Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

midodrine 5 mg Tab [VDMC]

Facility

$2.25

Service Code	HCPCS A9270
Hospital Charge Code	10406147
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of IA Commercial	$2.02
Rate for Payer: Aetna of IA Medical Rental Products	$2.02
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.69
Rate for Payer: Medical Associates Commercial	$1.69
Rate for Payer: Midlands Choice Commercial	$1.57
Rate for Payer: United Healthcare Commercial	$2.02

MILEAGE GROUND PER 10TH OF A MILE

Facility

$2.00

Service Code	HCPCS A0425 QN
Hospital Charge Code	5966784
Hospital Revenue Code	540
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of IA Commercial	$1.80
Rate for Payer: Aetna of IA Medical Rental Products	$1.80
Rate for Payer: Aetna of IA Medicare	$1.14
Rate for Payer: Amerigroup Medicaid	$1.15
Rate for Payer: Amerigroup Medicare	$0.91
Rate for Payer: Cash Price	$1.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.90
Rate for Payer: Iowa Total Care Managed Medicaid	$1.14
Rate for Payer: Medical Associates Commercial	$1.50
Rate for Payer: Medical Associates Managed Medicare	$0.90
Rate for Payer: Midlands Choice Commercial	$1.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1.16
Rate for Payer: Partners Health Alliance Commercial	$1.03
Rate for Payer: United Healthcare Commercial	$1.80
Rate for Payer: United Healthcare Managed Medicare	$1.70

MILEAGE GROUND PER 10TH OF A MILE

Facility

$2.00

Service Code	HCPCS A0425 QN
Hospital Charge Code	5966784
Hospital Revenue Code	540
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of IA Commercial	$1.80
Rate for Payer: Aetna of IA Medical Rental Products	$1.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.50
Rate for Payer: Medical Associates Commercial	$1.50
Rate for Payer: Midlands Choice Commercial	$1.40
Rate for Payer: United Healthcare Commercial	$1.80

MINI 4 HOLE ST

Facility

$133.00

Service Code	HCPCS C1713
Hospital Charge Code	8046726
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: United Healthcare Commercial	$119.70

MINI 4 HOLE ST

Facility

$133.00

Service Code	HCPCS C1713
Hospital Charge Code	8046726
Hospital Revenue Code	278
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of IA Commercial	$119.70
Rate for Payer: Aetna of IA Medical Rental Products	$119.70
Rate for Payer: Aetna of IA Medicare	$75.81
Rate for Payer: Amerigroup Medicaid	$76.71
Rate for Payer: Amerigroup Medicare	$60.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$99.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$59.85
Rate for Payer: Iowa Total Care Managed Medicaid	$75.97
Rate for Payer: Medical Associates Commercial	$99.75
Rate for Payer: Medical Associates Managed Medicare	$59.85
Rate for Payer: Midlands Choice Commercial	$93.10
Rate for Payer: Molina Healthcare Managed Medicaid	$77.09
Rate for Payer: Partners Health Alliance Commercial	$68.83
Rate for Payer: United Healthcare Commercial	$119.70
Rate for Payer: United Healthcare Managed Medicare	$78.47

minoxidil 2.5 mg Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	11224793
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Aetna of IA Medicare	$0.80
Rate for Payer: Amerigroup Medicaid	$0.81
Rate for Payer: Amerigroup Medicare	$0.64
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.63
Rate for Payer: Iowa Total Care Managed Medicaid	$0.80
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Medical Associates Managed Medicare	$0.63
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: Molina Healthcare Managed Medicaid	$0.81
Rate for Payer: Partners Health Alliance Commercial	$0.72
Rate for Payer: United Healthcare Commercial	$1.26
Rate for Payer: United Healthcare Managed Medicare	$0.82

minoxidil 2.5 mg Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	11224793
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.26

mirabegron 25 mg Tab [VDMC]

Facility

$57.45

Service Code	HCPCS A9270
Hospital Charge Code	10406338
Hospital Revenue Code	259
Min. Negotiated Rate	$40.22
Max. Negotiated Rate	$51.71
Rate for Payer: Aetna of IA Commercial	$51.71
Rate for Payer: Aetna of IA Medical Rental Products	$51.71
Rate for Payer: Cash Price	$45.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.09
Rate for Payer: Medical Associates Commercial	$43.09
Rate for Payer: Midlands Choice Commercial	$40.22
Rate for Payer: United Healthcare Commercial	$51.71

mirabegron 25 mg Tab [VDMC]

Facility

$57.45

Service Code	HCPCS A9270
Hospital Charge Code	10406338
Hospital Revenue Code	259
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$51.71
Rate for Payer: Aetna of IA Commercial	$51.71
Rate for Payer: Aetna of IA Medical Rental Products	$51.71
Rate for Payer: Aetna of IA Medicare	$32.75
Rate for Payer: Amerigroup Medicaid	$33.14
Rate for Payer: Amerigroup Medicare	$26.11
Rate for Payer: Cash Price	$45.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.09
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.85
Rate for Payer: Iowa Total Care Managed Medicaid	$32.82
Rate for Payer: Medical Associates Commercial	$43.09
Rate for Payer: Medical Associates Managed Medicare	$25.85
Rate for Payer: Midlands Choice Commercial	$40.22
Rate for Payer: Molina Healthcare Managed Medicaid	$33.30
Rate for Payer: Partners Health Alliance Commercial	$29.73
Rate for Payer: United Healthcare Commercial	$51.71
Rate for Payer: United Healthcare Managed Medicare	$33.90

mirtazapine 15 mg Tab [VDMC]

Facility

$1.46

Service Code	HCPCS A9270
Hospital Charge Code	10406476
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.31
Rate for Payer: Aetna of IA Commercial	$1.31
Rate for Payer: Aetna of IA Medical Rental Products	$1.31
Rate for Payer: Aetna of IA Medicare	$0.83
Rate for Payer: Amerigroup Medicaid	$0.84
Rate for Payer: Amerigroup Medicare	$0.66
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.66
Rate for Payer: Iowa Total Care Managed Medicaid	$0.83
Rate for Payer: Medical Associates Commercial	$1.10
Rate for Payer: Medical Associates Managed Medicare	$0.66
Rate for Payer: Midlands Choice Commercial	$1.02
Rate for Payer: Molina Healthcare Managed Medicaid	$0.85
Rate for Payer: Partners Health Alliance Commercial	$0.76
Rate for Payer: United Healthcare Commercial	$1.31
Rate for Payer: United Healthcare Managed Medicare	$0.86

mirtazapine 15 mg Tab [VDMC]

Facility

$1.46

Service Code	HCPCS A9270
Hospital Charge Code	10406476
Hospital Revenue Code	259
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.31
Rate for Payer: Aetna of IA Commercial	$1.31
Rate for Payer: Aetna of IA Medical Rental Products	$1.31
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.10
Rate for Payer: Medical Associates Commercial	$1.10
Rate for Payer: Midlands Choice Commercial	$1.02
Rate for Payer: United Healthcare Commercial	$1.31

misoprostol 100 mcg Tab [VDMC]

Facility

$2.65

Service Code	HCPCS A9270
Hospital Charge Code	10406616
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.39
Rate for Payer: Aetna of IA Commercial	$2.39
Rate for Payer: Aetna of IA Medical Rental Products	$2.39
Rate for Payer: Aetna of IA Medicare	$1.51
Rate for Payer: Amerigroup Medicaid	$1.53
Rate for Payer: Amerigroup Medicare	$1.20
Rate for Payer: Cash Price	$2.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.99
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.19
Rate for Payer: Iowa Total Care Managed Medicaid	$1.51
Rate for Payer: Medical Associates Commercial	$1.99
Rate for Payer: Medical Associates Managed Medicare	$1.19
Rate for Payer: Midlands Choice Commercial	$1.86
Rate for Payer: Molina Healthcare Managed Medicaid	$1.54
Rate for Payer: Partners Health Alliance Commercial	$1.37
Rate for Payer: United Healthcare Commercial	$2.39
Rate for Payer: United Healthcare Managed Medicare	$1.56

misoprostol 100 mcg Tab [VDMC]

Facility

$2.65

Service Code	HCPCS A9270
Hospital Charge Code	10406616
Hospital Revenue Code	259
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.39
Rate for Payer: Aetna of IA Commercial	$2.39
Rate for Payer: Aetna of IA Medical Rental Products	$2.39
Rate for Payer: Cash Price	$2.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.99
Rate for Payer: Medical Associates Commercial	$1.99
Rate for Payer: Midlands Choice Commercial	$1.86
Rate for Payer: United Healthcare Commercial	$2.39

Mitochondrial Antibody DMCL

Facility

$115.00

Service Code	CPT 83516
Hospital Charge Code	8037743
Hospital Revenue Code	302
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of IA Commercial	$103.50
Rate for Payer: Aetna of IA Medical Rental Products	$103.50
Rate for Payer: Aetna of IA Medicare	$65.55
Rate for Payer: Amerigroup Medicaid	$66.33
Rate for Payer: Amerigroup Medicare	$52.27
Rate for Payer: Cash Price	$92.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$86.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.75
Rate for Payer: Iowa Total Care Managed Medicaid	$65.69
Rate for Payer: Medical Associates Commercial	$86.25
Rate for Payer: Medical Associates Managed Medicare	$51.75
Rate for Payer: Midlands Choice Commercial	$80.50
Rate for Payer: Molina Healthcare Managed Medicaid	$66.65
Rate for Payer: Partners Health Alliance Commercial	$59.51
Rate for Payer: United Healthcare Commercial	$103.50
Rate for Payer: United Healthcare Managed Medicare	$67.85

Mitochondrial Antibody DMCL

Facility

$115.00

Service Code	CPT 83516
Hospital Charge Code	8037743
Hospital Revenue Code	302
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of IA Commercial	$103.50
Rate for Payer: Aetna of IA Medical Rental Products	$103.50
Rate for Payer: Cash Price	$92.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$86.25
Rate for Payer: Medical Associates Commercial	$86.25
Rate for Payer: Midlands Choice Commercial	$80.50
Rate for Payer: United Healthcare Commercial	$103.50

MNT FOLLOW-UP ASSESS EA 15 MIN

Facility

$89.00

Service Code	CPT 97803
Hospital Charge Code	5616790
Hospital Revenue Code	942
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: United Healthcare Commercial	$80.10

MNT FOLLOW-UP ASSESS EA 15 MIN

Facility

$89.00

Service Code	CPT 97803
Hospital Charge Code	5616790
Hospital Revenue Code	942
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Aetna of IA Medicare	$50.73
Rate for Payer: Amerigroup Medicaid	$51.34
Rate for Payer: Amerigroup Medicare	$40.45
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.05
Rate for Payer: Iowa Total Care Managed Medicaid	$50.84
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Medical Associates Managed Medicare	$40.05
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: Molina Healthcare Managed Medicaid	$51.58
Rate for Payer: Partners Health Alliance Commercial	$46.06
Rate for Payer: United Healthcare Commercial	$80.10
Rate for Payer: United Healthcare Managed Medicare	$52.51

MNT GROUP EA 30 MINUTES

Facility

$89.00

Service Code	CPT 97804
Hospital Charge Code	5616791
Hospital Revenue Code	942
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: United Healthcare Commercial	$80.10

MNT GROUP EA 30 MINUTES

Facility

$89.00

Service Code	CPT 97804
Hospital Charge Code	5616791
Hospital Revenue Code	942
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Aetna of IA Medicare	$50.73
Rate for Payer: Amerigroup Medicaid	$51.34
Rate for Payer: Amerigroup Medicare	$40.45
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.05
Rate for Payer: Iowa Total Care Managed Medicaid	$50.84
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Medical Associates Managed Medicare	$40.05
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: Molina Healthcare Managed Medicaid	$51.58
Rate for Payer: Partners Health Alliance Commercial	$46.06
Rate for Payer: United Healthcare Commercial	$80.10
Rate for Payer: United Healthcare Managed Medicare	$52.51

MNT INITIAL ASSESS EA 15 MIN

Facility

$89.00

Service Code	CPT 97802
Hospital Charge Code	5616789
Hospital Revenue Code	942
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: United Healthcare Commercial	$80.10

MNT INITIAL ASSESS EA 15 MIN

Facility

$89.00

Service Code	CPT 97802
Hospital Charge Code	5616789
Hospital Revenue Code	942
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of IA Commercial	$80.10
Rate for Payer: Aetna of IA Medical Rental Products	$80.10
Rate for Payer: Aetna of IA Medicare	$50.73
Rate for Payer: Amerigroup Medicaid	$51.34
Rate for Payer: Amerigroup Medicare	$40.45
Rate for Payer: Cash Price	$71.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$66.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.05
Rate for Payer: Iowa Total Care Managed Medicaid	$50.84
Rate for Payer: Medical Associates Commercial	$66.75
Rate for Payer: Medical Associates Managed Medicare	$40.05
Rate for Payer: Midlands Choice Commercial	$62.30
Rate for Payer: Molina Healthcare Managed Medicaid	$51.58
Rate for Payer: Partners Health Alliance Commercial	$46.06
Rate for Payer: United Healthcare Commercial	$80.10
Rate for Payer: United Healthcare Managed Medicare	$52.51

modafinil 100 mg Tab [VDMC]

Facility

$3.64

Service Code	HCPCS A9270
Hospital Charge Code	10610465
Hospital Revenue Code	259
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna of IA Commercial	$3.28
Rate for Payer: Aetna of IA Medical Rental Products	$3.28
Rate for Payer: Aetna of IA Medicare	$2.08
Rate for Payer: Amerigroup Medicaid	$2.10
Rate for Payer: Amerigroup Medicare	$1.65
Rate for Payer: Cash Price	$2.91
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.64
Rate for Payer: Iowa Total Care Managed Medicaid	$2.08
Rate for Payer: Medical Associates Commercial	$2.73
Rate for Payer: Medical Associates Managed Medicare	$1.64
Rate for Payer: Midlands Choice Commercial	$2.55
Rate for Payer: Molina Healthcare Managed Medicaid	$2.11
Rate for Payer: Partners Health Alliance Commercial	$1.88
Rate for Payer: United Healthcare Commercial	$3.28
Rate for Payer: United Healthcare Managed Medicare	$2.15

modafinil 100 mg Tab [VDMC]

Facility

$3.64

Service Code	HCPCS A9270
Hospital Charge Code	10610465
Hospital Revenue Code	259
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna of IA Commercial	$3.28
Rate for Payer: Aetna of IA Medical Rental Products	$3.28
Rate for Payer: Cash Price	$2.91
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.73
Rate for Payer: Medical Associates Commercial	$2.73
Rate for Payer: Midlands Choice Commercial	$2.55
Rate for Payer: United Healthcare Commercial	$3.28

MODIFIED BARIUM SWAL STUDY

Facility

$450.00

Service Code	CPT 92611 GN
Hospital Charge Code	5530783
Hospital Revenue Code	440
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna of IA Commercial	$405.00
Rate for Payer: Aetna of IA Medical Rental Products	$405.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$337.50
Rate for Payer: Medical Associates Commercial	$337.50
Rate for Payer: Midlands Choice Commercial	$315.00
Rate for Payer: United Healthcare Commercial	$405.00

MODIFIED BARIUM SWAL STUDY

Facility

$450.00

Service Code	CPT 92611 GN
Hospital Charge Code	5530783
Hospital Revenue Code	440
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna of IA Commercial	$405.00
Rate for Payer: Aetna of IA Medical Rental Products	$405.00
Rate for Payer: Aetna of IA Medicare	$256.50
Rate for Payer: Amerigroup Medicaid	$259.56
Rate for Payer: Amerigroup Medicare	$204.53
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$337.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$202.50
Rate for Payer: Iowa Total Care Managed Medicaid	$257.04
Rate for Payer: Medical Associates Commercial	$337.50
Rate for Payer: Medical Associates Managed Medicare	$202.50
Rate for Payer: Midlands Choice Commercial	$315.00
Rate for Payer: Molina Healthcare Managed Medicaid	$260.82
Rate for Payer: Partners Health Alliance Commercial	$232.88
Rate for Payer: United Healthcare Commercial	$405.00
Rate for Payer: United Healthcare Managed Medicare	$265.50

Know your out-of-pocket cost for care.

All Charges