Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

THERASKIN 1X1

Facility

$1,791.00

Service Code	HCPCS Q4121
Hospital Charge Code	8767259
Hospital Revenue Code	278
Min. Negotiated Rate	$805.95
Max. Negotiated Rate	$1,611.90
Rate for Payer: Aetna of IA Commercial	$1,611.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,611.90
Rate for Payer: Aetna of IA Medicare	$1,020.87
Rate for Payer: Amerigroup Medicaid	$1,033.05
Rate for Payer: Amerigroup Medicare	$814.01
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,343.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$805.95
Rate for Payer: Iowa Total Care Managed Medicaid	$1,023.02
Rate for Payer: Medical Associates Commercial	$1,343.25
Rate for Payer: Medical Associates Managed Medicare	$805.95
Rate for Payer: Midlands Choice Commercial	$1,253.70
Rate for Payer: Molina Healthcare Managed Medicaid	$1,038.06
Rate for Payer: Partners Health Alliance Commercial	$926.84
Rate for Payer: United Healthcare Commercial	$1,611.90
Rate for Payer: United Healthcare Managed Medicare	$1,056.69

THERASKIN 1X1

Facility

$1,791.00

Service Code	HCPCS Q4121
Hospital Charge Code	8767259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,253.70
Max. Negotiated Rate	$1,611.90
Rate for Payer: Aetna of IA Commercial	$1,611.90
Rate for Payer: Aetna of IA Medical Rental Products	$1,611.90
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,343.25
Rate for Payer: Medical Associates Commercial	$1,343.25
Rate for Payer: Midlands Choice Commercial	$1,253.70
Rate for Payer: United Healthcare Commercial	$1,611.90

THERASKIN 1X2

Facility

$1,944.00

Service Code	HCPCS Q4121
Hospital Charge Code	8793727
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$1,749.60
Rate for Payer: Aetna of IA Commercial	$1,749.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,749.60
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,458.00
Rate for Payer: Medical Associates Commercial	$1,458.00
Rate for Payer: Midlands Choice Commercial	$1,360.80
Rate for Payer: United Healthcare Commercial	$1,749.60

THERASKIN 1X2

Facility

$1,944.00

Service Code	HCPCS Q4121
Hospital Charge Code	8793727
Hospital Revenue Code	278
Min. Negotiated Rate	$874.80
Max. Negotiated Rate	$1,749.60
Rate for Payer: Aetna of IA Commercial	$1,749.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,749.60
Rate for Payer: Aetna of IA Medicare	$1,108.08
Rate for Payer: Amerigroup Medicaid	$1,121.30
Rate for Payer: Amerigroup Medicare	$883.55
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,458.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$874.80
Rate for Payer: Iowa Total Care Managed Medicaid	$1,110.41
Rate for Payer: Medical Associates Commercial	$1,458.00
Rate for Payer: Medical Associates Managed Medicare	$874.80
Rate for Payer: Midlands Choice Commercial	$1,360.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,126.74
Rate for Payer: Partners Health Alliance Commercial	$1,006.02
Rate for Payer: United Healthcare Commercial	$1,749.60
Rate for Payer: United Healthcare Managed Medicare	$1,146.96

THERA SKIN 2X3

Facility

$2,180.00

Service Code	HCPCS Q4121
Hospital Charge Code	8823254
Hospital Revenue Code	278
Min. Negotiated Rate	$981.00
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of IA Commercial	$1,962.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,962.00
Rate for Payer: Aetna of IA Medicare	$1,242.60
Rate for Payer: Amerigroup Medicaid	$1,257.42
Rate for Payer: Amerigroup Medicare	$990.81
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,635.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$981.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,245.22
Rate for Payer: Medical Associates Commercial	$1,635.00
Rate for Payer: Medical Associates Managed Medicare	$981.00
Rate for Payer: Midlands Choice Commercial	$1,526.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,263.53
Rate for Payer: Partners Health Alliance Commercial	$1,128.15
Rate for Payer: United Healthcare Commercial	$1,962.00
Rate for Payer: United Healthcare Managed Medicare	$1,286.20

THERA SKIN 2X3

Facility

$2,180.00

Service Code	HCPCS Q4121
Hospital Charge Code	8823254
Hospital Revenue Code	278
Min. Negotiated Rate	$1,526.00
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of IA Commercial	$1,962.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,962.00
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,635.00
Rate for Payer: Medical Associates Commercial	$1,635.00
Rate for Payer: Midlands Choice Commercial	$1,526.00
Rate for Payer: United Healthcare Commercial	$1,962.00

THER EXERCISES PER 15 MIN

Facility

$117.00

Service Code	CPT 97110 GP
Hospital Charge Code	1374020
Hospital Revenue Code	420
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: United Healthcare Commercial	$105.30

THER EXERCISES PER 15 MIN

Facility

$117.00

Service Code	CPT 97110 GP
Hospital Charge Code	1374020
Hospital Revenue Code	420
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Aetna of IA Medicare	$66.69
Rate for Payer: Amerigroup Medicaid	$67.49
Rate for Payer: Amerigroup Medicare	$53.18
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.65
Rate for Payer: Iowa Total Care Managed Medicaid	$66.83
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Medical Associates Managed Medicare	$52.65
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: Molina Healthcare Managed Medicaid	$67.81
Rate for Payer: Partners Health Alliance Commercial	$60.55
Rate for Payer: United Healthcare Commercial	$105.30
Rate for Payer: United Healthcare Managed Medicare	$69.03

THER INJECTION CARP TUNNEL

Facility

$350.00

Service Code	CPT 20526
Hospital Charge Code	7982933
Hospital Revenue Code	450
Min. Negotiated Rate	$157.50
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: Aetna of IA Medicare	$199.50
Rate for Payer: Amerigroup Medicaid	$201.88
Rate for Payer: Amerigroup Medicare	$159.07
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

THER INJECTION CARP TUNNEL

Facility

$350.00

Service Code	CPT 20526
Hospital Charge Code	7982933
Hospital Revenue Code	450
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

THER INJECTION CARP TUNNEL

Professional

Both

$257.00

Service Code	CPT 20526
Hospital Charge Code	7982746
Hospital Revenue Code	981
Min. Negotiated Rate	$118.43
Max. Negotiated Rate	$192.75
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Medical Associates Commercial	$192.75
Rate for Payer: Midlands Choice Commercial	$179.90
Rate for Payer: Partners Health Alliance Commercial	$192.75
Rate for Payer: United Healthcare Commercial	$118.43

THERMA CHOICE CATHETER

Facility

$1,780.00

Hospital Charge Code	8025932
Hospital Revenue Code	278
Min. Negotiated Rate	$801.00
Max. Negotiated Rate	$1,602.00
Rate for Payer: Aetna of IA Commercial	$1,602.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,602.00
Rate for Payer: Aetna of IA Medicare	$1,014.60
Rate for Payer: Amerigroup Medicaid	$1,026.70
Rate for Payer: Amerigroup Medicare	$809.01
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,335.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$801.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,016.74
Rate for Payer: Medical Associates Commercial	$1,335.00
Rate for Payer: Medical Associates Managed Medicare	$801.00
Rate for Payer: Midlands Choice Commercial	$1,246.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,031.69
Rate for Payer: Partners Health Alliance Commercial	$921.15
Rate for Payer: United Healthcare Commercial	$1,602.00
Rate for Payer: United Healthcare Managed Medicare	$1,050.20

THERMA CHOICE CATHETER

Facility

$1,780.00

Hospital Charge Code	8025932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.00
Max. Negotiated Rate	$1,602.00
Rate for Payer: Aetna of IA Commercial	$1,602.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,602.00
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,335.00
Rate for Payer: Medical Associates Commercial	$1,335.00
Rate for Payer: Midlands Choice Commercial	$1,246.00
Rate for Payer: United Healthcare Commercial	$1,602.00

THERMAL ENDOMETR TUMOR ABL

Professional

Both

$3,314.00

Service Code	CPT 58353
Hospital Charge Code	8069108
Hospital Revenue Code	975
Min. Negotiated Rate	$1,496.88
Max. Negotiated Rate	$2,485.50
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Medical Associates Commercial	$2,485.50
Rate for Payer: Midlands Choice Commercial	$2,319.80
Rate for Payer: Partners Health Alliance Commercial	$2,485.50
Rate for Payer: United Healthcare Commercial	$1,496.88

thiamine 100 mg/ml 2ml MDV Inj [VDMC]

Facility

$32.51

Service Code	HCPCS J3411
Hospital Charge Code	10424876
Hospital Revenue Code	259
Min. Negotiated Rate	$14.63
Max. Negotiated Rate	$29.26
Rate for Payer: Aetna of IA Commercial	$29.26
Rate for Payer: Aetna of IA Medical Rental Products	$29.26
Rate for Payer: Aetna of IA Medicare	$18.53
Rate for Payer: Amerigroup Medicaid	$18.75
Rate for Payer: Amerigroup Medicare	$14.78
Rate for Payer: Cash Price	$26.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.63
Rate for Payer: Iowa Total Care Managed Medicaid	$18.57
Rate for Payer: Medical Associates Commercial	$24.38
Rate for Payer: Medical Associates Managed Medicare	$14.63
Rate for Payer: Midlands Choice Commercial	$22.76
Rate for Payer: Molina Healthcare Managed Medicaid	$18.84
Rate for Payer: Partners Health Alliance Commercial	$16.82
Rate for Payer: United Healthcare Commercial	$29.26
Rate for Payer: United Healthcare Managed Medicare	$19.18

thiamine 100 mg/ml 2ml MDV Inj [VDMC]

Facility

$32.51

Service Code	HCPCS J3411
Hospital Charge Code	10424876
Hospital Revenue Code	259
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$29.26
Rate for Payer: Aetna of IA Commercial	$29.26
Rate for Payer: Aetna of IA Medical Rental Products	$29.26
Rate for Payer: Cash Price	$26.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.38
Rate for Payer: Medical Associates Commercial	$24.38
Rate for Payer: Midlands Choice Commercial	$22.76
Rate for Payer: United Healthcare Commercial	$29.26

thiamine 100 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10424807
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.15
Rate for Payer: Medical Associates Commercial	$1.15
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.39

thiamine 100 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10424807
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Aetna of IA Medicare	$0.88
Rate for Payer: Amerigroup Medicaid	$0.89
Rate for Payer: Amerigroup Medicare	$0.70
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.69
Rate for Payer: Iowa Total Care Managed Medicaid	$0.88
Rate for Payer: Medical Associates Commercial	$1.15
Rate for Payer: Medical Associates Managed Medicare	$0.69
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: Molina Healthcare Managed Medicaid	$0.89
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.39
Rate for Payer: United Healthcare Managed Medicare	$0.91

Thoracentesis Procedure

Facility

$528.00

Service Code	CPT 32554
Hospital Charge Code	8060785
Hospital Revenue Code	761
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of IA Commercial	$475.20
Rate for Payer: Aetna of IA Medical Rental Products	$475.20
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$396.00
Rate for Payer: Medical Associates Commercial	$396.00
Rate for Payer: Midlands Choice Commercial	$369.60
Rate for Payer: United Healthcare Commercial	$475.20

Thoracentesis Procedure

Facility

$528.00

Service Code	CPT 32554
Hospital Charge Code	8060785
Hospital Revenue Code	761
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of IA Commercial	$475.20
Rate for Payer: Aetna of IA Medical Rental Products	$475.20
Rate for Payer: Aetna of IA Medicare	$300.96
Rate for Payer: Amerigroup Medicaid	$304.55
Rate for Payer: Amerigroup Medicare	$239.98
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$396.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$237.60
Rate for Payer: Iowa Total Care Managed Medicaid	$301.59
Rate for Payer: Medical Associates Commercial	$396.00
Rate for Payer: Medical Associates Managed Medicare	$237.60
Rate for Payer: Midlands Choice Commercial	$369.60
Rate for Payer: Molina Healthcare Managed Medicaid	$306.03
Rate for Payer: Partners Health Alliance Commercial	$273.24
Rate for Payer: United Healthcare Commercial	$475.20
Rate for Payer: United Healthcare Managed Medicare	$311.52

THP Albuterol Inhaler [VDMC]

Facility

$82.88

Service Code	HCPCS A9270
Hospital Charge Code	10735590
Hospital Revenue Code	259
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$74.59
Rate for Payer: Aetna of IA Commercial	$74.59
Rate for Payer: Aetna of IA Medical Rental Products	$74.59
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.16
Rate for Payer: Medical Associates Commercial	$62.16
Rate for Payer: Midlands Choice Commercial	$58.02
Rate for Payer: United Healthcare Commercial	$74.59

THP Albuterol Inhaler [VDMC]

Facility

$82.88

Service Code	HCPCS A9270
Hospital Charge Code	10735590
Hospital Revenue Code	259
Min. Negotiated Rate	$37.30
Max. Negotiated Rate	$74.59
Rate for Payer: Aetna of IA Commercial	$74.59
Rate for Payer: Aetna of IA Medical Rental Products	$74.59
Rate for Payer: Aetna of IA Medicare	$47.24
Rate for Payer: Amerigroup Medicaid	$47.81
Rate for Payer: Amerigroup Medicare	$37.67
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.30
Rate for Payer: Iowa Total Care Managed Medicaid	$47.34
Rate for Payer: Medical Associates Commercial	$62.16
Rate for Payer: Medical Associates Managed Medicare	$37.30
Rate for Payer: Midlands Choice Commercial	$58.02
Rate for Payer: Molina Healthcare Managed Medicaid	$48.04
Rate for Payer: Partners Health Alliance Commercial	$42.89
Rate for Payer: United Healthcare Commercial	$74.59
Rate for Payer: United Healthcare Managed Medicare	$48.90

THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV [VDMC]

Facility

$10.32

Service Code	HCPCS A9270
Hospital Charge Code	26928539
Hospital Revenue Code	259
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$9.29
Rate for Payer: Aetna of IA Commercial	$9.29
Rate for Payer: Aetna of IA Medical Rental Products	$9.29
Rate for Payer: Aetna of IA Medicare	$5.88
Rate for Payer: Amerigroup Medicaid	$5.95
Rate for Payer: Amerigroup Medicare	$4.69
Rate for Payer: Cash Price	$8.26
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.74
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.65
Rate for Payer: Iowa Total Care Managed Medicaid	$5.90
Rate for Payer: Medical Associates Commercial	$7.74
Rate for Payer: Medical Associates Managed Medicare	$4.65
Rate for Payer: Midlands Choice Commercial	$7.23
Rate for Payer: Molina Healthcare Managed Medicaid	$5.98
Rate for Payer: Partners Health Alliance Commercial	$5.34
Rate for Payer: United Healthcare Commercial	$9.29
Rate for Payer: United Healthcare Managed Medicare	$6.09

THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV [VDMC]

Facility

$10.32

Service Code	HCPCS A9270
Hospital Charge Code	26928539
Hospital Revenue Code	259
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$9.29
Rate for Payer: Aetna of IA Commercial	$9.29
Rate for Payer: Aetna of IA Medical Rental Products	$9.29
Rate for Payer: Cash Price	$8.26
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$7.74
Rate for Payer: Medical Associates Commercial	$7.74
Rate for Payer: Midlands Choice Commercial	$7.23
Rate for Payer: United Healthcare Commercial	$9.29

THP amoxicillin 400 mg/5 mL Oral Liq 50ml [VDMC]

Facility

$22.32

Service Code	HCPCS A9270
Hospital Charge Code	10366522
Hospital Revenue Code	259
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$20.09
Rate for Payer: Aetna of IA Commercial	$20.09
Rate for Payer: Aetna of IA Medical Rental Products	$20.09
Rate for Payer: Cash Price	$17.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.74
Rate for Payer: Medical Associates Commercial	$16.74
Rate for Payer: Midlands Choice Commercial	$15.62
Rate for Payer: United Healthcare Commercial	$20.09

Know your out-of-pocket cost for care.

All Charges