Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Level 4: Per Additional Intervals (30 Min)

Facility

$570.00

Hospital Charge Code	1378484
Hospital Revenue Code	360
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

Level 4: Per Additional Intervals (30 Min)

Facility

$570.00

Hospital Charge Code	1378484
Hospital Revenue Code	360
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

Level 5

Facility

$7,300.00

Hospital Charge Code	1378488
Hospital Revenue Code	360
Min. Negotiated Rate	$3,285.00
Max. Negotiated Rate	$6,570.00
Rate for Payer: Aetna of IA Commercial	$6,570.00
Rate for Payer: Aetna of IA Medical Rental Products	$6,570.00
Rate for Payer: Aetna of IA Medicare	$4,161.00
Rate for Payer: Amerigroup Medicaid	$4,210.64
Rate for Payer: Amerigroup Medicare	$3,317.85
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5,475.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3,285.00
Rate for Payer: Iowa Total Care Managed Medicaid	$4,169.76
Rate for Payer: Medical Associates Commercial	$5,475.00
Rate for Payer: Medical Associates Managed Medicare	$3,285.00
Rate for Payer: Midlands Choice Commercial	$5,110.00
Rate for Payer: Molina Healthcare Managed Medicaid	$4,231.08
Rate for Payer: Partners Health Alliance Commercial	$3,777.75
Rate for Payer: United Healthcare Commercial	$6,570.00
Rate for Payer: United Healthcare Managed Medicare	$4,307.00

Level 5

Facility

$7,300.00

Hospital Charge Code	1378488
Hospital Revenue Code	360
Min. Negotiated Rate	$5,110.00
Max. Negotiated Rate	$6,570.00
Rate for Payer: Aetna of IA Commercial	$6,570.00
Rate for Payer: Aetna of IA Medical Rental Products	$6,570.00
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5,475.00
Rate for Payer: Medical Associates Commercial	$5,475.00
Rate for Payer: Midlands Choice Commercial	$5,110.00
Rate for Payer: United Healthcare Commercial	$6,570.00

LEVEL 5

Facility

$1,042.00

Service Code	CPT 99285 25
Hospital Charge Code	6922790
Hospital Revenue Code	450
Min. Negotiated Rate	$468.90
Max. Negotiated Rate	$937.80
Rate for Payer: Aetna of IA Commercial	$937.80
Rate for Payer: Aetna of IA Medical Rental Products	$937.80
Rate for Payer: Aetna of IA Medicare	$593.94
Rate for Payer: Amerigroup Medicaid	$601.03
Rate for Payer: Amerigroup Medicare	$473.59
Rate for Payer: Cash Price	$833.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$781.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$468.90
Rate for Payer: Iowa Total Care Managed Medicaid	$595.19
Rate for Payer: Medical Associates Commercial	$781.50
Rate for Payer: Medical Associates Managed Medicare	$468.90
Rate for Payer: Midlands Choice Commercial	$729.40
Rate for Payer: Molina Healthcare Managed Medicaid	$603.94
Rate for Payer: Partners Health Alliance Commercial	$539.24
Rate for Payer: United Healthcare Commercial	$937.80
Rate for Payer: United Healthcare Managed Medicare	$614.78

LEVEL 5

Professional

Both

$529.00

Service Code	CPT 99285
Hospital Charge Code	7982751
Hospital Revenue Code	981
Min. Negotiated Rate	$191.48
Max. Negotiated Rate	$396.75
Rate for Payer: Cash Price	$423.20
Rate for Payer: Cash Price	$423.20
Rate for Payer: Medical Associates Commercial	$396.75
Rate for Payer: Midlands Choice Commercial	$370.30
Rate for Payer: Partners Health Alliance Commercial	$396.75
Rate for Payer: United Healthcare Commercial	$191.48

LEVEL 5

Facility

$1,042.00

Service Code	CPT 99285 25
Hospital Charge Code	6922790
Hospital Revenue Code	450
Min. Negotiated Rate	$729.40
Max. Negotiated Rate	$937.80
Rate for Payer: Aetna of IA Commercial	$937.80
Rate for Payer: Aetna of IA Medical Rental Products	$937.80
Rate for Payer: Cash Price	$833.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$781.50
Rate for Payer: Medical Associates Commercial	$781.50
Rate for Payer: Midlands Choice Commercial	$729.40
Rate for Payer: United Healthcare Commercial	$937.80

Level 5: Per Additional Intervals (30 Min)

Facility

$365.00

Hospital Charge Code	1378488
Hospital Revenue Code	360
Min. Negotiated Rate	$164.25
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of IA Commercial	$328.50
Rate for Payer: Aetna of IA Medical Rental Products	$328.50
Rate for Payer: Aetna of IA Medicare	$208.05
Rate for Payer: Amerigroup Medicaid	$210.53
Rate for Payer: Amerigroup Medicare	$165.89
Rate for Payer: Cash Price	$292.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$164.25
Rate for Payer: Iowa Total Care Managed Medicaid	$208.49
Rate for Payer: Medical Associates Commercial	$273.75
Rate for Payer: Medical Associates Managed Medicare	$164.25
Rate for Payer: Midlands Choice Commercial	$255.50
Rate for Payer: Molina Healthcare Managed Medicaid	$211.55
Rate for Payer: Partners Health Alliance Commercial	$188.89
Rate for Payer: United Healthcare Commercial	$328.50
Rate for Payer: United Healthcare Managed Medicare	$215.35

Level 5: Per Additional Intervals (30 Min)

Facility

$365.00

Hospital Charge Code	1378488
Hospital Revenue Code	360
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of IA Commercial	$328.50
Rate for Payer: Aetna of IA Medical Rental Products	$328.50
Rate for Payer: Cash Price	$292.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$273.75
Rate for Payer: Medical Associates Commercial	$273.75
Rate for Payer: Midlands Choice Commercial	$255.50
Rate for Payer: United Healthcare Commercial	$328.50

Level 6

Facility

$8,068.00

Hospital Charge Code	1378482
Hospital Revenue Code	360
Min. Negotiated Rate	$3,630.60
Max. Negotiated Rate	$7,261.20
Rate for Payer: Aetna of IA Commercial	$7,261.20
Rate for Payer: Aetna of IA Medical Rental Products	$7,261.20
Rate for Payer: Aetna of IA Medicare	$4,598.76
Rate for Payer: Amerigroup Medicaid	$4,653.62
Rate for Payer: Amerigroup Medicare	$3,666.91
Rate for Payer: Cash Price	$6,454.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,051.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3,630.60
Rate for Payer: Iowa Total Care Managed Medicaid	$4,608.44
Rate for Payer: Medical Associates Commercial	$6,051.00
Rate for Payer: Medical Associates Managed Medicare	$3,630.60
Rate for Payer: Midlands Choice Commercial	$5,647.60
Rate for Payer: Molina Healthcare Managed Medicaid	$4,676.21
Rate for Payer: Partners Health Alliance Commercial	$4,175.19
Rate for Payer: United Healthcare Commercial	$7,261.20
Rate for Payer: United Healthcare Managed Medicare	$4,760.12

Level 6

Facility

$8,068.00

Hospital Charge Code	1378482
Hospital Revenue Code	360
Min. Negotiated Rate	$5,647.60
Max. Negotiated Rate	$7,261.20
Rate for Payer: Aetna of IA Commercial	$7,261.20
Rate for Payer: Aetna of IA Medical Rental Products	$7,261.20
Rate for Payer: Cash Price	$6,454.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6,051.00
Rate for Payer: Medical Associates Commercial	$6,051.00
Rate for Payer: Midlands Choice Commercial	$5,647.60
Rate for Payer: United Healthcare Commercial	$7,261.20

Level 6: Per Additional Intervals (30 Min)

Facility

$403.00

Hospital Charge Code	1378482
Hospital Revenue Code	360
Min. Negotiated Rate	$282.10
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of IA Commercial	$362.70
Rate for Payer: Aetna of IA Medical Rental Products	$362.70
Rate for Payer: Cash Price	$322.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$302.25
Rate for Payer: Medical Associates Commercial	$302.25
Rate for Payer: Midlands Choice Commercial	$282.10
Rate for Payer: United Healthcare Commercial	$362.70

Level 6: Per Additional Intervals (30 Min)

Facility

$403.00

Hospital Charge Code	1378482
Hospital Revenue Code	360
Min. Negotiated Rate	$181.35
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of IA Commercial	$362.70
Rate for Payer: Aetna of IA Medical Rental Products	$362.70
Rate for Payer: Aetna of IA Medicare	$229.71
Rate for Payer: Amerigroup Medicaid	$232.45
Rate for Payer: Amerigroup Medicare	$183.16
Rate for Payer: Cash Price	$322.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$302.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$181.35
Rate for Payer: Iowa Total Care Managed Medicaid	$230.19
Rate for Payer: Medical Associates Commercial	$302.25
Rate for Payer: Medical Associates Managed Medicare	$181.35
Rate for Payer: Midlands Choice Commercial	$282.10
Rate for Payer: Molina Healthcare Managed Medicaid	$233.58
Rate for Payer: Partners Health Alliance Commercial	$208.55
Rate for Payer: United Healthcare Commercial	$362.70
Rate for Payer: United Healthcare Managed Medicare	$237.77

levETIRAcetam 100 mg/mL 5ml cup Oral Sol [VDMC]

Facility

$13.70

Service Code	HCPCS A9270
Hospital Charge Code	10399512
Hospital Revenue Code	259
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$12.33
Rate for Payer: Aetna of IA Commercial	$12.33
Rate for Payer: Aetna of IA Medical Rental Products	$12.33
Rate for Payer: Aetna of IA Medicare	$7.81
Rate for Payer: Amerigroup Medicaid	$7.90
Rate for Payer: Amerigroup Medicare	$6.22
Rate for Payer: Cash Price	$10.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.27
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.16
Rate for Payer: Iowa Total Care Managed Medicaid	$7.82
Rate for Payer: Medical Associates Commercial	$10.27
Rate for Payer: Medical Associates Managed Medicare	$6.16
Rate for Payer: Midlands Choice Commercial	$9.59
Rate for Payer: Molina Healthcare Managed Medicaid	$7.94
Rate for Payer: Partners Health Alliance Commercial	$7.09
Rate for Payer: United Healthcare Commercial	$12.33
Rate for Payer: United Healthcare Managed Medicare	$8.08

levETIRAcetam 100 mg/mL 5ml cup Oral Sol [VDMC]

Facility

$13.70

Service Code	HCPCS A9270
Hospital Charge Code	10399512
Hospital Revenue Code	259
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$12.33
Rate for Payer: Aetna of IA Commercial	$12.33
Rate for Payer: Aetna of IA Medical Rental Products	$12.33
Rate for Payer: Cash Price	$10.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.27
Rate for Payer: Medical Associates Commercial	$10.27
Rate for Payer: Midlands Choice Commercial	$9.59
Rate for Payer: United Healthcare Commercial	$12.33

levETIRAcetam 500 mg/5ml Vial [VDMC]

Facility

$24.33

Service Code	HCPCS J1953
Hospital Charge Code	11263874
Hospital Revenue Code	259
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$21.89
Rate for Payer: Aetna of IA Commercial	$21.89
Rate for Payer: Aetna of IA Medical Rental Products	$21.89
Rate for Payer: Cash Price	$19.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.24
Rate for Payer: Medical Associates Commercial	$18.24
Rate for Payer: Midlands Choice Commercial	$17.03
Rate for Payer: United Healthcare Commercial	$21.89

levETIRAcetam 500 mg/5ml Vial [VDMC]

Facility

$24.33

Service Code	HCPCS J1953
Hospital Charge Code	11263874
Hospital Revenue Code	259
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$21.89
Rate for Payer: Aetna of IA Commercial	$21.89
Rate for Payer: Aetna of IA Medical Rental Products	$21.89
Rate for Payer: Aetna of IA Medicare	$13.87
Rate for Payer: Amerigroup Medicaid	$14.03
Rate for Payer: Amerigroup Medicare	$11.06
Rate for Payer: Cash Price	$19.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.24
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.95
Rate for Payer: Iowa Total Care Managed Medicaid	$13.90
Rate for Payer: Medical Associates Commercial	$18.24
Rate for Payer: Medical Associates Managed Medicare	$10.95
Rate for Payer: Midlands Choice Commercial	$17.03
Rate for Payer: Molina Healthcare Managed Medicaid	$14.10
Rate for Payer: Partners Health Alliance Commercial	$12.59
Rate for Payer: United Healthcare Commercial	$21.89
Rate for Payer: United Healthcare Managed Medicare	$14.35

levETIRAcetam 500 mg Tab [VDMC]

Facility

$1.53

Service Code	HCPCS A9270
Hospital Charge Code	10399579
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Aetna of IA Medicare	$0.87
Rate for Payer: Amerigroup Medicaid	$0.88
Rate for Payer: Amerigroup Medicare	$0.69
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.69
Rate for Payer: Iowa Total Care Managed Medicaid	$0.87
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Medical Associates Managed Medicare	$0.69
Rate for Payer: Midlands Choice Commercial	$1.07
Rate for Payer: Molina Healthcare Managed Medicaid	$0.88
Rate for Payer: Partners Health Alliance Commercial	$0.79
Rate for Payer: United Healthcare Commercial	$1.37
Rate for Payer: United Healthcare Managed Medicare	$0.90

levETIRAcetam 500 mg Tab [VDMC]

Facility

$1.53

Service Code	HCPCS A9270
Hospital Charge Code	10399579
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Midlands Choice Commercial	$1.07
Rate for Payer: United Healthcare Commercial	$1.37

levofloxacin 250 mg/50 mL IV Sol [VDMC]

Facility

$55.11

Service Code	HCPCS J1956
Hospital Charge Code	10399648
Hospital Revenue Code	259
Min. Negotiated Rate	$38.58
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of IA Commercial	$49.60
Rate for Payer: Aetna of IA Medical Rental Products	$49.60
Rate for Payer: Cash Price	$44.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.33
Rate for Payer: Medical Associates Commercial	$41.33
Rate for Payer: Midlands Choice Commercial	$38.58
Rate for Payer: United Healthcare Commercial	$49.60

levofloxacin 250 mg/50 mL IV Sol [VDMC]

Facility

$55.11

Service Code	HCPCS J1956
Hospital Charge Code	10399648
Hospital Revenue Code	259
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of IA Commercial	$49.60
Rate for Payer: Aetna of IA Medical Rental Products	$49.60
Rate for Payer: Aetna of IA Medicare	$31.41
Rate for Payer: Amerigroup Medicaid	$31.79
Rate for Payer: Amerigroup Medicare	$25.05
Rate for Payer: Cash Price	$44.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.80
Rate for Payer: Iowa Total Care Managed Medicaid	$31.48
Rate for Payer: Medical Associates Commercial	$41.33
Rate for Payer: Medical Associates Managed Medicare	$24.80
Rate for Payer: Midlands Choice Commercial	$38.58
Rate for Payer: Molina Healthcare Managed Medicaid	$31.94
Rate for Payer: Partners Health Alliance Commercial	$28.52
Rate for Payer: United Healthcare Commercial	$49.60
Rate for Payer: United Healthcare Managed Medicare	$32.52

levofloxacin 500 mg/100 mL IV Sol [VDMC]

Facility

$94.00

Service Code	HCPCS J1956
Hospital Charge Code	10399719
Hospital Revenue Code	259
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of IA Commercial	$84.60
Rate for Payer: Aetna of IA Medical Rental Products	$84.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$70.50
Rate for Payer: Medical Associates Commercial	$70.50
Rate for Payer: Midlands Choice Commercial	$65.80
Rate for Payer: United Healthcare Commercial	$84.60

levofloxacin 500 mg/100 mL IV Sol [VDMC]

Facility

$94.00

Service Code	HCPCS J1956
Hospital Charge Code	10399719
Hospital Revenue Code	259
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of IA Commercial	$84.60
Rate for Payer: Aetna of IA Medical Rental Products	$84.60
Rate for Payer: Aetna of IA Medicare	$53.58
Rate for Payer: Amerigroup Medicaid	$54.22
Rate for Payer: Amerigroup Medicare	$42.72
Rate for Payer: Cash Price	$75.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$70.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.30
Rate for Payer: Iowa Total Care Managed Medicaid	$53.69
Rate for Payer: Medical Associates Commercial	$70.50
Rate for Payer: Medical Associates Managed Medicare	$42.30
Rate for Payer: Midlands Choice Commercial	$65.80
Rate for Payer: Molina Healthcare Managed Medicaid	$54.48
Rate for Payer: Partners Health Alliance Commercial	$48.65
Rate for Payer: United Healthcare Commercial	$84.60
Rate for Payer: United Healthcare Managed Medicare	$55.46

levofloxacin 500 mg Tab UD [VDMC]

Facility

$1.73

Service Code	HCPCS A9270
Hospital Charge Code	11224623
Hospital Revenue Code	259
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of IA Commercial	$1.56
Rate for Payer: Aetna of IA Medical Rental Products	$1.56
Rate for Payer: Cash Price	$1.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.30
Rate for Payer: Medical Associates Commercial	$1.30
Rate for Payer: Midlands Choice Commercial	$1.21
Rate for Payer: United Healthcare Commercial	$1.56

levofloxacin 500 mg Tab UD [VDMC]

Facility

$1.73

Service Code	HCPCS A9270
Hospital Charge Code	11224623
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of IA Commercial	$1.56
Rate for Payer: Aetna of IA Medical Rental Products	$1.56
Rate for Payer: Aetna of IA Medicare	$0.99
Rate for Payer: Amerigroup Medicaid	$1.00
Rate for Payer: Amerigroup Medicare	$0.79
Rate for Payer: Cash Price	$1.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.30
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.78
Rate for Payer: Iowa Total Care Managed Medicaid	$0.99
Rate for Payer: Medical Associates Commercial	$1.30
Rate for Payer: Medical Associates Managed Medicare	$0.78
Rate for Payer: Midlands Choice Commercial	$1.21
Rate for Payer: Molina Healthcare Managed Medicaid	$1.01
Rate for Payer: Partners Health Alliance Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.56
Rate for Payer: United Healthcare Managed Medicare	$1.02

Know your out-of-pocket cost for care.

All Charges