Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

rabies vaccine, purified chick embryo cell 2.5 intl units SDV Pow[VDMC]

Facility

$1,542.88

Service Code	HCPCS 90675
Hospital Charge Code	18398617
Hospital Revenue Code	259
Min. Negotiated Rate	$1,080.02
Max. Negotiated Rate	$1,388.59
Rate for Payer: Aetna of IA Commercial	$1,388.59
Rate for Payer: Aetna of IA Medical Rental Products	$1,388.59
Rate for Payer: Cash Price	$1,234.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,157.16
Rate for Payer: Medical Associates Commercial	$1,157.16
Rate for Payer: Midlands Choice Commercial	$1,080.02
Rate for Payer: United Healthcare Commercial	$1,388.59

racepinephrine 2.25% Sol UD [VDMC]

Facility

$7.67

Service Code	HCPCS A9270
Hospital Charge Code	10437426
Hospital Revenue Code	259
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna of IA Commercial	$6.90
Rate for Payer: Aetna of IA Medical Rental Products	$6.90
Rate for Payer: Aetna of IA Medicare	$4.37
Rate for Payer: Amerigroup Medicaid	$4.42
Rate for Payer: Amerigroup Medicare	$3.48
Rate for Payer: Cash Price	$6.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$3.45
Rate for Payer: Iowa Total Care Managed Medicaid	$4.38
Rate for Payer: Medical Associates Commercial	$5.75
Rate for Payer: Medical Associates Managed Medicare	$3.45
Rate for Payer: Midlands Choice Commercial	$5.37
Rate for Payer: Molina Healthcare Managed Medicaid	$4.44
Rate for Payer: Partners Health Alliance Commercial	$3.97
Rate for Payer: United Healthcare Commercial	$6.90
Rate for Payer: United Healthcare Managed Medicare	$4.52

racepinephrine 2.25% Sol UD [VDMC]

Facility

$7.67

Service Code	HCPCS A9270
Hospital Charge Code	10437426
Hospital Revenue Code	259
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna of IA Commercial	$6.90
Rate for Payer: Aetna of IA Medical Rental Products	$6.90
Rate for Payer: Cash Price	$6.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$5.75
Rate for Payer: Medical Associates Commercial	$5.75
Rate for Payer: Midlands Choice Commercial	$5.37
Rate for Payer: United Healthcare Commercial	$6.90

RADIOTHERAPY

Facility

$28,015.43

Service Code	MSDRG 849
Min. Negotiated Rate	$27,609.40
Max. Negotiated Rate	$28,015.43
Rate for Payer: Amerigroup Medicaid	$27,880.08
Rate for Payer: Iowa Total Care Managed Medicaid	$27,609.40
Rate for Payer: Molina Healthcare Managed Medicaid	$28,015.43

raloxifene 60 mg Tab[VDMC]

Facility

$2.60

Service Code	HCPCS A9270
Hospital Charge Code	11522776
Hospital Revenue Code	259
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of IA Commercial	$2.34
Rate for Payer: Aetna of IA Medical Rental Products	$2.34
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.95
Rate for Payer: Medical Associates Commercial	$1.95
Rate for Payer: Midlands Choice Commercial	$1.82
Rate for Payer: United Healthcare Commercial	$2.34

raloxifene 60 mg Tab[VDMC]

Facility

$2.60

Service Code	HCPCS A9270
Hospital Charge Code	11522776
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of IA Commercial	$2.34
Rate for Payer: Aetna of IA Medical Rental Products	$2.34
Rate for Payer: Aetna of IA Medicare	$1.48
Rate for Payer: Amerigroup Medicaid	$1.50
Rate for Payer: Amerigroup Medicare	$1.18
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.17
Rate for Payer: Iowa Total Care Managed Medicaid	$1.49
Rate for Payer: Medical Associates Commercial	$1.95
Rate for Payer: Medical Associates Managed Medicare	$1.17
Rate for Payer: Midlands Choice Commercial	$1.82
Rate for Payer: Molina Healthcare Managed Medicaid	$1.51
Rate for Payer: Partners Health Alliance Commercial	$1.35
Rate for Payer: United Healthcare Commercial	$2.34
Rate for Payer: United Healthcare Managed Medicare	$1.53

ramipril 1.25 mg Cap [VDMC]

Facility

$1.30

Service Code	HCPCS A9270
Hospital Charge Code	10418397
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of IA Commercial	$1.17
Rate for Payer: Aetna of IA Medical Rental Products	$1.17
Rate for Payer: Aetna of IA Medicare	$0.74
Rate for Payer: Amerigroup Medicaid	$0.75
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.59
Rate for Payer: Iowa Total Care Managed Medicaid	$0.74
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Medical Associates Managed Medicare	$0.59
Rate for Payer: Midlands Choice Commercial	$0.91
Rate for Payer: Molina Healthcare Managed Medicaid	$0.76
Rate for Payer: Partners Health Alliance Commercial	$0.67
Rate for Payer: United Healthcare Commercial	$1.17
Rate for Payer: United Healthcare Managed Medicare	$0.77

ramipril 1.25 mg Cap [VDMC]

Facility

$1.30

Service Code	HCPCS A9270
Hospital Charge Code	10418397
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of IA Commercial	$1.17
Rate for Payer: Aetna of IA Medical Rental Products	$1.17
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Midlands Choice Commercial	$0.91
Rate for Payer: United Healthcare Commercial	$1.17

ramipril 5 mg Cap [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10418535
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Aetna of IA Medicare	$0.63
Rate for Payer: Amerigroup Medicaid	$0.64
Rate for Payer: Amerigroup Medicare	$0.50
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.50
Rate for Payer: Iowa Total Care Managed Medicaid	$0.63
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Medical Associates Managed Medicare	$0.50
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: Molina Healthcare Managed Medicaid	$0.64
Rate for Payer: Partners Health Alliance Commercial	$0.57
Rate for Payer: United Healthcare Commercial	$1.00
Rate for Payer: United Healthcare Managed Medicare	$0.65

ramipril 5 mg Cap [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10418535
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.00

RANGE OF MOTION (NOT HAND)

Facility

$50.00

Service Code	CPT 95851 GP
Hospital Charge Code	6344972
Hospital Revenue Code	420
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of IA Commercial	$45.00
Rate for Payer: Aetna of IA Medical Rental Products	$45.00
Rate for Payer: Aetna of IA Medicare	$28.50
Rate for Payer: Amerigroup Medicaid	$28.84
Rate for Payer: Amerigroup Medicare	$22.72
Rate for Payer: Cash Price	$40.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$37.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$22.50
Rate for Payer: Iowa Total Care Managed Medicaid	$28.56
Rate for Payer: Medical Associates Commercial	$37.50
Rate for Payer: Medical Associates Managed Medicare	$22.50
Rate for Payer: Midlands Choice Commercial	$35.00
Rate for Payer: Molina Healthcare Managed Medicaid	$28.98
Rate for Payer: Partners Health Alliance Commercial	$25.88
Rate for Payer: United Healthcare Commercial	$45.00
Rate for Payer: United Healthcare Managed Medicare	$29.50

RANGE OF MOTION (NOT HAND)

Facility

$50.00

Service Code	CPT 95851 GP
Hospital Charge Code	6344972
Hospital Revenue Code	420
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of IA Commercial	$45.00
Rate for Payer: Aetna of IA Medical Rental Products	$45.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$37.50
Rate for Payer: Medical Associates Commercial	$37.50
Rate for Payer: Midlands Choice Commercial	$35.00
Rate for Payer: United Healthcare Commercial	$45.00

ranolazine 500 mg oral ER (12hr) Tab [VDMC]

Facility

$2.81

Service Code	HCPCS A9270
Hospital Charge Code	10418675
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna of IA Commercial	$2.53
Rate for Payer: Aetna of IA Medical Rental Products	$2.53
Rate for Payer: Aetna of IA Medicare	$1.60
Rate for Payer: Amerigroup Medicaid	$1.62
Rate for Payer: Amerigroup Medicare	$1.28
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.26
Rate for Payer: Iowa Total Care Managed Medicaid	$1.60
Rate for Payer: Medical Associates Commercial	$2.11
Rate for Payer: Medical Associates Managed Medicare	$1.26
Rate for Payer: Midlands Choice Commercial	$1.97
Rate for Payer: Molina Healthcare Managed Medicaid	$1.63
Rate for Payer: Partners Health Alliance Commercial	$1.45
Rate for Payer: United Healthcare Commercial	$2.53
Rate for Payer: United Healthcare Managed Medicare	$1.66

ranolazine 500 mg oral ER (12hr) Tab [VDMC]

Facility

$2.81

Service Code	HCPCS A9270
Hospital Charge Code	10418675
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna of IA Commercial	$2.53
Rate for Payer: Aetna of IA Medical Rental Products	$2.53
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.11
Rate for Payer: Medical Associates Commercial	$2.11
Rate for Payer: Midlands Choice Commercial	$1.97
Rate for Payer: United Healthcare Commercial	$2.53

Rapid Plasma Reagin DMCL

Facility

$58.00

Service Code	CPT 86592
Hospital Charge Code	8037793
Hospital Revenue Code	302
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$33.45
Rate for Payer: Amerigroup Medicare	$26.36
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.10
Rate for Payer: Iowa Total Care Managed Medicaid	$33.13
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$26.10
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$33.62
Rate for Payer: Partners Health Alliance Commercial	$30.02
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

Rapid Plasma Reagin DMCL

Facility

$58.00

Service Code	CPT 86592
Hospital Charge Code	8037793
Hospital Revenue Code	302
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

rasagiline 1 mg oral tablet [VDMC]

Facility

$11.60

Service Code	HCPCS A9270
Hospital Charge Code	10418744
Hospital Revenue Code	259
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna of IA Commercial	$10.44
Rate for Payer: Aetna of IA Medical Rental Products	$10.44
Rate for Payer: Aetna of IA Medicare	$6.61
Rate for Payer: Amerigroup Medicaid	$6.69
Rate for Payer: Amerigroup Medicare	$5.27
Rate for Payer: Cash Price	$9.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.70
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.22
Rate for Payer: Iowa Total Care Managed Medicaid	$6.63
Rate for Payer: Medical Associates Commercial	$8.70
Rate for Payer: Medical Associates Managed Medicare	$5.22
Rate for Payer: Midlands Choice Commercial	$8.12
Rate for Payer: Molina Healthcare Managed Medicaid	$6.73
Rate for Payer: Partners Health Alliance Commercial	$6.01
Rate for Payer: United Healthcare Commercial	$10.44
Rate for Payer: United Healthcare Managed Medicare	$6.85

rasagiline 1 mg oral tablet [VDMC]

Facility

$11.60

Service Code	HCPCS A9270
Hospital Charge Code	10418744
Hospital Revenue Code	259
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna of IA Commercial	$10.44
Rate for Payer: Aetna of IA Medical Rental Products	$10.44
Rate for Payer: Cash Price	$9.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.70
Rate for Payer: Medical Associates Commercial	$8.70
Rate for Payer: Midlands Choice Commercial	$8.12
Rate for Payer: United Healthcare Commercial	$10.44

RBC AUTOMATED CELL COUNT

Facility

$34.00

Service Code	CPT 85041
Hospital Charge Code	4006787
Hospital Revenue Code	305
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$32.02
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Aetna of IA Medicare	$19.38
Rate for Payer: Amerigroup Medicaid	$19.61
Rate for Payer: Amerigroup Medicare	$15.45
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.30
Rate for Payer: Iowa Total Care Managed Medicaid	$19.42
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Medical Associates Managed Medicare	$15.30
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: Molina Healthcare Managed Medicaid	$19.71
Rate for Payer: Partners Health Alliance Commercial	$17.60
Rate for Payer: United Healthcare Commercial	$30.60
Rate for Payer: United Healthcare Managed Medicare	$20.06
Rate for Payer: Wellmark IA HMO WHPI	$29.07
Rate for Payer: Wellmark IA PPO	$32.02

RBC AUTOMATED CELL COUNT

Facility

$34.00

Service Code	CPT 85041
Hospital Charge Code	4006787
Hospital Revenue Code	305
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$30.60

RBC Folate DMCL

Facility

$165.00

Service Code	CPT 82747
Hospital Charge Code	8037794
Hospital Revenue Code	301
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of IA Commercial	$148.50
Rate for Payer: Aetna of IA Medical Rental Products	$148.50
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.75
Rate for Payer: Medical Associates Commercial	$123.75
Rate for Payer: Midlands Choice Commercial	$115.50
Rate for Payer: United Healthcare Commercial	$148.50

RBC Folate DMCL

Facility

$165.00

Service Code	CPT 82747
Hospital Charge Code	8037794
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of IA Commercial	$148.50
Rate for Payer: Aetna of IA Medical Rental Products	$148.50
Rate for Payer: Aetna of IA Medicare	$94.05
Rate for Payer: Amerigroup Medicaid	$95.17
Rate for Payer: Amerigroup Medicare	$74.99
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$123.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$74.25
Rate for Payer: Iowa Total Care Managed Medicaid	$94.25
Rate for Payer: Medical Associates Commercial	$123.75
Rate for Payer: Medical Associates Managed Medicare	$74.25
Rate for Payer: Midlands Choice Commercial	$115.50
Rate for Payer: Molina Healthcare Managed Medicaid	$95.63
Rate for Payer: Partners Health Alliance Commercial	$85.39
Rate for Payer: United Healthcare Commercial	$148.50
Rate for Payer: United Healthcare Managed Medicare	$97.35
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

REAMER, LOW PROFILE

Facility

$351.00

Hospital Charge Code	8047061
Hospital Revenue Code	278
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Aetna of IA Medicare	$200.07
Rate for Payer: Amerigroup Medicaid	$202.46
Rate for Payer: Amerigroup Medicare	$159.53
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$157.95
Rate for Payer: Iowa Total Care Managed Medicaid	$200.49
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Medical Associates Managed Medicare	$157.95
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: Molina Healthcare Managed Medicaid	$203.44
Rate for Payer: Partners Health Alliance Commercial	$181.64
Rate for Payer: United Healthcare Commercial	$315.90
Rate for Payer: United Healthcare Managed Medicare	$207.09

REAMER, LOW PROFILE

Facility

$351.00

Hospital Charge Code	8047061
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: United Healthcare Commercial	$315.90

REAMER SHAFT 8.0X448MM

Facility

$355.00

Hospital Charge Code	8025851
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of IA Commercial	$319.50
Rate for Payer: Aetna of IA Medical Rental Products	$319.50
Rate for Payer: Cash Price	$284.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$266.25
Rate for Payer: Medical Associates Commercial	$266.25
Rate for Payer: Midlands Choice Commercial	$248.50
Rate for Payer: United Healthcare Commercial	$319.50

Know your out-of-pocket cost for care.

All Charges