Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

94625 : Pulmonary rehabilitation without continuous oximetry

Facility

$239.00

Service Code	CPT 94625
Hospital Charge Code	8873990
Hospital Revenue Code	948
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

94727 LUNG VOLUMES CHARGE

Facility

$260.00

Service Code	CPT 94727
Hospital Charge Code	8036951
Hospital Revenue Code	460
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Aetna of IA Medicare	$148.20
Rate for Payer: Amerigroup Medicaid	$149.97
Rate for Payer: Amerigroup Medicare	$118.17
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$117.00
Rate for Payer: Iowa Total Care Managed Medicaid	$148.51
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Medical Associates Managed Medicare	$117.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: Molina Healthcare Managed Medicaid	$150.70
Rate for Payer: Partners Health Alliance Commercial	$134.55
Rate for Payer: United Healthcare Commercial	$234.00
Rate for Payer: United Healthcare Managed Medicare	$153.40
Rate for Payer: Wellmark IA HMO WHPI	$185.05
Rate for Payer: Wellmark IA PPO	$203.84

94727 LUNG VOLUMES CHARGE

Facility

$260.00

Service Code	CPT 94727
Hospital Charge Code	8036951
Hospital Revenue Code	460
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: United Healthcare Commercial	$234.00

94729 DLCO CHARGE

Facility

$260.00

Service Code	CPT 94729
Hospital Charge Code	8051727
Hospital Revenue Code	460
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Aetna of IA Medicare	$148.20
Rate for Payer: Amerigroup Medicaid	$149.97
Rate for Payer: Amerigroup Medicare	$118.17
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$117.00
Rate for Payer: Iowa Total Care Managed Medicaid	$148.51
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Medical Associates Managed Medicare	$117.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: Molina Healthcare Managed Medicaid	$150.70
Rate for Payer: Partners Health Alliance Commercial	$134.55
Rate for Payer: United Healthcare Commercial	$234.00
Rate for Payer: United Healthcare Managed Medicare	$153.40
Rate for Payer: Wellmark IA HMO WHPI	$185.05
Rate for Payer: Wellmark IA PPO	$203.84

94729 DLCO CHARGE

Facility

$260.00

Service Code	CPT 94729
Hospital Charge Code	8051727
Hospital Revenue Code	460
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of IA Commercial	$234.00
Rate for Payer: Aetna of IA Medical Rental Products	$234.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.00
Rate for Payer: Medical Associates Commercial	$195.00
Rate for Payer: Midlands Choice Commercial	$182.00
Rate for Payer: United Healthcare Commercial	$234.00

95800 SLEEP STUDY UNATTENDED

Facility

$350.00

Service Code	CPT 95800
Hospital Charge Code	6608790
Hospital Revenue Code	920
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$618.55
Rate for Payer: Aetna of IA Commercial	$315.00
Rate for Payer: Aetna of IA Medical Rental Products	$315.00
Rate for Payer: Aetna of IA Medicare	$199.50
Rate for Payer: Amerigroup Medicaid	$201.88
Rate for Payer: Amerigroup Medicare	$159.08
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$262.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$157.50
Rate for Payer: Iowa Total Care Managed Medicaid	$199.92
Rate for Payer: Medical Associates Commercial	$262.50
Rate for Payer: Medical Associates Managed Medicare	$157.50
Rate for Payer: Midlands Choice Commercial	$245.00
Rate for Payer: Molina Healthcare Managed Medicaid	$202.86
Rate for Payer: Partners Health Alliance Commercial	$181.12
Rate for Payer: United Healthcare Commercial	$315.00
Rate for Payer: United Healthcare Managed Medicare	$206.50
Rate for Payer: Wellmark IA HMO WHPI	$561.53
Rate for Payer: Wellmark IA PPO	$618.55

95800 SLEEP STUDY UNATTENDED

Facility

$350.00

Service Code	CPT 95800
Hospital Charge Code	6608790
Hospital Revenue Code	920
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna of IA Commercial	$315.00
Rate for Payer: Aetna of IA Medical Rental Products	$315.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$262.50
Rate for Payer: Medical Associates Commercial	$262.50
Rate for Payer: Midlands Choice Commercial	$245.00
Rate for Payer: United Healthcare Commercial	$315.00

95806 SLEEP STUDY UNATT AND RESP EFFT

Facility

$657.00

Service Code	CPT 95806
Hospital Charge Code	7832544
Hospital Revenue Code	920
Min. Negotiated Rate	$459.90
Max. Negotiated Rate	$591.30
Rate for Payer: Aetna of IA Commercial	$591.30
Rate for Payer: Aetna of IA Medical Rental Products	$591.30
Rate for Payer: Cash Price	$525.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$492.75
Rate for Payer: Medical Associates Commercial	$492.75
Rate for Payer: Midlands Choice Commercial	$459.90
Rate for Payer: United Healthcare Commercial	$591.30

95806 SLEEP STUDY UNATT AND RESP EFFT

Facility

$657.00

Service Code	CPT 95806
Hospital Charge Code	7832544
Hospital Revenue Code	920
Min. Negotiated Rate	$295.65
Max. Negotiated Rate	$618.55
Rate for Payer: Aetna of IA Commercial	$591.30
Rate for Payer: Aetna of IA Medical Rental Products	$591.30
Rate for Payer: Aetna of IA Medicare	$374.49
Rate for Payer: Amerigroup Medicaid	$378.96
Rate for Payer: Amerigroup Medicare	$298.61
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$492.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$295.65
Rate for Payer: Iowa Total Care Managed Medicaid	$375.28
Rate for Payer: Medical Associates Commercial	$492.75
Rate for Payer: Medical Associates Managed Medicare	$295.65
Rate for Payer: Midlands Choice Commercial	$459.90
Rate for Payer: Molina Healthcare Managed Medicaid	$380.80
Rate for Payer: Partners Health Alliance Commercial	$340.00
Rate for Payer: United Healthcare Commercial	$591.30
Rate for Payer: United Healthcare Managed Medicare	$387.63
Rate for Payer: Wellmark IA HMO WHPI	$561.53
Rate for Payer: Wellmark IA PPO	$618.55

99215 ESTAB PATIENT COMPREHENSIVE CHARGE

Professional

Both

$478.00

Service Code	CPT 99215
Hospital Charge Code	8101318
Hospital Revenue Code	983
Min. Negotiated Rate	$101.95
Max. Negotiated Rate	$358.50
Rate for Payer: Amerigroup Medicaid	$102.95
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cash Price	$382.40
Rate for Payer: Iowa Total Care Managed Medicaid	$101.95
Rate for Payer: Medical Associates Commercial	$358.50
Rate for Payer: Midlands Choice Commercial	$334.60
Rate for Payer: Molina Healthcare Managed Medicaid	$102.45
Rate for Payer: Partners Health Alliance Commercial	$358.50
Rate for Payer: United Healthcare Commercial	$159.85
Rate for Payer: Wellmark IA HMO WHPI	$258.00
Rate for Payer: Wellmark IA PPO	$258.00

99217 HSPTLST OBS DISCHDAY MGMT CHARGE

Professional

Both

$120.00

Service Code	CPT 99217
Hospital Charge Code	5136782
Hospital Revenue Code	983
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$116.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Medical Associates Commercial	$90.00
Rate for Payer: Midlands Choice Commercial	$84.00
Rate for Payer: Partners Health Alliance Commercial	$90.00
Rate for Payer: Wellmark IA HMO WHPI	$116.00
Rate for Payer: Wellmark IA PPO	$116.00

9 HOLE VL GRIDLOCK FIBULA PLATE

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Charge Code	8773163
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna of IA Commercial	$1,620.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,620.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,350.00
Rate for Payer: Medical Associates Commercial	$1,350.00
Rate for Payer: Midlands Choice Commercial	$1,260.00
Rate for Payer: United Healthcare Commercial	$1,620.00

9 HOLE VL GRIDLOCK FIBULA PLATE

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Charge Code	8773163
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna of IA Commercial	$1,620.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,620.00
Rate for Payer: Aetna of IA Medicare	$1,026.00
Rate for Payer: Amerigroup Medicaid	$1,038.24
Rate for Payer: Amerigroup Medicare	$818.10
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,350.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$810.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,028.16
Rate for Payer: Medical Associates Commercial	$1,350.00
Rate for Payer: Medical Associates Managed Medicare	$810.00
Rate for Payer: Midlands Choice Commercial	$1,260.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,043.28
Rate for Payer: Partners Health Alliance Commercial	$931.50
Rate for Payer: United Healthcare Commercial	$1,620.00
Rate for Payer: United Healthcare Managed Medicare	$1,062.00

abatacept 250 mg IV Inj SDV [VDMC]

Facility

$3,021.40

Service Code	HCPCS J0129
Hospital Charge Code	10362091
Hospital Revenue Code	259
Min. Negotiated Rate	$1,359.63
Max. Negotiated Rate	$2,719.26
Rate for Payer: Aetna of IA Commercial	$2,719.26
Rate for Payer: Aetna of IA Medical Rental Products	$2,719.26
Rate for Payer: Aetna of IA Medicare	$1,722.20
Rate for Payer: Amerigroup Medicaid	$1,742.74
Rate for Payer: Amerigroup Medicare	$1,373.23
Rate for Payer: Cash Price	$2,417.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,266.05
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,359.63
Rate for Payer: Iowa Total Care Managed Medicaid	$1,725.82
Rate for Payer: Medical Associates Commercial	$2,266.05
Rate for Payer: Medical Associates Managed Medicare	$1,359.63
Rate for Payer: Midlands Choice Commercial	$2,114.98
Rate for Payer: Molina Healthcare Managed Medicaid	$1,751.20
Rate for Payer: Partners Health Alliance Commercial	$1,563.57
Rate for Payer: United Healthcare Commercial	$2,719.26
Rate for Payer: United Healthcare Managed Medicare	$1,782.63

abatacept 250 mg IV Inj SDV [VDMC]

Facility

$3,021.40

Service Code	HCPCS J0129
Hospital Charge Code	10362091
Hospital Revenue Code	259
Min. Negotiated Rate	$2,114.98
Max. Negotiated Rate	$2,719.26
Rate for Payer: Aetna of IA Commercial	$2,719.26
Rate for Payer: Aetna of IA Medical Rental Products	$2,719.26
Rate for Payer: Cash Price	$2,417.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,266.05
Rate for Payer: Medical Associates Commercial	$2,266.05
Rate for Payer: Midlands Choice Commercial	$2,114.98
Rate for Payer: United Healthcare Commercial	$2,719.26

ABDOMEN SURGERY PROCEDURE

Facility

$2,025.00

Service Code	CPT 49999
Hospital Charge Code	7982912
Hospital Revenue Code	450
Min. Negotiated Rate	$911.25
Max. Negotiated Rate	$1,822.50
Rate for Payer: Aetna of IA Commercial	$1,822.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,822.50
Rate for Payer: Aetna of IA Medicare	$1,154.25
Rate for Payer: Amerigroup Medicaid	$1,168.02
Rate for Payer: Amerigroup Medicare	$920.36
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,518.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$911.25
Rate for Payer: Iowa Total Care Managed Medicaid	$1,156.68
Rate for Payer: Medical Associates Commercial	$1,518.75
Rate for Payer: Medical Associates Managed Medicare	$911.25
Rate for Payer: Midlands Choice Commercial	$1,417.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,173.69
Rate for Payer: Partners Health Alliance Commercial	$1,047.94
Rate for Payer: United Healthcare Commercial	$1,822.50
Rate for Payer: United Healthcare Managed Medicare	$1,194.75
Rate for Payer: Wellmark IA HMO WHPI	$1,506.63
Rate for Payer: Wellmark IA PPO	$1,659.63

ABDOMEN SURGERY PROCEDURE

Facility

$2,025.00

Service Code	CPT 49999
Hospital Charge Code	7982912
Hospital Revenue Code	450
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$1,822.50
Rate for Payer: Aetna of IA Commercial	$1,822.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,822.50
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,518.75
Rate for Payer: Medical Associates Commercial	$1,518.75
Rate for Payer: Midlands Choice Commercial	$1,417.50
Rate for Payer: United Healthcare Commercial	$1,822.50

ABDOMINAL/FEMORAL BLOCK CHARGE

Facility

$315.00

Hospital Charge Code	8059069
Hospital Revenue Code	361
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

ABDOMINAL/FEMORAL BLOCK CHARGE

Facility

$315.00

Hospital Charge Code	8059069
Hospital Revenue Code	361
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

Abdominal paracentesis w/ abdominal imaging

Professional

Both

$975.00

Service Code	CPT 49083
Hospital Charge Code	8068992
Hospital Revenue Code	975
Min. Negotiated Rate	$273.53
Max. Negotiated Rate	$731.25
Rate for Payer: Amerigroup Medicaid	$276.22
Rate for Payer: Cash Price	$780.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Iowa Total Care Managed Medicaid	$273.53
Rate for Payer: Medical Associates Commercial	$731.25
Rate for Payer: Midlands Choice Commercial	$682.50
Rate for Payer: Molina Healthcare Managed Medicaid	$274.87
Rate for Payer: Partners Health Alliance Commercial	$731.25
Rate for Payer: United Healthcare Commercial	$454.03
Rate for Payer: Wellmark IA HMO WHPI	$558.20
Rate for Payer: Wellmark IA PPO	$656.70

ABD PARACENTESIS

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	4862794
Hospital Revenue Code	450
Min. Negotiated Rate	$309.60
Max. Negotiated Rate	$1,659.63
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Aetna of IA Medicare	$392.16
Rate for Payer: Amerigroup Medicaid	$396.84
Rate for Payer: Amerigroup Medicare	$312.70
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$309.60
Rate for Payer: Iowa Total Care Managed Medicaid	$392.99
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Medical Associates Managed Medicare	$309.60
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: Molina Healthcare Managed Medicaid	$398.76
Rate for Payer: Partners Health Alliance Commercial	$356.04
Rate for Payer: United Healthcare Commercial	$619.20
Rate for Payer: United Healthcare Managed Medicare	$405.92
Rate for Payer: Wellmark IA HMO WHPI	$1,506.63
Rate for Payer: Wellmark IA PPO	$1,659.63

ABD PARACENTESIS

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	4862794
Hospital Revenue Code	450
Min. Negotiated Rate	$481.60
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: United Healthcare Commercial	$619.20

ABO PARACENTESIS

Professional

Both

$319.00

Service Code	CPT 49082
Hospital Charge Code	4658905
Hospital Revenue Code	975
Min. Negotiated Rate	$145.51
Max. Negotiated Rate	$478.80
Rate for Payer: Amerigroup Medicaid	$146.94
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Iowa Total Care Managed Medicaid	$145.51
Rate for Payer: Medical Associates Commercial	$239.25
Rate for Payer: Midlands Choice Commercial	$223.30
Rate for Payer: Molina Healthcare Managed Medicaid	$146.23
Rate for Payer: Partners Health Alliance Commercial	$239.25
Rate for Payer: United Healthcare Commercial	$306.45
Rate for Payer: Wellmark IA HMO WHPI	$407.00
Rate for Payer: Wellmark IA PPO	$478.80

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$6,968.67

Service Code	MSDRG 770
Min. Negotiated Rate	$6,867.67
Max. Negotiated Rate	$6,968.67
Rate for Payer: Amerigroup Medicaid	$6,935.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,867.67
Rate for Payer: Molina Healthcare Managed Medicaid	$6,968.67

ABORTION WITHOUT D&C

Facility

$5,528.55

Service Code	MSDRG 779
Min. Negotiated Rate	$5,448.42
Max. Negotiated Rate	$5,528.55
Rate for Payer: Amerigroup Medicaid	$5,501.84
Rate for Payer: Iowa Total Care Managed Medicaid	$5,448.42
Rate for Payer: Molina Healthcare Managed Medicaid	$5,528.55

Know your out-of-pocket cost for care.

All Charges