Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

mycophenolate mofetil 250 mg Cap [VDMC]

Facility

$2.45

Service Code	HCPCS A9270
Hospital Charge Code	10407718
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.20
Rate for Payer: Aetna of IA Commercial	$2.20
Rate for Payer: Aetna of IA Medical Rental Products	$2.20
Rate for Payer: Aetna of IA Medicare	$1.39
Rate for Payer: Amerigroup Medicaid	$1.41
Rate for Payer: Amerigroup Medicare	$1.11
Rate for Payer: Cash Price	$1.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.84
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.10
Rate for Payer: Iowa Total Care Managed Medicaid	$1.40
Rate for Payer: Medical Associates Commercial	$1.84
Rate for Payer: Medical Associates Managed Medicare	$1.10
Rate for Payer: Midlands Choice Commercial	$1.71
Rate for Payer: Molina Healthcare Managed Medicaid	$1.42
Rate for Payer: Partners Health Alliance Commercial	$1.27
Rate for Payer: United Healthcare Commercial	$2.20
Rate for Payer: United Healthcare Managed Medicare	$1.44

Mycoplasma Pneumonia antibody

Facility

$114.00

Service Code	CPT 86738
Hospital Charge Code	4108792
Hospital Revenue Code	302
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

Mycoplasma Pneumonia antibody

Facility

$114.00

Service Code	CPT 86738
Hospital Charge Code	4108792
Hospital Revenue Code	302
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

nabumetone 500 mg Tab [VDMC]

Facility

$1.34

Service Code	HCPCS A9270
Hospital Charge Code	10407789
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna of IA Commercial	$1.20
Rate for Payer: Aetna of IA Medical Rental Products	$1.20
Rate for Payer: Aetna of IA Medicare	$0.76
Rate for Payer: Amerigroup Medicaid	$0.77
Rate for Payer: Amerigroup Medicare	$0.61
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.60
Rate for Payer: Iowa Total Care Managed Medicaid	$0.76
Rate for Payer: Medical Associates Commercial	$1.00
Rate for Payer: Medical Associates Managed Medicare	$0.60
Rate for Payer: Midlands Choice Commercial	$0.94
Rate for Payer: Molina Healthcare Managed Medicaid	$0.77
Rate for Payer: Partners Health Alliance Commercial	$0.69
Rate for Payer: United Healthcare Commercial	$1.20
Rate for Payer: United Healthcare Managed Medicare	$0.79

nabumetone 500 mg Tab [VDMC]

Facility

$1.34

Service Code	HCPCS A9270
Hospital Charge Code	10407789
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna of IA Commercial	$1.20
Rate for Payer: Aetna of IA Medical Rental Products	$1.20
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.00
Rate for Payer: Medical Associates Commercial	$1.00
Rate for Payer: Midlands Choice Commercial	$0.94
Rate for Payer: United Healthcare Commercial	$1.20

naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]

Facility

$30.67

Service Code	HCPCS J2310
Hospital Charge Code	10408193
Hospital Revenue Code	259
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$27.60
Rate for Payer: Aetna of IA Commercial	$27.60
Rate for Payer: Aetna of IA Medical Rental Products	$27.60
Rate for Payer: Cash Price	$24.54
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.00
Rate for Payer: Medical Associates Commercial	$23.00
Rate for Payer: Midlands Choice Commercial	$21.47
Rate for Payer: United Healthcare Commercial	$27.60

naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]

Facility

$30.67

Service Code	HCPCS J2310
Hospital Charge Code	10408193
Hospital Revenue Code	259
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$27.60
Rate for Payer: Aetna of IA Commercial	$27.60
Rate for Payer: Aetna of IA Medical Rental Products	$27.60
Rate for Payer: Aetna of IA Medicare	$17.48
Rate for Payer: Amerigroup Medicaid	$17.69
Rate for Payer: Amerigroup Medicare	$13.94
Rate for Payer: Cash Price	$24.54
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.80
Rate for Payer: Iowa Total Care Managed Medicaid	$17.52
Rate for Payer: Medical Associates Commercial	$23.00
Rate for Payer: Medical Associates Managed Medicare	$13.80
Rate for Payer: Midlands Choice Commercial	$21.47
Rate for Payer: Molina Healthcare Managed Medicaid	$17.78
Rate for Payer: Partners Health Alliance Commercial	$15.87
Rate for Payer: United Healthcare Commercial	$27.60
Rate for Payer: United Healthcare Managed Medicare	$18.10

naloxone 1 mg/mL Inj Sol [VDMC]

Facility

$141.42

Service Code	HCPCS J2310
Hospital Charge Code	10408262
Hospital Revenue Code	259
Min. Negotiated Rate	$98.99
Max. Negotiated Rate	$127.27
Rate for Payer: Aetna of IA Commercial	$127.27
Rate for Payer: Aetna of IA Medical Rental Products	$127.27
Rate for Payer: Cash Price	$113.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$106.06
Rate for Payer: Medical Associates Commercial	$106.06
Rate for Payer: Midlands Choice Commercial	$98.99
Rate for Payer: United Healthcare Commercial	$127.27

naloxone 1 mg/mL Inj Sol [VDMC]

Facility

$141.42

Service Code	HCPCS J2310
Hospital Charge Code	10408262
Hospital Revenue Code	259
Min. Negotiated Rate	$63.64
Max. Negotiated Rate	$127.27
Rate for Payer: Aetna of IA Commercial	$127.27
Rate for Payer: Aetna of IA Medical Rental Products	$127.27
Rate for Payer: Aetna of IA Medicare	$80.61
Rate for Payer: Amerigroup Medicaid	$81.57
Rate for Payer: Amerigroup Medicare	$64.27
Rate for Payer: Cash Price	$113.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$106.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$63.64
Rate for Payer: Iowa Total Care Managed Medicaid	$80.78
Rate for Payer: Medical Associates Commercial	$106.06
Rate for Payer: Medical Associates Managed Medicare	$63.64
Rate for Payer: Midlands Choice Commercial	$98.99
Rate for Payer: Molina Healthcare Managed Medicaid	$81.96
Rate for Payer: Partners Health Alliance Commercial	$73.18
Rate for Payer: United Healthcare Commercial	$127.27
Rate for Payer: United Healthcare Managed Medicare	$83.44

naltrexone 50 mg Tab[VDMC]

Facility

$9.55

Service Code	HCPCS A9270
Hospital Charge Code	11391896
Hospital Revenue Code	259
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna of IA Commercial	$8.60
Rate for Payer: Aetna of IA Medical Rental Products	$8.60
Rate for Payer: Cash Price	$7.64
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.16
Rate for Payer: Medical Associates Commercial	$7.16
Rate for Payer: Midlands Choice Commercial	$6.69
Rate for Payer: United Healthcare Commercial	$8.60

naltrexone 50 mg Tab[VDMC]

Facility

$9.55

Service Code	HCPCS A9270
Hospital Charge Code	11391896
Hospital Revenue Code	259
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna of IA Commercial	$8.60
Rate for Payer: Aetna of IA Medical Rental Products	$8.60
Rate for Payer: Aetna of IA Medicare	$5.44
Rate for Payer: Amerigroup Medicaid	$5.51
Rate for Payer: Amerigroup Medicare	$4.34
Rate for Payer: Cash Price	$7.64
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.30
Rate for Payer: Iowa Total Care Managed Medicaid	$5.46
Rate for Payer: Medical Associates Commercial	$7.16
Rate for Payer: Medical Associates Managed Medicare	$4.30
Rate for Payer: Midlands Choice Commercial	$6.69
Rate for Payer: Molina Healthcare Managed Medicaid	$5.54
Rate for Payer: Partners Health Alliance Commercial	$4.94
Rate for Payer: United Healthcare Commercial	$8.60
Rate for Payer: United Healthcare Managed Medicare	$5.64

naproxen 500 mg Tab [VDMC]

Facility

$1.34

Service Code	HCPCS A9270
Hospital Charge Code	10408333
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.21
Rate for Payer: Aetna of IA Commercial	$1.21
Rate for Payer: Aetna of IA Medical Rental Products	$1.21
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.01
Rate for Payer: Medical Associates Commercial	$1.01
Rate for Payer: Midlands Choice Commercial	$0.94
Rate for Payer: United Healthcare Commercial	$1.21

naproxen 500 mg Tab [VDMC]

Facility

$1.34

Service Code	HCPCS A9270
Hospital Charge Code	10408333
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.21
Rate for Payer: Aetna of IA Commercial	$1.21
Rate for Payer: Aetna of IA Medical Rental Products	$1.21
Rate for Payer: Aetna of IA Medicare	$0.76
Rate for Payer: Amerigroup Medicaid	$0.77
Rate for Payer: Amerigroup Medicare	$0.61
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.01
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.60
Rate for Payer: Iowa Total Care Managed Medicaid	$0.77
Rate for Payer: Medical Associates Commercial	$1.01
Rate for Payer: Medical Associates Managed Medicare	$0.60
Rate for Payer: Midlands Choice Commercial	$0.94
Rate for Payer: Molina Healthcare Managed Medicaid	$0.78
Rate for Payer: Partners Health Alliance Commercial	$0.69
Rate for Payer: United Healthcare Commercial	$1.21
Rate for Payer: United Healthcare Managed Medicare	$0.79

NASAL CAUTERY/PACKING

Professional

Both

$315.00

Service Code	CPT 30901
Hospital Charge Code	7982782
Hospital Revenue Code	981
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$236.25
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Partners Health Alliance Commercial	$236.25
Rate for Payer: United Healthcare Commercial	$215.09

N BLOCK INJ FACIAL

Professional

Both

$444.00

Service Code	CPT 64402
Hospital Charge Code	7982765
Hospital Revenue Code	981
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$333.00
Rate for Payer: Cash Price	$355.20
Rate for Payer: Medical Associates Commercial	$333.00
Rate for Payer: Midlands Choice Commercial	$310.80
Rate for Payer: Partners Health Alliance Commercial	$333.00

N BLOCK INJ FACIAL

Facility

$570.00

Service Code	CPT 64402
Hospital Charge Code	4866813
Hospital Revenue Code	450
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

N BLOCK INJ FACIAL

Facility

$570.00

Service Code	CPT 64402
Hospital Charge Code	4866813
Hospital Revenue Code	450
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

N BLOCK OTHER PERIPHERAL

Professional

Both

$202.00

Service Code	CPT 64450
Hospital Charge Code	7982764
Hospital Revenue Code	981
Min. Negotiated Rate	$115.70
Max. Negotiated Rate	$151.50
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Partners Health Alliance Commercial	$151.50
Rate for Payer: United Healthcare Commercial	$115.70

N BLOCK OTHER PERIPHERAL

Facility

$635.00

Service Code	CPT 64450
Hospital Charge Code	4866820
Hospital Revenue Code	450
Min. Negotiated Rate	$444.50
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna of IA Commercial	$571.50
Rate for Payer: Aetna of IA Medical Rental Products	$571.50
Rate for Payer: Cash Price	$508.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$476.25
Rate for Payer: Medical Associates Commercial	$476.25
Rate for Payer: Midlands Choice Commercial	$444.50
Rate for Payer: United Healthcare Commercial	$571.50

N BLOCK OTHER PERIPHERAL

Facility

$635.00

Service Code	CPT 64450
Hospital Charge Code	4866820
Hospital Revenue Code	450
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna of IA Commercial	$571.50
Rate for Payer: Aetna of IA Medical Rental Products	$571.50
Rate for Payer: Aetna of IA Medicare	$361.95
Rate for Payer: Amerigroup Medicaid	$366.27
Rate for Payer: Amerigroup Medicare	$288.61
Rate for Payer: Cash Price	$508.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$476.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$285.75
Rate for Payer: Iowa Total Care Managed Medicaid	$362.71
Rate for Payer: Medical Associates Commercial	$476.25
Rate for Payer: Medical Associates Managed Medicare	$285.75
Rate for Payer: Midlands Choice Commercial	$444.50
Rate for Payer: Molina Healthcare Managed Medicaid	$368.05
Rate for Payer: Partners Health Alliance Commercial	$328.61
Rate for Payer: United Healthcare Commercial	$571.50
Rate for Payer: United Healthcare Managed Medicare	$374.65

NBS BIOTINIDASE

Facility

$138.00

Service Code	CPT 82261
Hospital Charge Code	8098975
Hospital Revenue Code	301
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of IA Commercial	$124.20
Rate for Payer: Aetna of IA Medical Rental Products	$124.20
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$103.50
Rate for Payer: Medical Associates Commercial	$103.50
Rate for Payer: Midlands Choice Commercial	$96.60
Rate for Payer: United Healthcare Commercial	$124.20

NBS BIOTINIDASE

Facility

$138.00

Service Code	CPT 82261
Hospital Charge Code	8098975
Hospital Revenue Code	301
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of IA Commercial	$124.20
Rate for Payer: Aetna of IA Medical Rental Products	$124.20
Rate for Payer: Aetna of IA Medicare	$78.66
Rate for Payer: Amerigroup Medicaid	$79.60
Rate for Payer: Amerigroup Medicare	$62.72
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$103.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.10
Rate for Payer: Iowa Total Care Managed Medicaid	$78.83
Rate for Payer: Medical Associates Commercial	$103.50
Rate for Payer: Medical Associates Managed Medicare	$62.10
Rate for Payer: Midlands Choice Commercial	$96.60
Rate for Payer: Molina Healthcare Managed Medicaid	$79.98
Rate for Payer: Partners Health Alliance Commercial	$71.42
Rate for Payer: United Healthcare Commercial	$124.20
Rate for Payer: United Healthcare Managed Medicare	$81.42

NBS FETAL ADN-HGB

Facility

$139.00

Service Code	CPT 83020
Hospital Charge Code	8098976
Hospital Revenue Code	301
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

NBS FETAL ADN-HGB

Facility

$139.00

Service Code	CPT 83020
Hospital Charge Code	8098976
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01

NBS PKU

Facility

$61.00

Service Code	CPT 84030
Hospital Charge Code	8099019
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99

Know your out-of-pocket cost for care.

All Charges