.49

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$302.74
Max. Negotiated Rate	$333.49
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$333.49

Service Code	CPT 10060
Hospital Revenue Code	490
Min. Negotiated Rate	$302.74
Max. Negotiated Rate	$333.49
Rate for Payer: Wellmark IA HMO WHPI	$302.74
Rate for Payer: Wellmark IA PPO	$333.49

INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION

Facility

$2,456.25

Service Code	CPT 10140
Hospital Revenue Code	360
Min. Negotiated Rate	$2,229.81
Max. Negotiated Rate	$2,456.25
Rate for Payer: Wellmark IA HMO WHPI	$2,229.81
Rate for Payer: Wellmark IA PPO	$2,456.25

INCISION OF ANAL ABSCESS

Facility

$1,894.00

Service Code	CPT 46050
Hospital Charge Code	4864971
Hospital Revenue Code	450
Min. Negotiated Rate	$1,325.80
Max. Negotiated Rate	$1,704.60
Rate for Payer: Aetna of IA Commercial	$1,704.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,704.60
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,420.50
Rate for Payer: Medical Associates Commercial	$1,420.50
Rate for Payer: Midlands Choice Commercial	$1,325.80
Rate for Payer: United Healthcare Commercial	$1,704.60

INCISION OF ANAL ABSCESS

Facility

$1,894.00

Service Code	CPT 46050
Hospital Charge Code	4864971
Hospital Revenue Code	450
Min. Negotiated Rate	$852.30
Max. Negotiated Rate	$4,161.95
Rate for Payer: Aetna of IA Commercial	$1,704.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,704.60
Rate for Payer: Aetna of IA Medicare	$1,079.58
Rate for Payer: Amerigroup Medicaid	$1,092.46
Rate for Payer: Amerigroup Medicare	$860.82
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,420.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$852.30
Rate for Payer: Iowa Total Care Managed Medicaid	$1,081.85
Rate for Payer: Medical Associates Commercial	$1,420.50
Rate for Payer: Medical Associates Managed Medicare	$852.30
Rate for Payer: Midlands Choice Commercial	$1,325.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,097.76
Rate for Payer: Partners Health Alliance Commercial	$980.14
Rate for Payer: United Healthcare Commercial	$1,704.60
Rate for Payer: United Healthcare Managed Medicare	$1,117.46
Rate for Payer: Wellmark IA HMO WHPI	$3,778.26
Rate for Payer: Wellmark IA PPO	$4,161.95

INCISION OF BREAST LESION

Facility

$2,068.00

Service Code	CPT 19020
Hospital Charge Code	7982928
Hospital Revenue Code	450
Min. Negotiated Rate	$930.60
Max. Negotiated Rate	$2,997.48
Rate for Payer: Aetna of IA Commercial	$1,861.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,861.20
Rate for Payer: Aetna of IA Medicare	$1,178.76
Rate for Payer: Amerigroup Medicaid	$1,192.82
Rate for Payer: Amerigroup Medicare	$939.91
Rate for Payer: Cash Price	$1,654.40
Rate for Payer: Cash Price	$1,654.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,551.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$930.60
Rate for Payer: Iowa Total Care Managed Medicaid	$1,181.24
Rate for Payer: Medical Associates Commercial	$1,551.00
Rate for Payer: Medical Associates Managed Medicare	$930.60
Rate for Payer: Midlands Choice Commercial	$1,447.60
Rate for Payer: Molina Healthcare Managed Medicaid	$1,198.61
Rate for Payer: Partners Health Alliance Commercial	$1,070.19
Rate for Payer: United Healthcare Commercial	$1,861.20
Rate for Payer: United Healthcare Managed Medicare	$1,220.12
Rate for Payer: Wellmark IA HMO WHPI	$2,721.14
Rate for Payer: Wellmark IA PPO	$2,997.48

INCISION OF BREAST LESION

Facility

$2,068.00

Service Code	CPT 19020
Hospital Charge Code	7982928
Hospital Revenue Code	450
Min. Negotiated Rate	$1,447.60
Max. Negotiated Rate	$1,861.20
Rate for Payer: Aetna of IA Commercial	$1,861.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,861.20
Rate for Payer: Cash Price	$1,654.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,551.00
Rate for Payer: Medical Associates Commercial	$1,551.00
Rate for Payer: Midlands Choice Commercial	$1,447.60
Rate for Payer: United Healthcare Commercial	$1,861.20

INCISION OF RECTAL ABSCESS

Facility

$2,317.00

Service Code	CPT 46040
Hospital Charge Code	4864970
Hospital Revenue Code	761
Min. Negotiated Rate	$1,621.90
Max. Negotiated Rate	$2,085.30
Rate for Payer: Aetna of IA Commercial	$2,085.30
Rate for Payer: Aetna of IA Medical Rental Products	$2,085.30
Rate for Payer: Cash Price	$1,853.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,737.75
Rate for Payer: Medical Associates Commercial	$1,737.75
Rate for Payer: Midlands Choice Commercial	$1,621.90
Rate for Payer: United Healthcare Commercial	$2,085.30

INCISION OF RECTAL ABSCESS

Professional

Both

$1,788.00

Service Code	CPT 46040
Hospital Charge Code	7982771
Hospital Revenue Code	981
Min. Negotiated Rate	$303.35
Max. Negotiated Rate	$1,341.00
Rate for Payer: Amerigroup Medicaid	$306.32
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Iowa Total Care Managed Medicaid	$303.35
Rate for Payer: Medical Associates Commercial	$1,341.00
Rate for Payer: Midlands Choice Commercial	$1,251.60
Rate for Payer: Molina Healthcare Managed Medicaid	$304.84
Rate for Payer: Partners Health Alliance Commercial	$1,341.00
Rate for Payer: United Healthcare Commercial	$821.15
Rate for Payer: Wellmark IA HMO WHPI	$1,073.50
Rate for Payer: Wellmark IA PPO	$1,263.00

INCISION OF RECTAL ABSCESS

Facility

$2,317.00

Service Code	CPT 46040
Hospital Charge Code	4864970
Hospital Revenue Code	761
Min. Negotiated Rate	$1,042.65
Max. Negotiated Rate	$4,161.95
Rate for Payer: Aetna of IA Commercial	$2,085.30
Rate for Payer: Aetna of IA Medical Rental Products	$2,085.30
Rate for Payer: Aetna of IA Medicare	$1,320.69
Rate for Payer: Amerigroup Medicaid	$1,336.45
Rate for Payer: Amerigroup Medicare	$1,053.08
Rate for Payer: Cash Price	$1,853.60
Rate for Payer: Cash Price	$1,853.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,737.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,042.65
Rate for Payer: Iowa Total Care Managed Medicaid	$1,323.47
Rate for Payer: Medical Associates Commercial	$1,737.75
Rate for Payer: Medical Associates Managed Medicare	$1,042.65
Rate for Payer: Midlands Choice Commercial	$1,621.90
Rate for Payer: Molina Healthcare Managed Medicaid	$1,342.93
Rate for Payer: Partners Health Alliance Commercial	$1,199.05
Rate for Payer: United Healthcare Commercial	$2,085.30
Rate for Payer: United Healthcare Managed Medicare	$1,367.03
Rate for Payer: Wellmark IA HMO WHPI	$3,778.26
Rate for Payer: Wellmark IA PPO	$4,161.95

INCISION OF TONGUE FOLD

Facility

$1,663.00

Service Code	CPT 41010
Hospital Charge Code	7982938
Hospital Revenue Code	450
Min. Negotiated Rate	$1,164.10
Max. Negotiated Rate	$1,496.70
Rate for Payer: Aetna of IA Commercial	$1,496.70
Rate for Payer: Aetna of IA Medical Rental Products	$1,496.70
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,247.25
Rate for Payer: Medical Associates Commercial	$1,247.25
Rate for Payer: Midlands Choice Commercial	$1,164.10
Rate for Payer: United Healthcare Commercial	$1,496.70

INCISION OF TONGUE FOLD

Facility

$1,663.00

Service Code	CPT 41010
Hospital Charge Code	7982938
Hospital Revenue Code	450
Min. Negotiated Rate	$748.35
Max. Negotiated Rate	$3,151.34
Rate for Payer: Aetna of IA Commercial	$1,496.70
Rate for Payer: Aetna of IA Medical Rental Products	$1,496.70
Rate for Payer: Aetna of IA Medicare	$947.91
Rate for Payer: Amerigroup Medicaid	$959.22
Rate for Payer: Amerigroup Medicare	$755.83
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,247.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$748.35
Rate for Payer: Iowa Total Care Managed Medicaid	$949.91
Rate for Payer: Medical Associates Commercial	$1,247.25
Rate for Payer: Medical Associates Managed Medicare	$748.35
Rate for Payer: Midlands Choice Commercial	$1,164.10
Rate for Payer: Molina Healthcare Managed Medicaid	$963.87
Rate for Payer: Partners Health Alliance Commercial	$860.60
Rate for Payer: United Healthcare Commercial	$1,496.70
Rate for Payer: United Healthcare Managed Medicare	$981.17
Rate for Payer: Wellmark IA HMO WHPI	$2,860.82
Rate for Payer: Wellmark IA PPO	$3,151.34

inclisiran 284 mg/1.5 mL Sol [VDMC]

Facility

$6,999.48

Service Code	HCPCS J1306
Hospital Charge Code	28747277
Hospital Revenue Code	259
Min. Negotiated Rate	$3,149.77
Max. Negotiated Rate	$6,299.53
Rate for Payer: Aetna of IA Commercial	$6,299.53
Rate for Payer: Aetna of IA Medical Rental Products	$6,299.53
Rate for Payer: Aetna of IA Medicare	$3,989.70
Rate for Payer: Amerigroup Medicaid	$4,037.30
Rate for Payer: Amerigroup Medicare	$3,181.26
Rate for Payer: Cash Price	$5,599.58
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5,249.61
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3,149.77
Rate for Payer: Iowa Total Care Managed Medicaid	$3,998.10
Rate for Payer: Medical Associates Commercial	$5,249.61
Rate for Payer: Medical Associates Managed Medicare	$3,149.77
Rate for Payer: Midlands Choice Commercial	$4,899.64
Rate for Payer: Molina Healthcare Managed Medicaid	$4,056.90
Rate for Payer: Partners Health Alliance Commercial	$3,622.23
Rate for Payer: United Healthcare Commercial	$6,299.53
Rate for Payer: United Healthcare Managed Medicare	$4,129.69

inclisiran 284 mg/1.5 mL Sol [VDMC]

Facility

$6,999.48

Service Code	HCPCS J1306
Hospital Charge Code	28747277
Hospital Revenue Code	259
Min. Negotiated Rate	$4,899.64
Max. Negotiated Rate	$6,299.53
Rate for Payer: Aetna of IA Commercial	$6,299.53
Rate for Payer: Aetna of IA Medical Rental Products	$6,299.53
Rate for Payer: Cash Price	$5,599.58
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5,249.61
Rate for Payer: Medical Associates Commercial	$5,249.61
Rate for Payer: Midlands Choice Commercial	$4,899.64
Rate for Payer: United Healthcare Commercial	$6,299.53

INC/REPL SPINE NSTIM PG/RCVR

Professional

Both

$1,229.00

Service Code	CPT 63685
Hospital Charge Code	8015885
Hospital Revenue Code	975
Min. Negotiated Rate	$471.08
Max. Negotiated Rate	$921.75
Rate for Payer: Amerigroup Medicaid	$475.70
Rate for Payer: Cash Price	$983.20
Rate for Payer: Cash Price	$983.20
Rate for Payer: Iowa Total Care Managed Medicaid	$471.08
Rate for Payer: Medical Associates Commercial	$921.75
Rate for Payer: Midlands Choice Commercial	$860.30
Rate for Payer: Molina Healthcare Managed Medicaid	$473.39
Rate for Payer: Partners Health Alliance Commercial	$921.75
Rate for Payer: United Healthcare Commercial	$542.26
Rate for Payer: Wellmark IA HMO WHPI	$644.00
Rate for Payer: Wellmark IA PPO	$757.60

indapamide 2.5 mg Tab [VDMC]

Facility

$1.39

Service Code	HCPCS A9270
Hospital Charge Code	10396186
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of IA Commercial	$1.25
Rate for Payer: Aetna of IA Medical Rental Products	$1.25
Rate for Payer: Aetna of IA Medicare	$0.79
Rate for Payer: Amerigroup Medicaid	$0.80
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.04
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.62
Rate for Payer: Iowa Total Care Managed Medicaid	$0.79
Rate for Payer: Medical Associates Commercial	$1.04
Rate for Payer: Medical Associates Managed Medicare	$0.62
Rate for Payer: Midlands Choice Commercial	$0.97
Rate for Payer: Molina Healthcare Managed Medicaid	$0.80
Rate for Payer: Partners Health Alliance Commercial	$0.72
Rate for Payer: United Healthcare Commercial	$1.25
Rate for Payer: United Healthcare Managed Medicare	$0.82

indapamide 2.5 mg Tab [VDMC]

Facility

$1.39

Service Code	HCPCS A9270
Hospital Charge Code	10396186
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of IA Commercial	$1.25
Rate for Payer: Aetna of IA Medical Rental Products	$1.25
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.04
Rate for Payer: Medical Associates Commercial	$1.04
Rate for Payer: Midlands Choice Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.25

INDIVIDUAL PSYCHOTHERAPHY 60 MIN

Professional

Both

$363.00

Service Code	CPT 90837 AJ\|HO
Hospital Charge Code	4849289
Hospital Revenue Code	914
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$272.25
Rate for Payer: Amerigroup Medicaid	$84.04
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Iowa Total Care Managed Medicaid	$83.22
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: Molina Healthcare Managed Medicaid	$83.63
Rate for Payer: Optum Behavioral Health	$139.72
Rate for Payer: Partners Health Alliance Commercial	$272.25
Rate for Payer: United Healthcare Commercial	$218.35
Rate for Payer: Wellmark IA HMO WHPI	$205.60
Rate for Payer: Wellmark IA PPO	$205.60

INDIVIDUAL PSYCHOTHERAPY 45 MIN

Professional

Both

$363.00

Service Code	CPT 90834 AJ\|HO
Hospital Charge Code	4849288
Hospital Revenue Code	914
Min. Negotiated Rate	$56.82
Max. Negotiated Rate	$272.25
Rate for Payer: Amerigroup Medicaid	$57.38
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Iowa Total Care Managed Medicaid	$56.82
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: Molina Healthcare Managed Medicaid	$57.10
Rate for Payer: Optum Behavioral Health	$94.97
Rate for Payer: Partners Health Alliance Commercial	$272.25
Rate for Payer: United Healthcare Commercial	$145.73
Rate for Payer: Wellmark IA HMO WHPI	$139.40
Rate for Payer: Wellmark IA PPO	$139.40

Know your out-of-pocket cost for care.

All Charges