Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

THP promethazine/codeine 6.25/10mg/5mL syrup [VDMC]

Facility

$11.17

Service Code	HCPCS A9270
Hospital Charge Code	10734004
Hospital Revenue Code	259
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna of IA Commercial	$10.05
Rate for Payer: Aetna of IA Medical Rental Products	$10.05
Rate for Payer: Cash Price	$8.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.38
Rate for Payer: Medical Associates Commercial	$8.38
Rate for Payer: Midlands Choice Commercial	$7.82
Rate for Payer: United Healthcare Commercial	$10.05

THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL [VDMC]

Facility

$32.73

Service Code	HCPCS A9270
Hospital Charge Code	11422706
Hospital Revenue Code	259
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$29.45
Rate for Payer: Aetna of IA Commercial	$29.45
Rate for Payer: Aetna of IA Medical Rental Products	$29.45
Rate for Payer: Aetna of IA Medicare	$18.65
Rate for Payer: Amerigroup Medicaid	$18.88
Rate for Payer: Amerigroup Medicare	$14.87
Rate for Payer: Cash Price	$26.18
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.55
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.73
Rate for Payer: Iowa Total Care Managed Medicaid	$18.69
Rate for Payer: Medical Associates Commercial	$24.55
Rate for Payer: Medical Associates Managed Medicare	$14.73
Rate for Payer: Midlands Choice Commercial	$22.91
Rate for Payer: Molina Healthcare Managed Medicaid	$18.97
Rate for Payer: Partners Health Alliance Commercial	$16.94
Rate for Payer: United Healthcare Commercial	$29.45
Rate for Payer: United Healthcare Managed Medicare	$19.31

THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL [VDMC]

Facility

$32.73

Service Code	HCPCS A9270
Hospital Charge Code	11422706
Hospital Revenue Code	259
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$29.45
Rate for Payer: Aetna of IA Commercial	$29.45
Rate for Payer: Aetna of IA Medical Rental Products	$29.45
Rate for Payer: Cash Price	$26.18
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.55
Rate for Payer: Medical Associates Commercial	$24.55
Rate for Payer: Midlands Choice Commercial	$22.91
Rate for Payer: United Healthcare Commercial	$29.45

THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet[VDMC]

Facility

$13.60

Service Code	HCPCS A9270
Hospital Charge Code	10735326
Hospital Revenue Code	259
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna of IA Commercial	$12.24
Rate for Payer: Aetna of IA Medical Rental Products	$12.24
Rate for Payer: Aetna of IA Medicare	$7.75
Rate for Payer: Amerigroup Medicaid	$7.84
Rate for Payer: Amerigroup Medicare	$6.18
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.20
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.12
Rate for Payer: Iowa Total Care Managed Medicaid	$7.77
Rate for Payer: Medical Associates Commercial	$10.20
Rate for Payer: Medical Associates Managed Medicare	$6.12
Rate for Payer: Midlands Choice Commercial	$9.52
Rate for Payer: Molina Healthcare Managed Medicaid	$7.88
Rate for Payer: Partners Health Alliance Commercial	$7.04
Rate for Payer: United Healthcare Commercial	$12.24
Rate for Payer: United Healthcare Managed Medicare	$8.02

THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet[VDMC]

Facility

$13.60

Service Code	HCPCS A9270
Hospital Charge Code	10735326
Hospital Revenue Code	259
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna of IA Commercial	$12.24
Rate for Payer: Aetna of IA Medical Rental Products	$12.24
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.20
Rate for Payer: Medical Associates Commercial	$10.20
Rate for Payer: Midlands Choice Commercial	$9.52
Rate for Payer: United Healthcare Commercial	$12.24

THP Tizanidine 4mg 5 tablets [VDMC]

Facility

$11.12

Service Code	HCPCS A9270
Hospital Charge Code	28941700
Hospital Revenue Code	259
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna of IA Commercial	$10.00
Rate for Payer: Aetna of IA Medical Rental Products	$10.00
Rate for Payer: Cash Price	$8.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.34
Rate for Payer: Medical Associates Commercial	$8.34
Rate for Payer: Midlands Choice Commercial	$7.78
Rate for Payer: United Healthcare Commercial	$10.00

THP Tizanidine 4mg 5 tablets [VDMC]

Facility

$11.12

Service Code	HCPCS A9270
Hospital Charge Code	28941700
Hospital Revenue Code	259
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna of IA Commercial	$10.00
Rate for Payer: Aetna of IA Medical Rental Products	$10.00
Rate for Payer: Aetna of IA Medicare	$6.34
Rate for Payer: Amerigroup Medicaid	$6.41
Rate for Payer: Amerigroup Medicare	$5.05
Rate for Payer: Cash Price	$8.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.34
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6.35
Rate for Payer: Medical Associates Commercial	$8.34
Rate for Payer: Medical Associates Managed Medicare	$5.00
Rate for Payer: Midlands Choice Commercial	$7.78
Rate for Payer: Molina Healthcare Managed Medicaid	$6.44
Rate for Payer: Partners Health Alliance Commercial	$5.75
Rate for Payer: United Healthcare Commercial	$10.00
Rate for Payer: United Healthcare Managed Medicare	$6.56

THP tramadol 50 mg tab [VDMC]

Facility

$11.08

Service Code	HCPCS A9270
Hospital Charge Code	10735637
Hospital Revenue Code	259
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$9.97
Rate for Payer: Aetna of IA Commercial	$9.97
Rate for Payer: Aetna of IA Medical Rental Products	$9.97
Rate for Payer: Aetna of IA Medicare	$6.31
Rate for Payer: Amerigroup Medicaid	$6.39
Rate for Payer: Amerigroup Medicare	$5.03
Rate for Payer: Cash Price	$8.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.99
Rate for Payer: Iowa Total Care Managed Medicaid	$6.33
Rate for Payer: Medical Associates Commercial	$8.31
Rate for Payer: Medical Associates Managed Medicare	$4.99
Rate for Payer: Midlands Choice Commercial	$7.75
Rate for Payer: Molina Healthcare Managed Medicaid	$6.42
Rate for Payer: Partners Health Alliance Commercial	$5.73
Rate for Payer: United Healthcare Commercial	$9.97
Rate for Payer: United Healthcare Managed Medicare	$6.54

THP tramadol 50 mg tab [VDMC]

Facility

$11.08

Service Code	HCPCS A9270
Hospital Charge Code	10735637
Hospital Revenue Code	259
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$9.97
Rate for Payer: Aetna of IA Commercial	$9.97
Rate for Payer: Aetna of IA Medical Rental Products	$9.97
Rate for Payer: Cash Price	$8.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.31
Rate for Payer: Medical Associates Commercial	$8.31
Rate for Payer: Midlands Choice Commercial	$7.75
Rate for Payer: United Healthcare Commercial	$9.97

THROAT CULTURE

Facility

$105.00

Service Code	CPT 87070
Hospital Charge Code	633905
Hospital Revenue Code	306
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of IA Commercial	$94.50
Rate for Payer: Aetna of IA Medical Rental Products	$94.50
Rate for Payer: Aetna of IA Medicare	$59.85
Rate for Payer: Amerigroup Medicaid	$60.56
Rate for Payer: Amerigroup Medicare	$47.72
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$47.25
Rate for Payer: Iowa Total Care Managed Medicaid	$59.98
Rate for Payer: Medical Associates Commercial	$78.75
Rate for Payer: Medical Associates Managed Medicare	$47.25
Rate for Payer: Midlands Choice Commercial	$73.50
Rate for Payer: Molina Healthcare Managed Medicaid	$60.86
Rate for Payer: Partners Health Alliance Commercial	$54.34
Rate for Payer: United Healthcare Commercial	$94.50
Rate for Payer: United Healthcare Managed Medicare	$61.95

THROAT CULTURE

Facility

$105.00

Service Code	CPT 87070
Hospital Charge Code	633905
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of IA Commercial	$94.50
Rate for Payer: Aetna of IA Medical Rental Products	$94.50
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.75
Rate for Payer: Medical Associates Commercial	$78.75
Rate for Payer: Midlands Choice Commercial	$73.50
Rate for Payer: United Healthcare Commercial	$94.50

THROMBIN TIME

Facility

$55.00

Service Code	CPT 85670
Hospital Charge Code	8093945
Hospital Revenue Code	305
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

THROMBIN TIME

Facility

$55.00

Service Code	CPT 85670
Hospital Charge Code	8093945
Hospital Revenue Code	305
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Aetna of IA Medicare	$31.35
Rate for Payer: Amerigroup Medicaid	$31.72
Rate for Payer: Amerigroup Medicare	$25.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.75
Rate for Payer: Iowa Total Care Managed Medicaid	$31.42
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Medical Associates Managed Medicare	$24.75
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: Molina Healthcare Managed Medicaid	$31.88
Rate for Payer: Partners Health Alliance Commercial	$28.46
Rate for Payer: United Healthcare Commercial	$49.50
Rate for Payer: United Healthcare Managed Medicare	$32.45

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: United Healthcare Commercial	$117.00

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Aetna of IA Medicare	$74.10
Rate for Payer: Amerigroup Medicaid	$74.98
Rate for Payer: Amerigroup Medicare	$59.09
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.50
Rate for Payer: Iowa Total Care Managed Medicaid	$74.26
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Medical Associates Managed Medicare	$58.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: Molina Healthcare Managed Medicaid	$75.35
Rate for Payer: Partners Health Alliance Commercial	$67.28
Rate for Payer: United Healthcare Commercial	$117.00
Rate for Payer: United Healthcare Managed Medicare	$76.70

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.26

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna of IA Commercial	$2.94
Rate for Payer: Aetna of IA Medical Rental Products	$2.94
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.45
Rate for Payer: Medical Associates Commercial	$2.45
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: United Healthcare Commercial	$2.94

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.26

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna of IA Commercial	$2.94
Rate for Payer: Aetna of IA Medical Rental Products	$2.94
Rate for Payer: Aetna of IA Medicare	$1.86
Rate for Payer: Amerigroup Medicaid	$1.88
Rate for Payer: Amerigroup Medicare	$1.48
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.45
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.47
Rate for Payer: Iowa Total Care Managed Medicaid	$1.86
Rate for Payer: Medical Associates Commercial	$2.45
Rate for Payer: Medical Associates Managed Medicare	$1.47
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: Molina Healthcare Managed Medicaid	$1.89
Rate for Payer: Partners Health Alliance Commercial	$1.69
Rate for Payer: United Healthcare Commercial	$2.94
Rate for Payer: United Healthcare Managed Medicare	$1.92

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Aetna of IA Medicare	$78.09
Rate for Payer: Amerigroup Medicaid	$79.02
Rate for Payer: Amerigroup Medicare	$62.27
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$61.65
Rate for Payer: Iowa Total Care Managed Medicaid	$78.25
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Medical Associates Managed Medicare	$61.65
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: Molina Healthcare Managed Medicaid	$79.41
Rate for Payer: Partners Health Alliance Commercial	$70.90
Rate for Payer: United Healthcare Commercial	$123.30
Rate for Payer: United Healthcare Managed Medicare	$80.83

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: United Healthcare Commercial	$123.30

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Aetna of IA Medicare	$144.21
Rate for Payer: Amerigroup Medicaid	$145.93
Rate for Payer: Amerigroup Medicare	$114.99
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$113.85
Rate for Payer: Iowa Total Care Managed Medicaid	$144.51
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Medical Associates Managed Medicare	$113.85
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: Molina Healthcare Managed Medicaid	$146.64
Rate for Payer: Partners Health Alliance Commercial	$130.93
Rate for Payer: United Healthcare Commercial	$227.70
Rate for Payer: United Healthcare Managed Medicare	$149.27

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: United Healthcare Commercial	$227.70

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: United Healthcare Commercial	$25.68

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Aetna of IA Medicare	$16.26
Rate for Payer: Amerigroup Medicaid	$16.46
Rate for Payer: Amerigroup Medicare	$12.97
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.84
Rate for Payer: Iowa Total Care Managed Medicaid	$16.30
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Medical Associates Managed Medicare	$12.84
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: Molina Healthcare Managed Medicaid	$16.54
Rate for Payer: Partners Health Alliance Commercial	$14.76
Rate for Payer: United Healthcare Commercial	$25.68
Rate for Payer: United Healthcare Managed Medicare	$16.83

Know your out-of-pocket cost for care.

All Charges