Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

ALLERGIC REACTIONS WITH MCC

Facility

$12,722.41

Service Code	MSDRG 915
Min. Negotiated Rate	$12,538.03
Max. Negotiated Rate	$12,722.41
Rate for Payer: Amerigroup Medicaid	$12,660.95
Rate for Payer: Iowa Total Care Managed Medicaid	$12,538.03
Rate for Payer: Molina Healthcare Managed Medicaid	$12,722.41

ALLERGIC REACTIONS WITHOUT MCC

Facility

$6,048.75

Service Code	MSDRG 916
Min. Negotiated Rate	$5,961.08
Max. Negotiated Rate	$6,048.75
Rate for Payer: Amerigroup Medicaid	$6,019.52
Rate for Payer: Iowa Total Care Managed Medicaid	$5,961.08
Rate for Payer: Molina Healthcare Managed Medicaid	$6,048.75

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$157,709.97

Service Code	MSDRG 014
Min. Negotiated Rate	$155,424.25
Max. Negotiated Rate	$157,709.97
Rate for Payer: Amerigroup Medicaid	$156,948.01
Rate for Payer: Iowa Total Care Managed Medicaid	$155,424.25
Rate for Payer: Molina Healthcare Managed Medicaid	$157,709.97

ALLOGRAFT 30X40MM 722-TS

Facility

$3,960.00

Service Code	HCPCS L8699
Hospital Charge Code	8942325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$3,564.00
Rate for Payer: Aetna of IA Commercial	$3,564.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,564.00
Rate for Payer: Aetna of IA Medicare	$2,257.20
Rate for Payer: Amerigroup Medicaid	$2,284.13
Rate for Payer: Amerigroup Medicare	$1,799.82
Rate for Payer: Cash Price	$3,168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,970.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,782.00
Rate for Payer: Iowa Total Care Managed Medicaid	$2,261.95
Rate for Payer: Medical Associates Commercial	$2,970.00
Rate for Payer: Medical Associates Managed Medicare	$1,782.00
Rate for Payer: Midlands Choice Commercial	$2,772.00
Rate for Payer: Molina Healthcare Managed Medicaid	$2,295.22
Rate for Payer: Partners Health Alliance Commercial	$2,049.30
Rate for Payer: United Healthcare Commercial	$3,564.00
Rate for Payer: United Healthcare Managed Medicare	$2,336.40

ALLOGRAFT 30X40MM 722-TS

Facility

$3,960.00

Service Code	HCPCS L8699
Hospital Charge Code	8942325
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.00
Max. Negotiated Rate	$3,564.00
Rate for Payer: Aetna of IA Commercial	$3,564.00
Rate for Payer: Aetna of IA Medical Rental Products	$3,564.00
Rate for Payer: Cash Price	$3,168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,970.00
Rate for Payer: Medical Associates Commercial	$2,970.00
Rate for Payer: Midlands Choice Commercial	$2,772.00
Rate for Payer: United Healthcare Commercial	$3,564.00

allopurinol 100 mg Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10364795
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of IA Commercial	$1.02
Rate for Payer: Aetna of IA Medical Rental Products	$1.02
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.85
Rate for Payer: Medical Associates Commercial	$0.85
Rate for Payer: Midlands Choice Commercial	$0.79
Rate for Payer: United Healthcare Commercial	$1.02

allopurinol 100 mg Tab [VDMC]

Facility

$1.13

Service Code	HCPCS A9270
Hospital Charge Code	10364795
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of IA Commercial	$1.02
Rate for Payer: Aetna of IA Medical Rental Products	$1.02
Rate for Payer: Aetna of IA Medicare	$0.64
Rate for Payer: Amerigroup Medicaid	$0.65
Rate for Payer: Amerigroup Medicare	$0.51
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.85
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.51
Rate for Payer: Iowa Total Care Managed Medicaid	$0.65
Rate for Payer: Medical Associates Commercial	$0.85
Rate for Payer: Medical Associates Managed Medicare	$0.51
Rate for Payer: Midlands Choice Commercial	$0.79
Rate for Payer: Molina Healthcare Managed Medicaid	$0.66
Rate for Payer: Partners Health Alliance Commercial	$0.58
Rate for Payer: United Healthcare Commercial	$1.02
Rate for Payer: United Healthcare Managed Medicare	$0.67

allopurinol 300 mg Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	11263409
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Aetna of IA Medicare	$0.75
Rate for Payer: Amerigroup Medicaid	$0.76
Rate for Payer: Amerigroup Medicare	$0.60
Rate for Payer: Cash Price	$1.05
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	$0.75
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Medical Associates Managed Medicare	$0.59
Rate for Payer: Midlands Choice Commercial	$0.92
Rate for Payer: Molina Healthcare Managed Medicaid	$0.76
Rate for Payer: Partners Health Alliance Commercial	$0.68
Rate for Payer: United Healthcare Commercial	$1.18
Rate for Payer: United Healthcare Managed Medicare	$0.77

allopurinol 300 mg Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	11263409
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Cash Price	$1.05
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	$0.92
Rate for Payer: United Healthcare Commercial	$1.18

ALPHA 1-ANTITRYPSIN

Facility

$139.00

Service Code	CPT 82103
Hospital Charge Code	8037489
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

ALPHA 1-ANTITRYPSIN

Facility

$139.00

Service Code	CPT 82103
Hospital Charge Code	8037489
Hospital Revenue Code	301
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

alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]

Facility

$1,267.36

Service Code	HCPCS J0256
Hospital Charge Code	22367300
Hospital Revenue Code	259
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,140.62
Rate for Payer: Aetna of IA Commercial	$1,140.62
Rate for Payer: Aetna of IA Medical Rental Products	$1,140.62
Rate for Payer: Cash Price	$1,013.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$950.52
Rate for Payer: Medical Associates Commercial	$950.52
Rate for Payer: Midlands Choice Commercial	$887.15
Rate for Payer: United Healthcare Commercial	$1,140.62

alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]

Facility

$1,267.36

Service Code	HCPCS J0256
Hospital Charge Code	22367300
Hospital Revenue Code	259
Min. Negotiated Rate	$570.31
Max. Negotiated Rate	$1,140.62
Rate for Payer: Aetna of IA Commercial	$1,140.62
Rate for Payer: Aetna of IA Medical Rental Products	$1,140.62
Rate for Payer: Aetna of IA Medicare	$722.40
Rate for Payer: Amerigroup Medicaid	$731.01
Rate for Payer: Amerigroup Medicare	$576.02
Rate for Payer: Cash Price	$1,013.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$950.52
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$570.31
Rate for Payer: Iowa Total Care Managed Medicaid	$723.92
Rate for Payer: Medical Associates Commercial	$950.52
Rate for Payer: Medical Associates Managed Medicare	$570.31
Rate for Payer: Midlands Choice Commercial	$887.15
Rate for Payer: Molina Healthcare Managed Medicaid	$734.56
Rate for Payer: Partners Health Alliance Commercial	$655.86
Rate for Payer: United Healthcare Commercial	$1,140.62
Rate for Payer: United Healthcare Managed Medicare	$747.74

ALPHA FETOPROTEIN

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8086832
Hospital Revenue Code	301
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

ALPHA FETOPROTEIN

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8086832
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Alpha Fetoprotein Tumor Marker DMCL

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8037491
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Alpha Fetoprotein Tumor Marker DMCL

Facility

$139.00

Service Code	CPT 82105
Hospital Charge Code	8037491
Hospital Revenue Code	301
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

ALPRAZolam 0.25 mg Tab [VDMC]

Facility

$3.08

Service Code	HCPCS A9270
Hospital Charge Code	10364933
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.77
Rate for Payer: Aetna of IA Commercial	$2.77
Rate for Payer: Aetna of IA Medical Rental Products	$2.77
Rate for Payer: Aetna of IA Medicare	$1.76
Rate for Payer: Amerigroup Medicaid	$1.78
Rate for Payer: Amerigroup Medicare	$1.40
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.39
Rate for Payer: Iowa Total Care Managed Medicaid	$1.76
Rate for Payer: Medical Associates Commercial	$2.31
Rate for Payer: Medical Associates Managed Medicare	$1.39
Rate for Payer: Midlands Choice Commercial	$2.16
Rate for Payer: Molina Healthcare Managed Medicaid	$1.79
Rate for Payer: Partners Health Alliance Commercial	$1.59
Rate for Payer: United Healthcare Commercial	$2.77
Rate for Payer: United Healthcare Managed Medicare	$1.82

ALPRAZolam 0.25 mg Tab [VDMC]

Facility

$3.08

Service Code	HCPCS A9270
Hospital Charge Code	10364933
Hospital Revenue Code	259
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.77
Rate for Payer: Aetna of IA Commercial	$2.77
Rate for Payer: Aetna of IA Medical Rental Products	$2.77
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.31
Rate for Payer: Medical Associates Commercial	$2.31
Rate for Payer: Midlands Choice Commercial	$2.16
Rate for Payer: United Healthcare Commercial	$2.77

ALPRAZolam 0.5 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365002
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Aetna of IA Medicare	$1.77
Rate for Payer: Amerigroup Medicaid	$1.79
Rate for Payer: Amerigroup Medicare	$1.41
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.32
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.39
Rate for Payer: Iowa Total Care Managed Medicaid	$1.77
Rate for Payer: Medical Associates Commercial	$2.32
Rate for Payer: Medical Associates Managed Medicare	$1.39
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: Molina Healthcare Managed Medicaid	$1.79
Rate for Payer: Partners Health Alliance Commercial	$1.60
Rate for Payer: United Healthcare Commercial	$2.79
Rate for Payer: United Healthcare Managed Medicare	$1.83

ALPRAZolam 0.5 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365002
Hospital Revenue Code	259
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.32
Rate for Payer: Medical Associates Commercial	$2.32
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: United Healthcare Commercial	$2.79

ALPRAZolam 1 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365142
Hospital Revenue Code	259
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.33
Rate for Payer: Medical Associates Commercial	$2.33
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: United Healthcare Commercial	$2.79

ALPRAZolam 1 mg Tab [VDMC]

Facility

$3.10

Service Code	HCPCS A9270
Hospital Charge Code	10365142
Hospital Revenue Code	259
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of IA Commercial	$2.79
Rate for Payer: Aetna of IA Medical Rental Products	$2.79
Rate for Payer: Aetna of IA Medicare	$1.77
Rate for Payer: Amerigroup Medicaid	$1.79
Rate for Payer: Amerigroup Medicare	$1.41
Rate for Payer: Cash Price	$2.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1.77
Rate for Payer: Medical Associates Commercial	$2.33
Rate for Payer: Medical Associates Managed Medicare	$1.40
Rate for Payer: Midlands Choice Commercial	$2.17
Rate for Payer: Molina Healthcare Managed Medicaid	$1.80
Rate for Payer: Partners Health Alliance Commercial	$1.61
Rate for Payer: United Healthcare Commercial	$2.79
Rate for Payer: United Healthcare Managed Medicare	$1.83

ALS1 EMERGENCY

Facility

$889.00

Service Code	HCPCS A0427 QN
Hospital Charge Code	5230783
Hospital Revenue Code	540
Min. Negotiated Rate	$400.05
Max. Negotiated Rate	$800.10
Rate for Payer: Aetna of IA Commercial	$800.10
Rate for Payer: Aetna of IA Medical Rental Products	$800.10
Rate for Payer: Aetna of IA Medicare	$506.73
Rate for Payer: Amerigroup Medicaid	$512.78
Rate for Payer: Amerigroup Medicare	$404.05
Rate for Payer: Cash Price	$711.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$666.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$400.05
Rate for Payer: Iowa Total Care Managed Medicaid	$507.80
Rate for Payer: Medical Associates Commercial	$666.75
Rate for Payer: Medical Associates Managed Medicare	$400.05
Rate for Payer: Midlands Choice Commercial	$622.30
Rate for Payer: Molina Healthcare Managed Medicaid	$515.26
Rate for Payer: Partners Health Alliance Commercial	$460.06
Rate for Payer: United Healthcare Commercial	$800.10
Rate for Payer: United Healthcare Managed Medicare	$755.65

ALS1 EMERGENCY

Facility

$889.00

Service Code	HCPCS A0427 QN
Hospital Charge Code	5230783
Hospital Revenue Code	540
Min. Negotiated Rate	$622.30
Max. Negotiated Rate	$800.10
Rate for Payer: Aetna of IA Commercial	$800.10
Rate for Payer: Aetna of IA Medical Rental Products	$800.10
Rate for Payer: Cash Price	$711.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$666.75
Rate for Payer: Medical Associates Commercial	$666.75
Rate for Payer: Midlands Choice Commercial	$622.30
Rate for Payer: United Healthcare Commercial	$800.10

Know your out-of-pocket cost for care.

All Charges