Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

Facility

$782.56

Service Code	CPT 20550
Hospital Revenue Code	360
Min. Negotiated Rate	$710.42
Max. Negotiated Rate	$782.56
Rate for Payer: Wellmark IA HMO WHPI	$710.42
Rate for Payer: Wellmark IA PPO	$782.56

INJECT SACROILIAC JOINT

Facility

$438.00

Service Code	CPT 27096
Hospital Charge Code	7982935
Hospital Revenue Code	450
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$1,236.32
Rate for Payer: Aetna of IA Commercial	$394.20
Rate for Payer: Aetna of IA Medical Rental Products	$394.20
Rate for Payer: Aetna of IA Medicare	$249.66
Rate for Payer: Amerigroup Medicaid	$252.64
Rate for Payer: Amerigroup Medicare	$199.07
Rate for Payer: Cash Price	$350.40
Rate for Payer: Cash Price	$350.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$328.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$197.10
Rate for Payer: Iowa Total Care Managed Medicaid	$250.19
Rate for Payer: Medical Associates Commercial	$328.50
Rate for Payer: Medical Associates Managed Medicare	$197.10
Rate for Payer: Midlands Choice Commercial	$306.60
Rate for Payer: Molina Healthcare Managed Medicaid	$253.86
Rate for Payer: Partners Health Alliance Commercial	$226.66
Rate for Payer: United Healthcare Commercial	$394.20
Rate for Payer: United Healthcare Managed Medicare	$258.42
Rate for Payer: Wellmark IA HMO WHPI	$1,122.35
Rate for Payer: Wellmark IA PPO	$1,236.32

INJECT SACROILIAC JOINT

Facility

$438.00

Service Code	CPT 27096
Hospital Charge Code	7982935
Hospital Revenue Code	450
Min. Negotiated Rate	$306.60
Max. Negotiated Rate	$394.20
Rate for Payer: Aetna of IA Commercial	$394.20
Rate for Payer: Aetna of IA Medical Rental Products	$394.20
Rate for Payer: Cash Price	$350.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$328.50
Rate for Payer: Medical Associates Commercial	$328.50
Rate for Payer: Midlands Choice Commercial	$306.60
Rate for Payer: United Healthcare Commercial	$394.20

INJECT SPINE CERV/THORACIC

Facility

$1,359.00

Service Code	CPT 62320
Hospital Charge Code	7982936
Hospital Revenue Code	450
Min. Negotiated Rate	$611.55
Max. Negotiated Rate	$1,679.15
Rate for Payer: Aetna of IA Commercial	$1,223.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,223.10
Rate for Payer: Aetna of IA Medicare	$774.63
Rate for Payer: Amerigroup Medicaid	$783.87
Rate for Payer: Amerigroup Medicare	$617.67
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,019.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$611.55
Rate for Payer: Iowa Total Care Managed Medicaid	$776.26
Rate for Payer: Medical Associates Commercial	$1,019.25
Rate for Payer: Medical Associates Managed Medicare	$611.55
Rate for Payer: Midlands Choice Commercial	$951.30
Rate for Payer: Molina Healthcare Managed Medicaid	$787.68
Rate for Payer: Partners Health Alliance Commercial	$703.28
Rate for Payer: United Healthcare Commercial	$1,223.10
Rate for Payer: United Healthcare Managed Medicare	$801.81
Rate for Payer: Wellmark IA HMO WHPI	$1,524.35
Rate for Payer: Wellmark IA PPO	$1,679.15

INJECT SPINE CERV/THORACIC

Facility

$1,359.00

Service Code	CPT 62320
Hospital Charge Code	7982936
Hospital Revenue Code	450
Min. Negotiated Rate	$951.30
Max. Negotiated Rate	$1,223.10
Rate for Payer: Aetna of IA Commercial	$1,223.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,223.10
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,019.25
Rate for Payer: Medical Associates Commercial	$1,019.25
Rate for Payer: Midlands Choice Commercial	$951.30
Rate for Payer: United Healthcare Commercial	$1,223.10

INJECT SPINE LUMBAR/SACRAL

Facility

$1,359.00

Service Code	CPT 62322
Hospital Charge Code	4866806
Hospital Revenue Code	450
Min. Negotiated Rate	$951.30
Max. Negotiated Rate	$1,223.10
Rate for Payer: Aetna of IA Commercial	$1,223.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,223.10
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,019.25
Rate for Payer: Medical Associates Commercial	$1,019.25
Rate for Payer: Midlands Choice Commercial	$951.30
Rate for Payer: United Healthcare Commercial	$1,223.10

INJECT SPINE LUMBAR/SACRAL

Facility

$1,359.00

Service Code	CPT 62322
Hospital Charge Code	4866806
Hospital Revenue Code	450
Min. Negotiated Rate	$611.55
Max. Negotiated Rate	$1,679.15
Rate for Payer: Aetna of IA Commercial	$1,223.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,223.10
Rate for Payer: Aetna of IA Medicare	$774.63
Rate for Payer: Amerigroup Medicaid	$783.87
Rate for Payer: Amerigroup Medicare	$617.67
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,019.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$611.55
Rate for Payer: Iowa Total Care Managed Medicaid	$776.26
Rate for Payer: Medical Associates Commercial	$1,019.25
Rate for Payer: Medical Associates Managed Medicare	$611.55
Rate for Payer: Midlands Choice Commercial	$951.30
Rate for Payer: Molina Healthcare Managed Medicaid	$787.68
Rate for Payer: Partners Health Alliance Commercial	$703.28
Rate for Payer: United Healthcare Commercial	$1,223.10
Rate for Payer: United Healthcare Managed Medicare	$801.81
Rate for Payer: Wellmark IA HMO WHPI	$1,524.35
Rate for Payer: Wellmark IA PPO	$1,679.15

INJECT TRIGGER POINTS 3/>

Facility

$438.00

Service Code	CPT 20553
Hospital Charge Code	7982934
Hospital Revenue Code	450
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$782.56
Rate for Payer: Aetna of IA Commercial	$394.20
Rate for Payer: Aetna of IA Medical Rental Products	$394.20
Rate for Payer: Aetna of IA Medicare	$249.66
Rate for Payer: Amerigroup Medicaid	$252.64
Rate for Payer: Amerigroup Medicare	$199.07
Rate for Payer: Cash Price	$350.40
Rate for Payer: Cash Price	$350.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$328.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$197.10
Rate for Payer: Iowa Total Care Managed Medicaid	$250.19
Rate for Payer: Medical Associates Commercial	$328.50
Rate for Payer: Medical Associates Managed Medicare	$197.10
Rate for Payer: Midlands Choice Commercial	$306.60
Rate for Payer: Molina Healthcare Managed Medicaid	$253.86
Rate for Payer: Partners Health Alliance Commercial	$226.66
Rate for Payer: United Healthcare Commercial	$394.20
Rate for Payer: United Healthcare Managed Medicare	$258.42
Rate for Payer: Wellmark IA HMO WHPI	$710.42
Rate for Payer: Wellmark IA PPO	$782.56

INJECT TRIGGER POINTS 3/>

Facility

$438.00

Service Code	CPT 20553
Hospital Charge Code	7982934
Hospital Revenue Code	450
Min. Negotiated Rate	$306.60
Max. Negotiated Rate	$394.20
Rate for Payer: Aetna of IA Commercial	$394.20
Rate for Payer: Aetna of IA Medical Rental Products	$394.20
Rate for Payer: Cash Price	$350.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$328.50
Rate for Payer: Medical Associates Commercial	$328.50
Rate for Payer: Midlands Choice Commercial	$306.60
Rate for Payer: United Healthcare Commercial	$394.20

INJ FORAMEN EPIDURAL ADD ON

Professional

Both

$289.00

Service Code	CPT 64484
Hospital Charge Code	8015854
Hospital Revenue Code	975
Min. Negotiated Rate	$157.89
Max. Negotiated Rate	$246.20
Rate for Payer: Amerigroup Medicaid	$173.75
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Iowa Total Care Managed Medicaid	$172.06
Rate for Payer: Medical Associates Commercial	$216.75
Rate for Payer: Midlands Choice Commercial	$202.30
Rate for Payer: Molina Healthcare Managed Medicaid	$172.91
Rate for Payer: Partners Health Alliance Commercial	$216.75
Rate for Payer: United Healthcare Commercial	$157.89
Rate for Payer: Wellmark IA HMO WHPI	$209.20
Rate for Payer: Wellmark IA PPO	$246.20

INJ FORAMEN EPIDURAL L/S

Professional

Both

$720.00

Service Code	CPT 64483
Hospital Charge Code	8015433
Hospital Revenue Code	975
Min. Negotiated Rate	$187.80
Max. Negotiated Rate	$545.40
Rate for Payer: Amerigroup Medicaid	$189.64
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Iowa Total Care Managed Medicaid	$187.80
Rate for Payer: Medical Associates Commercial	$540.00
Rate for Payer: Midlands Choice Commercial	$504.00
Rate for Payer: Molina Healthcare Managed Medicaid	$188.72
Rate for Payer: Partners Health Alliance Commercial	$540.00
Rate for Payer: United Healthcare Commercial	$357.65
Rate for Payer: Wellmark IA HMO WHPI	$463.60
Rate for Payer: Wellmark IA PPO	$545.40

INJ PARAVERTEBRAL FACET JOINT C/T

Professional

Both

$624.00

Service Code	CPT 64490
Hospital Charge Code	8015855
Hospital Revenue Code	975
Min. Negotiated Rate	$158.80
Max. Negotiated Rate	$468.00
Rate for Payer: Amerigroup Medicaid	$160.36
Rate for Payer: Cash Price	$499.20
Rate for Payer: Cash Price	$499.20
Rate for Payer: Iowa Total Care Managed Medicaid	$158.80
Rate for Payer: Medical Associates Commercial	$468.00
Rate for Payer: Midlands Choice Commercial	$436.80
Rate for Payer: Molina Healthcare Managed Medicaid	$159.58
Rate for Payer: Partners Health Alliance Commercial	$468.00
Rate for Payer: United Healthcare Commercial	$288.62
Rate for Payer: Wellmark IA HMO WHPI	$362.70
Rate for Payer: Wellmark IA PPO	$426.70

INJ PARAVERT F JNT L/S 1 LEV

Professional

Both

$566.00

Service Code	CPT 64493
Hospital Charge Code	8015865
Hospital Revenue Code	975
Min. Negotiated Rate	$141.97
Max. Negotiated Rate	$424.50
Rate for Payer: Amerigroup Medicaid	$143.37
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cash Price	$452.80
Rate for Payer: Iowa Total Care Managed Medicaid	$141.97
Rate for Payer: Medical Associates Commercial	$424.50
Rate for Payer: Midlands Choice Commercial	$396.20
Rate for Payer: Molina Healthcare Managed Medicaid	$142.67
Rate for Payer: Partners Health Alliance Commercial	$424.50
Rate for Payer: United Healthcare Commercial	$262.74
Rate for Payer: Wellmark IA HMO WHPI	$333.90
Rate for Payer: Wellmark IA PPO	$392.80

INJ PARAVERT F JNT L/S 2 LEV

Professional

Both

$286.00

Service Code	CPT 64495
Hospital Charge Code	8015867
Hospital Revenue Code	975
Min. Negotiated Rate	$74.17
Max. Negotiated Rate	$214.50
Rate for Payer: Amerigroup Medicaid	$74.90
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Iowa Total Care Managed Medicaid	$74.17
Rate for Payer: Medical Associates Commercial	$214.50
Rate for Payer: Midlands Choice Commercial	$200.20
Rate for Payer: Molina Healthcare Managed Medicaid	$74.54
Rate for Payer: Partners Health Alliance Commercial	$214.50
Rate for Payer: United Healthcare Commercial	$135.36
Rate for Payer: Wellmark IA HMO WHPI	$171.00
Rate for Payer: Wellmark IA PPO	$201.20

INJ PARAVERT F JNT L/S 2 LEV

Professional

Both

$285.00

Service Code	CPT 64494
Hospital Charge Code	8015866
Hospital Revenue Code	975
Min. Negotiated Rate	$73.26
Max. Negotiated Rate	$213.75
Rate for Payer: Amerigroup Medicaid	$73.97
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Iowa Total Care Managed Medicaid	$73.26
Rate for Payer: Medical Associates Commercial	$213.75
Rate for Payer: Midlands Choice Commercial	$199.50
Rate for Payer: Molina Healthcare Managed Medicaid	$73.62
Rate for Payer: Partners Health Alliance Commercial	$213.75
Rate for Payer: United Healthcare Commercial	$135.36
Rate for Payer: Wellmark IA HMO WHPI	$171.00
Rate for Payer: Wellmark IA PPO	$201.20

INJ PARAVERT F JOINT C/T 2 LEV

Professional

Both

$309.00

Service Code	CPT 64491
Hospital Charge Code	8015859
Hospital Revenue Code	975
Min. Negotiated Rate	$80.55
Max. Negotiated Rate	$231.75
Rate for Payer: Amerigroup Medicaid	$81.34
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Iowa Total Care Managed Medicaid	$80.55
Rate for Payer: Medical Associates Commercial	$231.75
Rate for Payer: Midlands Choice Commercial	$216.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.94
Rate for Payer: Partners Health Alliance Commercial	$231.75
Rate for Payer: United Healthcare Commercial	$145.62
Rate for Payer: Wellmark IA HMO WHPI	$182.90
Rate for Payer: Wellmark IA PPO	$215.20

INJ PARAVERT F JOINT C/T 3 LEV

Professional

Both

$310.00

Service Code	CPT 64492
Hospital Charge Code	8015864
Hospital Revenue Code	975
Min. Negotiated Rate	$81.47
Max. Negotiated Rate	$232.50
Rate for Payer: Amerigroup Medicaid	$82.27
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Iowa Total Care Managed Medicaid	$81.47
Rate for Payer: Medical Associates Commercial	$232.50
Rate for Payer: Midlands Choice Commercial	$217.00
Rate for Payer: Molina Healthcare Managed Medicaid	$81.87
Rate for Payer: Partners Health Alliance Commercial	$232.50
Rate for Payer: United Healthcare Commercial	$146.67
Rate for Payer: Wellmark IA HMO WHPI	$183.50
Rate for Payer: Wellmark IA PPO	$215.90

INJ PERFLUTREN LIP MICROS,ML

Facility

$121.00

Service Code	HCPCS Q9957
Hospital Charge Code	8910875
Hospital Revenue Code	255
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of IA Commercial	$108.90
Rate for Payer: Aetna of IA Medical Rental Products	$108.90
Rate for Payer: Cash Price	$96.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$90.75
Rate for Payer: Medical Associates Commercial	$90.75
Rate for Payer: Midlands Choice Commercial	$84.70
Rate for Payer: United Healthcare Commercial	$108.90

INJ PERFLUTREN LIP MICROS,ML

Facility

$121.00

Service Code	HCPCS Q9957
Hospital Charge Code	8910875
Hospital Revenue Code	255
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of IA Commercial	$108.90
Rate for Payer: Aetna of IA Medical Rental Products	$108.90
Rate for Payer: Aetna of IA Medicare	$68.97
Rate for Payer: Amerigroup Medicaid	$69.79
Rate for Payer: Amerigroup Medicare	$54.99
Rate for Payer: Cash Price	$96.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$90.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$54.45
Rate for Payer: Iowa Total Care Managed Medicaid	$69.12
Rate for Payer: Medical Associates Commercial	$90.75
Rate for Payer: Medical Associates Managed Medicare	$54.45
Rate for Payer: Midlands Choice Commercial	$84.70
Rate for Payer: Molina Healthcare Managed Medicaid	$70.13
Rate for Payer: Partners Health Alliance Commercial	$62.62
Rate for Payer: United Healthcare Commercial	$108.90
Rate for Payer: United Healthcare Managed Medicare	$71.39

INJ SGL TENDON SHTH OR LIGAMENT

Professional

Both

$175.00

Service Code	CPT 20550
Hospital Charge Code	8101266
Hospital Revenue Code	975
Min. Negotiated Rate	$67.27
Max. Negotiated Rate	$131.25
Rate for Payer: Amerigroup Medicaid	$67.93
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Iowa Total Care Managed Medicaid	$67.27
Rate for Payer: Medical Associates Commercial	$131.25
Rate for Payer: Midlands Choice Commercial	$122.50
Rate for Payer: Molina Healthcare Managed Medicaid	$67.60
Rate for Payer: Partners Health Alliance Commercial	$131.25
Rate for Payer: United Healthcare Commercial	$83.22
Rate for Payer: Wellmark IA HMO WHPI	$109.40
Rate for Payer: Wellmark IA PPO	$128.80

INJ SINGLE/MULT TRIGGER PTS 1/2 MUSCLES

Professional

Both

$183.00

Service Code	CPT 20552
Hospital Charge Code	8037760
Hospital Revenue Code	975
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$137.25
Rate for Payer: Amerigroup Medicaid	$59.17
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Iowa Total Care Managed Medicaid	$58.60
Rate for Payer: Medical Associates Commercial	$137.25
Rate for Payer: Midlands Choice Commercial	$128.10
Rate for Payer: Molina Healthcare Managed Medicaid	$58.89
Rate for Payer: Partners Health Alliance Commercial	$137.25
Rate for Payer: United Healthcare Commercial	$84.30
Rate for Payer: Wellmark IA HMO WHPI	$99.40
Rate for Payer: Wellmark IA PPO	$116.90

INJ SINGLE/MULT TRIGGER PTS 3 OR MORE MU

Professional

Both

$211.00

Service Code	CPT 20553
Hospital Charge Code	8015253
Hospital Revenue Code	975
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$158.25
Rate for Payer: Amerigroup Medicaid	$59.17
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Iowa Total Care Managed Medicaid	$58.60
Rate for Payer: Medical Associates Commercial	$158.25
Rate for Payer: Midlands Choice Commercial	$147.70
Rate for Payer: Molina Healthcare Managed Medicaid	$58.89
Rate for Payer: Partners Health Alliance Commercial	$158.25
Rate for Payer: United Healthcare Commercial	$96.83
Rate for Payer: Wellmark IA HMO WHPI	$114.50
Rate for Payer: Wellmark IA PPO	$134.70

INJ SINGLE TENDON

Professional

Both

$201.00

Service Code	CPT 20551
Hospital Charge Code	8015895
Hospital Revenue Code	975
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$150.75
Rate for Payer: Amerigroup Medicaid	$59.17
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Iowa Total Care Managed Medicaid	$58.60
Rate for Payer: Medical Associates Commercial	$150.75
Rate for Payer: Midlands Choice Commercial	$140.70
Rate for Payer: Molina Healthcare Managed Medicaid	$58.89
Rate for Payer: Partners Health Alliance Commercial	$150.75
Rate for Payer: United Healthcare Commercial	$85.31
Rate for Payer: Wellmark IA HMO WHPI	$108.80
Rate for Payer: Wellmark IA PPO	$128.00

INJ TRIGGER POINT 1/2 MUSCL

Facility

$424.00

Service Code	CPT 20552
Hospital Charge Code	4864796
Hospital Revenue Code	450
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$782.56
Rate for Payer: Aetna of IA Commercial	$381.60
Rate for Payer: Aetna of IA Medical Rental Products	$381.60
Rate for Payer: Aetna of IA Medicare	$241.68
Rate for Payer: Amerigroup Medicaid	$244.56
Rate for Payer: Amerigroup Medicare	$192.71
Rate for Payer: Cash Price	$339.20
Rate for Payer: Cash Price	$339.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$318.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$190.80
Rate for Payer: Iowa Total Care Managed Medicaid	$242.19
Rate for Payer: Medical Associates Commercial	$318.00
Rate for Payer: Medical Associates Managed Medicare	$190.80
Rate for Payer: Midlands Choice Commercial	$296.80
Rate for Payer: Molina Healthcare Managed Medicaid	$245.75
Rate for Payer: Partners Health Alliance Commercial	$219.42
Rate for Payer: United Healthcare Commercial	$381.60
Rate for Payer: United Healthcare Managed Medicare	$250.16
Rate for Payer: Wellmark IA HMO WHPI	$710.42
Rate for Payer: Wellmark IA PPO	$782.56

INJ TRIGGER POINT 1/2 MUSCL

Facility

$424.00

Service Code	CPT 20552
Hospital Charge Code	4864796
Hospital Revenue Code	450
Min. Negotiated Rate	$296.80
Max. Negotiated Rate	$381.60
Rate for Payer: Aetna of IA Commercial	$381.60
Rate for Payer: Aetna of IA Medical Rental Products	$381.60
Rate for Payer: Cash Price	$339.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$318.00
Rate for Payer: Medical Associates Commercial	$318.00
Rate for Payer: Midlands Choice Commercial	$296.80
Rate for Payer: United Healthcare Commercial	$381.60

Know your out-of-pocket cost for care.

All Charges