Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

1.6MM COMPRESSION WIRE X 150MM

Facility

$71.00

Service Code	CPT C1763
Hospital Charge Code	8748467
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of IA Commercial	$63.90
Rate for Payer: Aetna of IA Medical Rental Products	$63.90
Rate for Payer: Cash Price	$56.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$53.25
Rate for Payer: Medical Associates Commercial	$53.25
Rate for Payer: Midlands Choice Commercial	$49.70
Rate for Payer: United Healthcare Commercial	$63.90

1.6MM KIRSCHNER WIRE X 150MM

Facility

$159.00

Service Code	CPT C1763
Hospital Charge Code	8748487
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: United Healthcare Commercial	$143.10

1.6MM KIRSCHNER WIRE X 150MM

Facility

$159.00

Service Code	CPT C1763
Hospital Charge Code	8748487
Hospital Revenue Code	278
Min. Negotiated Rate	$79.47
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of IA Commercial	$143.10
Rate for Payer: Aetna of IA Medical Rental Products	$143.10
Rate for Payer: Aetna of IA Medicare	$90.63
Rate for Payer: Amerigroup Medicaid	$80.25
Rate for Payer: Amerigroup Medicare	$80.30
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$119.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$79.50
Rate for Payer: Iowa Total Care Managed Medicaid	$79.47
Rate for Payer: Medical Associates Commercial	$119.25
Rate for Payer: Medical Associates Managed Medicare	$79.50
Rate for Payer: Midlands Choice Commercial	$111.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.69
Rate for Payer: Molina Healthcare Managed Medicare	$80.64
Rate for Payer: Oscar Health of IA Commercial	$119.25
Rate for Payer: Partners Health Alliance Commercial	$119.25
Rate for Payer: United Healthcare Commercial	$143.10
Rate for Payer: United Healthcare Managed Medicare	$93.81

17110 Destruction of benign lesions up to 14 lesions

Professional

Both

$366.00

Service Code	CPT 17110
Hospital Charge Code	8799108
Hospital Revenue Code	975
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$140.02
Rate for Payer: Aetna of IA Medicare	$62.83
Rate for Payer: Amerigroup Medicaid	$64.97
Rate for Payer: Cash Price	$292.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.40
Rate for Payer: Iowa Total Care Managed Medicaid	$64.09
Rate for Payer: Medical Associates Commercial	$119.38
Rate for Payer: Medical Associates Managed Medicare	$62.83
Rate for Payer: Midlands Choice Commercial	$140.02
Rate for Payer: Oscar Health of IA Commercial	$108.70
Rate for Payer: Partners Health Alliance Commercial	$94.24

18MMX15MMX15MM SNIPER STAPLE

Facility

$1,629.00

Service Code	CPT C1713
Hospital Charge Code	8857932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,140.30
Max. Negotiated Rate	$1,466.10
Rate for Payer: Aetna of IA Commercial	$1,466.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,466.10
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,221.75
Rate for Payer: Medical Associates Commercial	$1,221.75
Rate for Payer: Midlands Choice Commercial	$1,140.30
Rate for Payer: United Healthcare Commercial	$1,466.10

18MMX15MMX15MM SNIPER STAPLE

Facility

$1,629.00

Service Code	CPT C1713
Hospital Charge Code	8857932
Hospital Revenue Code	278
Min. Negotiated Rate	$814.17
Max. Negotiated Rate	$1,466.10
Rate for Payer: Aetna of IA Commercial	$1,466.10
Rate for Payer: Aetna of IA Medical Rental Products	$1,466.10
Rate for Payer: Aetna of IA Medicare	$928.53
Rate for Payer: Amerigroup Medicaid	$822.16
Rate for Payer: Amerigroup Medicare	$822.64
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,221.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$814.50
Rate for Payer: Iowa Total Care Managed Medicaid	$814.17
Rate for Payer: Medical Associates Commercial	$1,221.75
Rate for Payer: Medical Associates Managed Medicare	$814.50
Rate for Payer: Midlands Choice Commercial	$1,140.30
Rate for Payer: Molina Healthcare Managed Medicaid	$826.72
Rate for Payer: Molina Healthcare Managed Medicare	$826.23
Rate for Payer: Oscar Health of IA Commercial	$1,221.75
Rate for Payer: Partners Health Alliance Commercial	$1,221.75
Rate for Payer: United Healthcare Commercial	$1,466.10
Rate for Payer: United Healthcare Managed Medicare	$961.11

19100 BREAST BIOPSY NEEDLE CORE

Professional

Both

$499.00

Service Code	CPT 19100
Hospital Charge Code	8069039
Min. Negotiated Rate	$60.57
Max. Negotiated Rate	$374.25
Rate for Payer: Amerigroup Medicaid	$62.63
Rate for Payer: Cash Price	$399.20
Rate for Payer: Cash Price	$399.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$72.68
Rate for Payer: Iowa Total Care Managed Medicaid	$61.78
Rate for Payer: Medical Associates Commercial	$374.25
Rate for Payer: Medical Associates Managed Medicare	$60.57
Rate for Payer: Midlands Choice Commercial	$349.30
Rate for Payer: Oscar Health of IA Commercial	$104.79
Rate for Payer: Partners Health Alliance Commercial	$90.86

19120 REMOVAL OF BREAST LESION

Professional

Both

$1,643.00

Service Code	CPT 19120
Hospital Charge Code	8069146
Hospital Revenue Code	975
Min. Negotiated Rate	$373.39
Max. Negotiated Rate	$1,150.10
Rate for Payer: Aetna of IA Medicare	$373.39
Rate for Payer: Amerigroup Medicaid	$386.09
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$448.07
Rate for Payer: Iowa Total Care Managed Medicaid	$380.86
Rate for Payer: Medical Associates Commercial	$709.44
Rate for Payer: Medical Associates Managed Medicare	$373.39
Rate for Payer: Midlands Choice Commercial	$1,150.10
Rate for Payer: Oscar Health of IA Commercial	$645.96
Rate for Payer: Partners Health Alliance Commercial	$560.08

19301 MASTECTOMY PARTIAL

Professional

Both

$2,189.00

Service Code	CPT 19301
Hospital Charge Code	8069176
Hospital Revenue Code	975
Min. Negotiated Rate	$586.45
Max. Negotiated Rate	$1,532.30
Rate for Payer: Aetna of IA Medicare	$586.45
Rate for Payer: Amerigroup Medicaid	$606.39
Rate for Payer: Cash Price	$1,751.20
Rate for Payer: Cash Price	$1,751.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$703.74
Rate for Payer: Iowa Total Care Managed Medicaid	$598.18
Rate for Payer: Medical Associates Commercial	$1,114.26
Rate for Payer: Medical Associates Managed Medicare	$586.45
Rate for Payer: Midlands Choice Commercial	$1,532.30
Rate for Payer: Oscar Health of IA Commercial	$1,014.56
Rate for Payer: Partners Health Alliance Commercial	$879.68

19302 MASTECTOMY PART W LYMPHADENECT

Professional

Both

$3,021.00

Service Code	CPT 19302
Hospital Charge Code	8069192
Hospital Revenue Code	975
Min. Negotiated Rate	$804.94
Max. Negotiated Rate	$2,114.70
Rate for Payer: Aetna of IA Medicare	$804.94
Rate for Payer: Amerigroup Medicaid	$832.31
Rate for Payer: Cash Price	$2,416.80
Rate for Payer: Cash Price	$2,416.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$965.93
Rate for Payer: Iowa Total Care Managed Medicaid	$821.04
Rate for Payer: Medical Associates Commercial	$1,529.39
Rate for Payer: Medical Associates Managed Medicare	$804.94
Rate for Payer: Midlands Choice Commercial	$2,114.70
Rate for Payer: Oscar Health of IA Commercial	$1,392.55
Rate for Payer: Partners Health Alliance Commercial	$1,207.41

19303 MASTECTOMY SIMPLE AND COMPLETE

Professional

Both

$3,393.00

Service Code	CPT 19303
Hospital Charge Code	8069153
Min. Negotiated Rate	$849.82
Max. Negotiated Rate	$2,544.75
Rate for Payer: Amerigroup Medicaid	$878.71
Rate for Payer: Cash Price	$2,714.40
Rate for Payer: Cash Price	$2,714.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,019.78
Rate for Payer: Iowa Total Care Managed Medicaid	$866.82
Rate for Payer: Medical Associates Commercial	$2,544.75
Rate for Payer: Medical Associates Managed Medicare	$849.82
Rate for Payer: Midlands Choice Commercial	$2,375.10
Rate for Payer: Oscar Health of IA Commercial	$1,470.19
Rate for Payer: Partners Health Alliance Commercial	$1,274.73

19307 MASTECTOMY MODIFIED RADICAL

Professional

Both

$4,017.00

Service Code	CPT 19307
Hospital Charge Code	8069014
Min. Negotiated Rate	$1,046.09
Max. Negotiated Rate	$3,012.75
Rate for Payer: Amerigroup Medicaid	$1,081.66
Rate for Payer: Cash Price	$3,213.60
Rate for Payer: Cash Price	$3,213.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,255.31
Rate for Payer: Iowa Total Care Managed Medicaid	$1,067.01
Rate for Payer: Medical Associates Commercial	$3,012.75
Rate for Payer: Medical Associates Managed Medicare	$1,046.09
Rate for Payer: Midlands Choice Commercial	$2,811.90
Rate for Payer: Oscar Health of IA Commercial	$1,809.74
Rate for Payer: Partners Health Alliance Commercial	$1,569.14

20240 Biopsy of bone; open superficial

Professional

Both

$503.00

Service Code	CPT 20240
Hospital Charge Code	8799109
Hospital Revenue Code	975
Min. Negotiated Rate	$127.92
Max. Negotiated Rate	$352.10
Rate for Payer: Aetna of IA Medicare	$127.92
Rate for Payer: Amerigroup Medicaid	$132.27
Rate for Payer: Cash Price	$402.40
Rate for Payer: Cash Price	$402.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$153.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.48
Rate for Payer: Medical Associates Commercial	$243.05
Rate for Payer: Medical Associates Managed Medicare	$127.92
Rate for Payer: Midlands Choice Commercial	$352.10
Rate for Payer: Oscar Health of IA Commercial	$221.30
Rate for Payer: Partners Health Alliance Commercial	$191.88

20526 Carpal tunnel injection

Professional

Both

$257.00

Service Code	CPT 20526
Hospital Charge Code	8799110
Hospital Revenue Code	975
Min. Negotiated Rate	$50.96
Max. Negotiated Rate	$179.90
Rate for Payer: Aetna of IA Medicare	$50.96
Rate for Payer: Amerigroup Medicaid	$52.69
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.15
Rate for Payer: Iowa Total Care Managed Medicaid	$51.98
Rate for Payer: Medical Associates Commercial	$96.82
Rate for Payer: Medical Associates Managed Medicare	$50.96
Rate for Payer: Midlands Choice Commercial	$179.90
Rate for Payer: Oscar Health of IA Commercial	$88.16
Rate for Payer: Partners Health Alliance Commercial	$76.44

20600 Arthrocentesis- injection small joint/bursa (fingers/toes)

Professional

Both

$161.00

Service Code	CPT 20600
Hospital Charge Code	8799111
Hospital Revenue Code	975
Min. Negotiated Rate	$32.52
Max. Negotiated Rate	$112.70
Rate for Payer: Aetna of IA Medicare	$32.52
Rate for Payer: Amerigroup Medicaid	$33.63
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$39.02
Rate for Payer: Iowa Total Care Managed Medicaid	$33.17
Rate for Payer: Medical Associates Commercial	$61.79
Rate for Payer: Medical Associates Managed Medicare	$32.52
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Oscar Health of IA Commercial	$56.26
Rate for Payer: Partners Health Alliance Commercial	$48.78

20605 Arthrocentesis- injection intermediate joint/bursa (TMJ wrist elbow ankle)

Professional

Both

$168.00

Service Code	CPT 20605
Hospital Charge Code	8799112
Hospital Revenue Code	975
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$117.60
Rate for Payer: Aetna of IA Medicare	$33.48
Rate for Payer: Amerigroup Medicaid	$34.62
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.18
Rate for Payer: Iowa Total Care Managed Medicaid	$34.15
Rate for Payer: Medical Associates Commercial	$63.61
Rate for Payer: Medical Associates Managed Medicare	$33.48
Rate for Payer: Midlands Choice Commercial	$117.60
Rate for Payer: Oscar Health of IA Commercial	$57.92
Rate for Payer: Partners Health Alliance Commercial	$50.22

20611 Drain/injection major joint/bursa w/ ultrasound guidance

Professional

Both

$313.00

Service Code	CPT 20611
Hospital Charge Code	8799113
Hospital Revenue Code	975
Min. Negotiated Rate	$53.51
Max. Negotiated Rate	$219.10
Rate for Payer: Aetna of IA Medicare	$53.51
Rate for Payer: Amerigroup Medicaid	$55.33
Rate for Payer: Cash Price	$250.40
Rate for Payer: Cash Price	$250.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$64.21
Rate for Payer: Iowa Total Care Managed Medicaid	$54.58
Rate for Payer: Medical Associates Commercial	$101.67
Rate for Payer: Medical Associates Managed Medicare	$53.51
Rate for Payer: Midlands Choice Commercial	$219.10
Rate for Payer: Oscar Health of IA Commercial	$92.57
Rate for Payer: Partners Health Alliance Commercial	$80.26

20670 Removal implant superficial (separate procedure)

Professional

Both

$1,228.00

Service Code	CPT 20670
Hospital Charge Code	8799114
Hospital Revenue Code	975
Min. Negotiated Rate	$132.01
Max. Negotiated Rate	$859.60
Rate for Payer: Aetna of IA Medicare	$132.01
Rate for Payer: Amerigroup Medicaid	$136.50
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cash Price	$982.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$158.41
Rate for Payer: Iowa Total Care Managed Medicaid	$134.65
Rate for Payer: Medical Associates Commercial	$250.82
Rate for Payer: Medical Associates Managed Medicare	$132.01
Rate for Payer: Midlands Choice Commercial	$859.60
Rate for Payer: Oscar Health of IA Commercial	$228.38
Rate for Payer: Partners Health Alliance Commercial	$198.02

20680 Removal implanted device deep

Professional

Both

$2,055.00

Service Code	CPT 20680
Hospital Charge Code	8799115
Hospital Revenue Code	975
Min. Negotiated Rate	$381.12
Max. Negotiated Rate	$893.80
Rate for Payer: Aetna of IA Medicare	$381.12
Rate for Payer: Amerigroup Medicaid	$394.08
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$457.34
Rate for Payer: Iowa Total Care Managed Medicaid	$388.74
Rate for Payer: Medical Associates Commercial	$724.13
Rate for Payer: Medical Associates Managed Medicare	$381.12
Rate for Payer: Midlands Choice Commercial	$893.80
Rate for Payer: Oscar Health of IA Commercial	$659.34
Rate for Payer: Partners Health Alliance Commercial	$571.68

20690 APPLY BONE FIXATION DEVICE 1 PLATE

Professional

Both

$2,009.00

Service Code	CPT 20690
Hospital Charge Code	8799116
Hospital Revenue Code	975
Min. Negotiated Rate	$538.64
Max. Negotiated Rate	$1,406.30
Rate for Payer: Aetna of IA Medicare	$538.64
Rate for Payer: Amerigroup Medicaid	$556.95
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$646.37
Rate for Payer: Iowa Total Care Managed Medicaid	$549.41
Rate for Payer: Medical Associates Commercial	$1,023.42
Rate for Payer: Medical Associates Managed Medicare	$538.64
Rate for Payer: Midlands Choice Commercial	$1,406.30
Rate for Payer: Oscar Health of IA Commercial	$931.85
Rate for Payer: Partners Health Alliance Commercial	$807.96

2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID

Facility

$180.00

Service Code	CPT C1713
Hospital Charge Code	8771318
Hospital Revenue Code	278
Min. Negotiated Rate	$89.96
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$90.85
Rate for Payer: Amerigroup Medicare	$90.90
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.00
Rate for Payer: Iowa Total Care Managed Medicaid	$89.96
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$90.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$91.35
Rate for Payer: Molina Healthcare Managed Medicare	$91.30
Rate for Payer: Oscar Health of IA Commercial	$135.00
Rate for Payer: Partners Health Alliance Commercial	$135.00
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20

2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID

Facility

$180.00

Service Code	CPT C1713
Hospital Charge Code	8771318
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID 3910900019

Facility

$100.00

Service Code	CPT C1713
Hospital Charge Code	8797132
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID 3910900019

Facility

$100.00

Service Code	CPT C1713
Hospital Charge Code	8797132
Hospital Revenue Code	278
Min. Negotiated Rate	$49.98
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$50.47
Rate for Payer: Amerigroup Medicare	$50.50
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$50.00
Rate for Payer: Iowa Total Care Managed Medicaid	$49.98
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$50.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$50.75
Rate for Payer: Molina Healthcare Managed Medicare	$50.72
Rate for Payer: Oscar Health of IA Commercial	$75.00
Rate for Payer: Partners Health Alliance Commercial	$75.00
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00

21116 Temporomandibular joint injection

Professional

Both

$656.00

Service Code	CPT 21116
Hospital Charge Code	8799117
Hospital Revenue Code	975
Min. Negotiated Rate	$40.57
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna of IA Medicare	$40.57
Rate for Payer: Amerigroup Medicaid	$41.95
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cash Price	$524.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.68
Rate for Payer: Iowa Total Care Managed Medicaid	$41.38
Rate for Payer: Medical Associates Commercial	$77.08
Rate for Payer: Medical Associates Managed Medicare	$40.57
Rate for Payer: Midlands Choice Commercial	$459.20
Rate for Payer: Oscar Health of IA Commercial	$70.19
Rate for Payer: Partners Health Alliance Commercial	$60.86

Know your out-of-pocket cost for care.

All Charges