Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

N-Terminal pro Brain Natriuretic Peptide

Facility

$231.00

Service Code	CPT 83880
Hospital Charge Code	1503769
Hospital Revenue Code	301
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of IA Commercial	$207.90
Rate for Payer: Aetna of IA Medical Rental Products	$207.90
Rate for Payer: Cash Price	$184.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$173.25
Rate for Payer: Medical Associates Commercial	$173.25
Rate for Payer: Midlands Choice Commercial	$161.70
Rate for Payer: United Healthcare Commercial	$207.90

N-Terminal pro Brain Natriuretic Peptide

Facility

$231.00

Service Code	CPT 83880
Hospital Charge Code	1503769
Hospital Revenue Code	301
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of IA Commercial	$207.90
Rate for Payer: Aetna of IA Medical Rental Products	$207.90
Rate for Payer: Aetna of IA Medicare	$131.67
Rate for Payer: Amerigroup Medicaid	$133.24
Rate for Payer: Amerigroup Medicare	$104.99
Rate for Payer: Cash Price	$184.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$173.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$103.95
Rate for Payer: Iowa Total Care Managed Medicaid	$131.95
Rate for Payer: Medical Associates Commercial	$173.25
Rate for Payer: Medical Associates Managed Medicare	$103.95
Rate for Payer: Midlands Choice Commercial	$161.70
Rate for Payer: Molina Healthcare Managed Medicaid	$133.89
Rate for Payer: Partners Health Alliance Commercial	$119.54
Rate for Payer: United Healthcare Commercial	$207.90
Rate for Payer: United Healthcare Managed Medicare	$136.29

NURSEMAIDS ELBOW CHILD

Professional

Both

$388.00

Service Code	CPT 24640
Hospital Charge Code	7982808
Hospital Revenue Code	981
Min. Negotiated Rate	$155.57
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Medical Associates Commercial	$291.00
Rate for Payer: Midlands Choice Commercial	$271.60
Rate for Payer: Partners Health Alliance Commercial	$291.00
Rate for Payer: United Healthcare Commercial	$155.57

nystatin 100000 units/mL Sus UD 5 mL [VDMC]

Facility

$7.61

Service Code	HCPCS A9270
Hospital Charge Code	10431892
Hospital Revenue Code	259
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$6.85
Rate for Payer: Aetna of IA Commercial	$6.85
Rate for Payer: Aetna of IA Medical Rental Products	$6.85
Rate for Payer: Cash Price	$6.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.71
Rate for Payer: Medical Associates Commercial	$5.71
Rate for Payer: Midlands Choice Commercial	$5.33
Rate for Payer: United Healthcare Commercial	$6.85

nystatin 100000 units/mL Sus UD 5 mL [VDMC]

Facility

$7.61

Service Code	HCPCS A9270
Hospital Charge Code	10431892
Hospital Revenue Code	259
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$6.85
Rate for Payer: Aetna of IA Commercial	$6.85
Rate for Payer: Aetna of IA Medical Rental Products	$6.85
Rate for Payer: Aetna of IA Medicare	$4.34
Rate for Payer: Amerigroup Medicaid	$4.39
Rate for Payer: Amerigroup Medicare	$3.46
Rate for Payer: Cash Price	$6.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.71
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.43
Rate for Payer: Iowa Total Care Managed Medicaid	$4.35
Rate for Payer: Medical Associates Commercial	$5.71
Rate for Payer: Medical Associates Managed Medicare	$3.43
Rate for Payer: Midlands Choice Commercial	$5.33
Rate for Payer: Molina Healthcare Managed Medicaid	$4.41
Rate for Payer: Partners Health Alliance Commercial	$3.94
Rate for Payer: United Healthcare Commercial	$6.85
Rate for Payer: United Healthcare Managed Medicare	$4.49

nystatin Top 100,000 units/g Crm 15 gm [VDMC]

Facility

$30.00

Service Code	HCPCS A9270
Hospital Charge Code	10409549
Hospital Revenue Code	259
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: United Healthcare Commercial	$27.00

nystatin Top 100,000 units/g Crm 15 gm [VDMC]

Facility

$30.00

Service Code	HCPCS A9270
Hospital Charge Code	10409549
Hospital Revenue Code	259
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Aetna of IA Medicare	$17.10
Rate for Payer: Amerigroup Medicaid	$17.30
Rate for Payer: Amerigroup Medicare	$13.64
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.50
Rate for Payer: Iowa Total Care Managed Medicaid	$17.14
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Medical Associates Managed Medicare	$13.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: Molina Healthcare Managed Medicaid	$17.39
Rate for Payer: Partners Health Alliance Commercial	$15.53
Rate for Payer: United Healthcare Commercial	$27.00
Rate for Payer: United Healthcare Managed Medicare	$17.70

nystatin Top 100,000 units/g Oint 15 gm [VDMC]

Facility

$19.60

Service Code	HCPCS A9270
Hospital Charge Code	10409679
Hospital Revenue Code	259
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$17.64
Rate for Payer: Aetna of IA Commercial	$17.64
Rate for Payer: Aetna of IA Medical Rental Products	$17.64
Rate for Payer: Cash Price	$15.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.70
Rate for Payer: Medical Associates Commercial	$14.70
Rate for Payer: Midlands Choice Commercial	$13.72
Rate for Payer: United Healthcare Commercial	$17.64

nystatin Top 100,000 units/g Oint 15 gm [VDMC]

Facility

$19.60

Service Code	HCPCS A9270
Hospital Charge Code	10409679
Hospital Revenue Code	259
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$17.64
Rate for Payer: Aetna of IA Commercial	$17.64
Rate for Payer: Aetna of IA Medical Rental Products	$17.64
Rate for Payer: Aetna of IA Medicare	$11.17
Rate for Payer: Amerigroup Medicaid	$11.31
Rate for Payer: Amerigroup Medicare	$8.91
Rate for Payer: Cash Price	$15.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.70
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.82
Rate for Payer: Iowa Total Care Managed Medicaid	$11.20
Rate for Payer: Medical Associates Commercial	$14.70
Rate for Payer: Medical Associates Managed Medicare	$8.82
Rate for Payer: Midlands Choice Commercial	$13.72
Rate for Payer: Molina Healthcare Managed Medicaid	$11.36
Rate for Payer: Partners Health Alliance Commercial	$10.14
Rate for Payer: United Healthcare Commercial	$17.64
Rate for Payer: United Healthcare Managed Medicare	$11.56

nystatin Top 100,000 units/g Pwdr 15 gm [VDMC]

Facility

$36.64

Service Code	HCPCS A9270
Hospital Charge Code	10409744
Hospital Revenue Code	259
Min. Negotiated Rate	$16.49
Max. Negotiated Rate	$32.98
Rate for Payer: Aetna of IA Commercial	$32.98
Rate for Payer: Aetna of IA Medical Rental Products	$32.98
Rate for Payer: Aetna of IA Medicare	$20.88
Rate for Payer: Amerigroup Medicaid	$21.13
Rate for Payer: Amerigroup Medicare	$16.65
Rate for Payer: Cash Price	$29.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.48
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.49
Rate for Payer: Iowa Total Care Managed Medicaid	$20.93
Rate for Payer: Medical Associates Commercial	$27.48
Rate for Payer: Medical Associates Managed Medicare	$16.49
Rate for Payer: Midlands Choice Commercial	$25.65
Rate for Payer: Molina Healthcare Managed Medicaid	$21.24
Rate for Payer: Partners Health Alliance Commercial	$18.96
Rate for Payer: United Healthcare Commercial	$32.98
Rate for Payer: United Healthcare Managed Medicare	$21.62

nystatin Top 100,000 units/g Pwdr 15 gm [VDMC]

Facility

$36.64

Service Code	HCPCS A9270
Hospital Charge Code	10409744
Hospital Revenue Code	259
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$32.98
Rate for Payer: Aetna of IA Commercial	$32.98
Rate for Payer: Aetna of IA Medical Rental Products	$32.98
Rate for Payer: Cash Price	$29.31
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.48
Rate for Payer: Medical Associates Commercial	$27.48
Rate for Payer: Midlands Choice Commercial	$25.65
Rate for Payer: United Healthcare Commercial	$32.98

OBSERVATION OR INPT MODERATE COMPLEXITY

Facility

$278.00

Service Code	CPT 99235
Hospital Charge Code	5140783
Hospital Revenue Code	982
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$250.20
Rate for Payer: Aetna of IA Commercial	$250.20
Rate for Payer: Aetna of IA Medical Rental Products	$250.20
Rate for Payer: Cash Price	$222.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$208.50
Rate for Payer: Medical Associates Commercial	$208.50
Rate for Payer: Midlands Choice Commercial	$194.60
Rate for Payer: United Healthcare Commercial	$250.20

OBSERVATION OR INPT MODERATE COMPLEXITY

Facility

$278.00

Service Code	CPT 99235
Hospital Charge Code	5140783
Hospital Revenue Code	982
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$250.20
Rate for Payer: Aetna of IA Commercial	$250.20
Rate for Payer: Aetna of IA Medical Rental Products	$250.20
Rate for Payer: Aetna of IA Medicare	$158.46
Rate for Payer: Amerigroup Medicaid	$160.35
Rate for Payer: Amerigroup Medicare	$126.35
Rate for Payer: Cash Price	$222.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$208.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.10
Rate for Payer: Iowa Total Care Managed Medicaid	$158.79
Rate for Payer: Medical Associates Commercial	$208.50
Rate for Payer: Medical Associates Managed Medicare	$125.10
Rate for Payer: Midlands Choice Commercial	$194.60
Rate for Payer: Molina Healthcare Managed Medicaid	$161.13
Rate for Payer: Partners Health Alliance Commercial	$143.87
Rate for Payer: United Healthcare Commercial	$250.20

Occ Health Pre Work Screen

Facility

$75.00

Hospital Charge Code	8782365
Hospital Revenue Code	420
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of IA Commercial	$67.50
Rate for Payer: Aetna of IA Medical Rental Products	$67.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.25
Rate for Payer: Medical Associates Commercial	$56.25
Rate for Payer: Midlands Choice Commercial	$52.50
Rate for Payer: United Healthcare Commercial	$67.50

Occ Health Pre Work Screen

Facility

$75.00

Hospital Charge Code	8782365
Hospital Revenue Code	420
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of IA Commercial	$67.50
Rate for Payer: Aetna of IA Medical Rental Products	$67.50
Rate for Payer: Aetna of IA Medicare	$42.75
Rate for Payer: Amerigroup Medicaid	$43.26
Rate for Payer: Amerigroup Medicare	$34.09
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$56.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.75
Rate for Payer: Iowa Total Care Managed Medicaid	$42.84
Rate for Payer: Medical Associates Commercial	$56.25
Rate for Payer: Medical Associates Managed Medicare	$33.75
Rate for Payer: Midlands Choice Commercial	$52.50
Rate for Payer: Molina Healthcare Managed Medicaid	$43.47
Rate for Payer: Partners Health Alliance Commercial	$38.81
Rate for Payer: United Healthcare Commercial	$67.50
Rate for Payer: United Healthcare Managed Medicare	$44.25

OCCULT BLOOD OTHER

Facility

$41.00

Service Code	CPT 82271
Hospital Charge Code	4022862
Hospital Revenue Code	301
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Aetna of IA Medicare	$23.37
Rate for Payer: Amerigroup Medicaid	$23.65
Rate for Payer: Amerigroup Medicare	$18.63
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.45
Rate for Payer: Iowa Total Care Managed Medicaid	$23.42
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Medical Associates Managed Medicare	$18.45
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: Molina Healthcare Managed Medicaid	$23.76
Rate for Payer: Partners Health Alliance Commercial	$21.22
Rate for Payer: United Healthcare Commercial	$36.90
Rate for Payer: United Healthcare Managed Medicare	$24.19

OCCULT BLOOD OTHER

Facility

$41.00

Service Code	CPT 82271
Hospital Charge Code	4022862
Hospital Revenue Code	301
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: United Healthcare Commercial	$36.90

OCCULT-BLOOD-STOOL

Facility

$65.00

Service Code	HCPCS G0328
Hospital Charge Code	4022859
Hospital Revenue Code	301
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: United Healthcare Commercial	$58.50

OCCULT-BLOOD-STOOL

Facility

$65.00

Service Code	HCPCS G0328
Hospital Charge Code	4022859
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of IA Commercial	$58.50
Rate for Payer: Aetna of IA Medical Rental Products	$58.50
Rate for Payer: Aetna of IA Medicare	$37.05
Rate for Payer: Amerigroup Medicaid	$37.49
Rate for Payer: Amerigroup Medicare	$29.54
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.25
Rate for Payer: Iowa Total Care Managed Medicaid	$37.13
Rate for Payer: Medical Associates Commercial	$48.75
Rate for Payer: Medical Associates Managed Medicare	$29.25
Rate for Payer: Midlands Choice Commercial	$45.50
Rate for Payer: Molina Healthcare Managed Medicaid	$37.67
Rate for Payer: Partners Health Alliance Commercial	$33.64
Rate for Payer: United Healthcare Commercial	$58.50
Rate for Payer: United Healthcare Managed Medicare	$38.35

octreotide 100 mcg/mL Sol [VDMC]

Facility

$26.07

Service Code	HCPCS J2354
Hospital Charge Code	23341694
Hospital Revenue Code	259
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$23.46
Rate for Payer: Aetna of IA Commercial	$23.46
Rate for Payer: Aetna of IA Medical Rental Products	$23.46
Rate for Payer: Cash Price	$20.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.55
Rate for Payer: Medical Associates Commercial	$19.55
Rate for Payer: Midlands Choice Commercial	$18.25
Rate for Payer: United Healthcare Commercial	$23.46

octreotide 100 mcg/mL Sol [VDMC]

Facility

$26.07

Service Code	HCPCS J2354
Hospital Charge Code	23341694
Hospital Revenue Code	259
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$23.46
Rate for Payer: Aetna of IA Commercial	$23.46
Rate for Payer: Aetna of IA Medical Rental Products	$23.46
Rate for Payer: Aetna of IA Medicare	$14.86
Rate for Payer: Amerigroup Medicaid	$15.04
Rate for Payer: Amerigroup Medicare	$11.85
Rate for Payer: Cash Price	$20.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.55
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.73
Rate for Payer: Iowa Total Care Managed Medicaid	$14.89
Rate for Payer: Medical Associates Commercial	$19.55
Rate for Payer: Medical Associates Managed Medicare	$11.73
Rate for Payer: Midlands Choice Commercial	$18.25
Rate for Payer: Molina Healthcare Managed Medicaid	$15.11
Rate for Payer: Partners Health Alliance Commercial	$13.49
Rate for Payer: United Healthcare Commercial	$23.46
Rate for Payer: United Healthcare Managed Medicare	$15.38

Ocular lubricant preserved drops Sol 15ml [VDMC]

Facility

$22.36

Service Code	HCPCS A9270
Hospital Charge Code	22702443
Hospital Revenue Code	259
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$20.12
Rate for Payer: Aetna of IA Commercial	$20.12
Rate for Payer: Aetna of IA Medical Rental Products	$20.12
Rate for Payer: Cash Price	$17.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.77
Rate for Payer: Medical Associates Commercial	$16.77
Rate for Payer: Midlands Choice Commercial	$15.65
Rate for Payer: United Healthcare Commercial	$20.12

Ocular lubricant preserved drops Sol 15ml [VDMC]

Facility

$22.36

Service Code	HCPCS A9270
Hospital Charge Code	22702443
Hospital Revenue Code	259
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$20.12
Rate for Payer: Aetna of IA Commercial	$20.12
Rate for Payer: Aetna of IA Medical Rental Products	$20.12
Rate for Payer: Aetna of IA Medicare	$12.75
Rate for Payer: Amerigroup Medicaid	$12.90
Rate for Payer: Amerigroup Medicare	$10.16
Rate for Payer: Cash Price	$17.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.77
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.06
Rate for Payer: Iowa Total Care Managed Medicaid	$12.77
Rate for Payer: Medical Associates Commercial	$16.77
Rate for Payer: Medical Associates Managed Medicare	$10.06
Rate for Payer: Midlands Choice Commercial	$15.65
Rate for Payer: Molina Healthcare Managed Medicaid	$12.96
Rate for Payer: Partners Health Alliance Commercial	$11.57
Rate for Payer: United Healthcare Commercial	$20.12
Rate for Payer: United Healthcare Managed Medicare	$13.19

ofloxacin ophthalmic 0.3% 5ml drops [VDMC]

Facility

$59.32

Service Code	HCPCS A9270
Hospital Charge Code	11338413
Hospital Revenue Code	259
Min. Negotiated Rate	$41.52
Max. Negotiated Rate	$53.39
Rate for Payer: Aetna of IA Commercial	$53.39
Rate for Payer: Aetna of IA Medical Rental Products	$53.39
Rate for Payer: Cash Price	$47.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.49
Rate for Payer: Medical Associates Commercial	$44.49
Rate for Payer: Midlands Choice Commercial	$41.52
Rate for Payer: United Healthcare Commercial	$53.39

ofloxacin ophthalmic 0.3% 5ml drops [VDMC]

Facility

$59.32

Service Code	HCPCS A9270
Hospital Charge Code	11338413
Hospital Revenue Code	259
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$53.39
Rate for Payer: Aetna of IA Commercial	$53.39
Rate for Payer: Aetna of IA Medical Rental Products	$53.39
Rate for Payer: Aetna of IA Medicare	$33.81
Rate for Payer: Amerigroup Medicaid	$34.22
Rate for Payer: Amerigroup Medicare	$26.96
Rate for Payer: Cash Price	$47.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.49
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.69
Rate for Payer: Iowa Total Care Managed Medicaid	$33.88
Rate for Payer: Medical Associates Commercial	$44.49
Rate for Payer: Medical Associates Managed Medicare	$26.69
Rate for Payer: Midlands Choice Commercial	$41.52
Rate for Payer: Molina Healthcare Managed Medicaid	$34.38
Rate for Payer: Partners Health Alliance Commercial	$30.70
Rate for Payer: United Healthcare Commercial	$53.39
Rate for Payer: United Healthcare Managed Medicare	$35.00

Know your out-of-pocket cost for care.

All Charges