Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ofloxacin Otic 0.3% 5ml drops [VDMC]

Facility

$254.16

Service Code	HCPCS A9270
Hospital Charge Code	10436579
Hospital Revenue Code	259
Min. Negotiated Rate	$114.37
Max. Negotiated Rate	$228.74
Rate for Payer: Aetna of IA Commercial	$228.74
Rate for Payer: Aetna of IA Medical Rental Products	$228.74
Rate for Payer: Aetna of IA Medicare	$144.87
Rate for Payer: Amerigroup Medicaid	$146.60
Rate for Payer: Amerigroup Medicare	$115.52
Rate for Payer: Cash Price	$203.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$190.62
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$114.37
Rate for Payer: Iowa Total Care Managed Medicaid	$145.18
Rate for Payer: Medical Associates Commercial	$190.62
Rate for Payer: Medical Associates Managed Medicare	$114.37
Rate for Payer: Midlands Choice Commercial	$177.91
Rate for Payer: Molina Healthcare Managed Medicaid	$147.31
Rate for Payer: Partners Health Alliance Commercial	$131.53
Rate for Payer: United Healthcare Commercial	$228.74
Rate for Payer: United Healthcare Managed Medicare	$149.95

ofloxacin Otic 0.3% 5ml drops [VDMC]

Facility

$254.16

Service Code	HCPCS A9270
Hospital Charge Code	10436579
Hospital Revenue Code	259
Min. Negotiated Rate	$177.91
Max. Negotiated Rate	$228.74
Rate for Payer: Aetna of IA Commercial	$228.74
Rate for Payer: Aetna of IA Medical Rental Products	$228.74
Rate for Payer: Cash Price	$203.33
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$190.62
Rate for Payer: Medical Associates Commercial	$190.62
Rate for Payer: Midlands Choice Commercial	$177.91
Rate for Payer: United Healthcare Commercial	$228.74

OHPS Group Psychotherapy

Facility

$221.00

Service Code	CPT 90853
Hospital Charge Code	8987990
Hospital Revenue Code	915
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: United Healthcare Commercial	$198.90

OHPS Group Psychotherapy

Facility

$221.00

Service Code	CPT 90853
Hospital Charge Code	8987990
Hospital Revenue Code	915
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of IA Commercial	$198.90
Rate for Payer: Aetna of IA Medical Rental Products	$198.90
Rate for Payer: Aetna of IA Medicare	$125.97
Rate for Payer: Amerigroup Medicaid	$127.47
Rate for Payer: Amerigroup Medicare	$100.44
Rate for Payer: Cash Price	$176.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$99.45
Rate for Payer: Iowa Total Care Managed Medicaid	$126.24
Rate for Payer: Medical Associates Commercial	$165.75
Rate for Payer: Medical Associates Managed Medicare	$99.45
Rate for Payer: Midlands Choice Commercial	$154.70
Rate for Payer: Molina Healthcare Managed Medicaid	$128.09
Rate for Payer: Partners Health Alliance Commercial	$114.37
Rate for Payer: United Healthcare Commercial	$198.90

OHPS Psychotherapy - Family w/o Patient

Facility

$177.00

Service Code	CPT 90846
Hospital Charge Code	8987988
Hospital Revenue Code	916
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Aetna of IA Medicare	$100.89
Rate for Payer: Amerigroup Medicaid	$102.09
Rate for Payer: Amerigroup Medicare	$80.45
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.65
Rate for Payer: Iowa Total Care Managed Medicaid	$101.10
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Medical Associates Managed Medicare	$79.65
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: Molina Healthcare Managed Medicaid	$102.59
Rate for Payer: Partners Health Alliance Commercial	$91.60
Rate for Payer: United Healthcare Commercial	$159.30

OHPS Psychotherapy - Family w/o Patient

Facility

$177.00

Service Code	CPT 90846
Hospital Charge Code	8987988
Hospital Revenue Code	916
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: United Healthcare Commercial	$159.30

OHPS Psychotherapy - Family w/ Patient

Facility

$177.00

Service Code	CPT 90847
Hospital Charge Code	8987989
Hospital Revenue Code	916
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Aetna of IA Medicare	$100.89
Rate for Payer: Amerigroup Medicaid	$102.09
Rate for Payer: Amerigroup Medicare	$80.45
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.65
Rate for Payer: Iowa Total Care Managed Medicaid	$101.10
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Medical Associates Managed Medicare	$79.65
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: Molina Healthcare Managed Medicaid	$102.59
Rate for Payer: Partners Health Alliance Commercial	$91.60
Rate for Payer: United Healthcare Commercial	$159.30

OHPS Psychotherapy - Family w/ Patient

Facility

$177.00

Service Code	CPT 90847
Hospital Charge Code	8987989
Hospital Revenue Code	916
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of IA Commercial	$159.30
Rate for Payer: Aetna of IA Medical Rental Products	$159.30
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$132.75
Rate for Payer: Medical Associates Commercial	$132.75
Rate for Payer: Midlands Choice Commercial	$123.90
Rate for Payer: United Healthcare Commercial	$159.30

OHPS Psychotherapy - Individual 16-37 min

Facility

$181.00

Service Code	CPT 90832
Hospital Charge Code	8987985
Hospital Revenue Code	914
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of IA Commercial	$162.90
Rate for Payer: Aetna of IA Medical Rental Products	$162.90
Rate for Payer: Cash Price	$144.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.75
Rate for Payer: Medical Associates Commercial	$135.75
Rate for Payer: Midlands Choice Commercial	$126.70
Rate for Payer: United Healthcare Commercial	$162.90

OHPS Psychotherapy - Individual 16-37 min

Facility

$181.00

Service Code	CPT 90832
Hospital Charge Code	8987985
Hospital Revenue Code	914
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of IA Commercial	$162.90
Rate for Payer: Aetna of IA Medical Rental Products	$162.90
Rate for Payer: Aetna of IA Medicare	$103.17
Rate for Payer: Amerigroup Medicaid	$104.40
Rate for Payer: Amerigroup Medicare	$82.26
Rate for Payer: Cash Price	$144.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.45
Rate for Payer: Iowa Total Care Managed Medicaid	$103.39
Rate for Payer: Medical Associates Commercial	$135.75
Rate for Payer: Medical Associates Managed Medicare	$81.45
Rate for Payer: Midlands Choice Commercial	$126.70
Rate for Payer: Molina Healthcare Managed Medicaid	$104.91
Rate for Payer: Partners Health Alliance Commercial	$93.67
Rate for Payer: United Healthcare Commercial	$162.90

OHPS Psychotherapy - Individual 38-57 min

Facility

$363.00

Service Code	CPT 90834
Hospital Charge Code	8987986
Hospital Revenue Code	914
Min. Negotiated Rate	$254.10
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of IA Commercial	$326.70
Rate for Payer: Aetna of IA Medical Rental Products	$326.70
Rate for Payer: Cash Price	$290.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$272.25
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: United Healthcare Commercial	$326.70

OHPS Psychotherapy - Individual 38-57 min

Facility

$363.00

Service Code	CPT 90834
Hospital Charge Code	8987986
Hospital Revenue Code	914
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of IA Commercial	$326.70
Rate for Payer: Aetna of IA Medical Rental Products	$326.70
Rate for Payer: Aetna of IA Medicare	$206.91
Rate for Payer: Amerigroup Medicaid	$209.38
Rate for Payer: Amerigroup Medicare	$164.98
Rate for Payer: Cash Price	$290.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$272.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$163.35
Rate for Payer: Iowa Total Care Managed Medicaid	$207.35
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Medical Associates Managed Medicare	$163.35
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: Molina Healthcare Managed Medicaid	$210.39
Rate for Payer: Partners Health Alliance Commercial	$187.85
Rate for Payer: United Healthcare Commercial	$326.70

OHPS Psychotherapy - Individual 58 min or more

Facility

$363.00

Service Code	CPT 90837
Hospital Charge Code	8987987
Hospital Revenue Code	914
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of IA Commercial	$326.70
Rate for Payer: Aetna of IA Medical Rental Products	$326.70
Rate for Payer: Aetna of IA Medicare	$206.91
Rate for Payer: Amerigroup Medicaid	$209.38
Rate for Payer: Amerigroup Medicare	$164.98
Rate for Payer: Cash Price	$290.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$272.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$163.35
Rate for Payer: Iowa Total Care Managed Medicaid	$207.35
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Medical Associates Managed Medicare	$163.35
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: Molina Healthcare Managed Medicaid	$210.39
Rate for Payer: Partners Health Alliance Commercial	$187.85
Rate for Payer: United Healthcare Commercial	$326.70

OHPS Psychotherapy - Individual 58 min or more

Facility

$363.00

Service Code	CPT 90837
Hospital Charge Code	8987987
Hospital Revenue Code	914
Min. Negotiated Rate	$254.10
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of IA Commercial	$326.70
Rate for Payer: Aetna of IA Medical Rental Products	$326.70
Rate for Payer: Cash Price	$290.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$272.25
Rate for Payer: Medical Associates Commercial	$272.25
Rate for Payer: Midlands Choice Commercial	$254.10
Rate for Payer: United Healthcare Commercial	$326.70

OLANZapine 5 mg Tab [VDMC]

Facility

$2.11

Service Code	HCPCS A9270
Hospital Charge Code	10410136
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.90
Rate for Payer: Aetna of IA Commercial	$1.90
Rate for Payer: Aetna of IA Medical Rental Products	$1.90
Rate for Payer: Aetna of IA Medicare	$1.20
Rate for Payer: Amerigroup Medicaid	$1.22
Rate for Payer: Amerigroup Medicare	$0.96
Rate for Payer: Cash Price	$1.69
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.58
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.95
Rate for Payer: Iowa Total Care Managed Medicaid	$1.20
Rate for Payer: Medical Associates Commercial	$1.58
Rate for Payer: Medical Associates Managed Medicare	$0.95
Rate for Payer: Midlands Choice Commercial	$1.48
Rate for Payer: Molina Healthcare Managed Medicaid	$1.22
Rate for Payer: Partners Health Alliance Commercial	$1.09
Rate for Payer: United Healthcare Commercial	$1.90
Rate for Payer: United Healthcare Managed Medicare	$1.24

OLANZapine 5 mg Tab [VDMC]

Facility

$2.11

Service Code	HCPCS A9270
Hospital Charge Code	10410136
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.90
Rate for Payer: Aetna of IA Commercial	$1.90
Rate for Payer: Aetna of IA Medical Rental Products	$1.90
Rate for Payer: Cash Price	$1.69
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.58
Rate for Payer: Medical Associates Commercial	$1.58
Rate for Payer: Midlands Choice Commercial	$1.48
Rate for Payer: United Healthcare Commercial	$1.90

OLIGOCLONAL BANDING

Facility

$164.00

Service Code	CPT 83916
Hospital Charge Code	8093941
Hospital Revenue Code	301
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of IA Commercial	$147.60
Rate for Payer: Aetna of IA Medical Rental Products	$147.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.00
Rate for Payer: Medical Associates Commercial	$123.00
Rate for Payer: Midlands Choice Commercial	$114.80
Rate for Payer: United Healthcare Commercial	$147.60

OLIGOCLONAL BANDING

Facility

$164.00

Service Code	CPT 83916
Hospital Charge Code	8093941
Hospital Revenue Code	301
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of IA Commercial	$147.60
Rate for Payer: Aetna of IA Medical Rental Products	$147.60
Rate for Payer: Aetna of IA Medicare	$93.48
Rate for Payer: Amerigroup Medicaid	$94.60
Rate for Payer: Amerigroup Medicare	$74.54
Rate for Payer: Cash Price	$131.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$73.80
Rate for Payer: Iowa Total Care Managed Medicaid	$93.68
Rate for Payer: Medical Associates Commercial	$123.00
Rate for Payer: Medical Associates Managed Medicare	$73.80
Rate for Payer: Midlands Choice Commercial	$114.80
Rate for Payer: Molina Healthcare Managed Medicaid	$95.05
Rate for Payer: Partners Health Alliance Commercial	$84.87
Rate for Payer: United Healthcare Commercial	$147.60
Rate for Payer: United Healthcare Managed Medicare	$96.76

Oligoclonal Band Profile DMCL

Facility

$164.00

Service Code	CPT 83916
Hospital Charge Code	8037734
Hospital Revenue Code	301
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of IA Commercial	$147.60
Rate for Payer: Aetna of IA Medical Rental Products	$147.60
Rate for Payer: Aetna of IA Medicare	$93.48
Rate for Payer: Amerigroup Medicaid	$94.60
Rate for Payer: Amerigroup Medicare	$74.54
Rate for Payer: Cash Price	$131.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$73.80
Rate for Payer: Iowa Total Care Managed Medicaid	$93.68
Rate for Payer: Medical Associates Commercial	$123.00
Rate for Payer: Medical Associates Managed Medicare	$73.80
Rate for Payer: Midlands Choice Commercial	$114.80
Rate for Payer: Molina Healthcare Managed Medicaid	$95.05
Rate for Payer: Partners Health Alliance Commercial	$84.87
Rate for Payer: United Healthcare Commercial	$147.60
Rate for Payer: United Healthcare Managed Medicare	$96.76

Oligoclonal Band Profile DMCL

Facility

$164.00

Service Code	CPT 83916
Hospital Charge Code	8037734
Hospital Revenue Code	301
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of IA Commercial	$147.60
Rate for Payer: Aetna of IA Medical Rental Products	$147.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.00
Rate for Payer: Medical Associates Commercial	$123.00
Rate for Payer: Midlands Choice Commercial	$114.80
Rate for Payer: United Healthcare Commercial	$147.60

OLIVE WIRE 0.062

Facility

$54.00

Service Code	HCPCS C1713
Hospital Charge Code	8759904
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of IA Commercial	$48.60
Rate for Payer: Aetna of IA Medical Rental Products	$48.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.50
Rate for Payer: Medical Associates Commercial	$40.50
Rate for Payer: Midlands Choice Commercial	$37.80
Rate for Payer: United Healthcare Commercial	$48.60

OLIVE WIRE 0.062

Facility

$54.00

Service Code	HCPCS C1713
Hospital Charge Code	8759904
Hospital Revenue Code	278
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of IA Commercial	$48.60
Rate for Payer: Aetna of IA Medical Rental Products	$48.60
Rate for Payer: Aetna of IA Medicare	$30.78
Rate for Payer: Amerigroup Medicaid	$31.15
Rate for Payer: Amerigroup Medicare	$24.54
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.30
Rate for Payer: Iowa Total Care Managed Medicaid	$30.84
Rate for Payer: Medical Associates Commercial	$40.50
Rate for Payer: Medical Associates Managed Medicare	$24.30
Rate for Payer: Midlands Choice Commercial	$37.80
Rate for Payer: Molina Healthcare Managed Medicaid	$31.30
Rate for Payer: Partners Health Alliance Commercial	$27.95
Rate for Payer: United Healthcare Commercial	$48.60
Rate for Payer: United Healthcare Managed Medicare	$31.86

OLIVE WIRE 1.4MM

Facility

$172.00

Hospital Charge Code	8047370
Hospital Revenue Code	278
Min. Negotiated Rate	$120.40
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of IA Commercial	$154.80
Rate for Payer: Aetna of IA Medical Rental Products	$154.80
Rate for Payer: Cash Price	$137.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$129.00
Rate for Payer: Medical Associates Commercial	$129.00
Rate for Payer: Midlands Choice Commercial	$120.40
Rate for Payer: United Healthcare Commercial	$154.80

OLIVE WIRE 1.4MM

Facility

$172.00

Hospital Charge Code	8047370
Hospital Revenue Code	278
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of IA Commercial	$154.80
Rate for Payer: Aetna of IA Medical Rental Products	$154.80
Rate for Payer: Aetna of IA Medicare	$98.04
Rate for Payer: Amerigroup Medicaid	$99.21
Rate for Payer: Amerigroup Medicare	$78.17
Rate for Payer: Cash Price	$137.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$129.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$77.40
Rate for Payer: Iowa Total Care Managed Medicaid	$98.25
Rate for Payer: Medical Associates Commercial	$129.00
Rate for Payer: Medical Associates Managed Medicare	$77.40
Rate for Payer: Midlands Choice Commercial	$120.40
Rate for Payer: Molina Healthcare Managed Medicaid	$99.69
Rate for Payer: Partners Health Alliance Commercial	$89.01
Rate for Payer: United Healthcare Commercial	$154.80
Rate for Payer: United Healthcare Managed Medicare	$101.48

olmesartan 20 mg Tab [VDMC]

Facility

$1.29

Service Code	HCPCS A9270
Hospital Charge Code	10410207
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of IA Commercial	$1.16
Rate for Payer: Aetna of IA Medical Rental Products	$1.16
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.97
Rate for Payer: Medical Associates Commercial	$0.97
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.16

Know your out-of-pocket cost for care.

All Charges