|
trospium chloride 20 mg Tab
|
Facility
IP
|
$1.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of IA Commercial |
$1.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.58
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
|
|
trospium chloride 20 mg Tab
|
Facility
OP
|
$1.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of IA Commercial |
$1.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.58
|
| Rate for Payer: Aetna of IA Medicare |
$1.00
|
| Rate for Payer: Amerigroup Medicaid |
$0.89
|
| Rate for Payer: Amerigroup Medicare |
$0.89
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$1.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.04
|
|
|
Tryptase DMCL
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
Tryptase DMCL
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$62.08
|
| Rate for Payer: Amerigroup Medicare |
$62.12
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.48
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
TSH
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| 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 |
$69.14
|
| Rate for Payer: Amerigroup Medicare |
$69.18
|
| Rate for Payer: Cash Price |
$109.60
|
| 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 |
$68.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.47
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.50
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
TSH
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
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
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
ULTRASOUND PER 15 MIN APPLICATION
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1374021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
ULTRASOUND PER 15 MIN APPLICATION
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1374021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
umeclidinium 62.5 mcg (0.0625 mg)/inh Pow
|
Facility
OP
|
$162.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna of IA Commercial |
$146.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.05
|
| Rate for Payer: Aetna of IA Medicare |
$92.50
|
| Rate for Payer: Amerigroup Medicaid |
$81.90
|
| Rate for Payer: Amerigroup Medicare |
$81.95
|
| Rate for Payer: Cash Price |
$129.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.11
|
| Rate for Payer: Medical Associates Commercial |
$121.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.14
|
| Rate for Payer: Midlands Choice Commercial |
$113.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$146.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$95.75
|
|
|
umeclidinium 62.5 mcg (0.0625 mg)/inh Pow
|
Facility
IP
|
$162.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna of IA Commercial |
$146.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.05
|
| Rate for Payer: Cash Price |
$129.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.71
|
| Rate for Payer: Medical Associates Commercial |
$121.71
|
| Rate for Payer: Midlands Choice Commercial |
$113.60
|
| Rate for Payer: United Healthcare Commercial |
$146.05
|
|
|
Uncomplicated Peptic Ulcer With MCC
|
Facility
IP
|
$12,905.37
|
|
|
Service Code
|
MS-DRG 383
|
| Hospital Charge Code |
224
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,905.37 |
| Rate for Payer: Amerigroup Medicaid |
$12,843.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,718.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,905.37
|
|
|
Uncomplicated Peptic Ulcer Without MCC
|
Facility
IP
|
$8,751.88
|
|
|
Service Code
|
MS-DRG 384
|
| Hospital Charge Code |
225
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,751.88 |
| Rate for Payer: Amerigroup Medicaid |
$8,709.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,625.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,751.88
|
|
|
Unlisted procedure, dentoalveolar structures
|
Facility
OP
|
$3,851.25
|
|
|
Service Code
|
CPT 41899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,501.14 |
| Max. Negotiated Rate |
$3,851.25 |
| Rate for Payer: Wellmark IA HMO |
$3,501.14
|
| Rate for Payer: Wellmark IA PPO |
$3,851.25
|
|
|
Unlisted procedure, foot or toes
|
Facility
OP
|
$3,346.57
|
|
|
Service Code
|
CPT 28899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,042.34 |
| Max. Negotiated Rate |
$3,346.57 |
| Rate for Payer: Wellmark IA HMO |
$3,042.34
|
| Rate for Payer: Wellmark IA PPO |
$3,346.57
|
|
|
Upper Limb and Toe Amputation for Circulatory System Disorders With CC
|
Facility
IP
|
$14,740.00
|
|
|
Service Code
|
MS-DRG 256
|
| Hospital Charge Code |
118
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,740.00 |
| Rate for Payer: Amerigroup Medicaid |
$14,668.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14,526.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,740.00
|
|
|
Upper Limb and Toe Amputation for Circulatory System Disorders With MCC
|
Facility
IP
|
$15,048.07
|
|
|
Service Code
|
MS-DRG 255
|
| Hospital Charge Code |
117
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,048.07 |
| Rate for Payer: Amerigroup Medicaid |
$14,975.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14,829.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,048.07
|
|
|
Upper Limb and Toe Amputation for Circulatory System Disorders Without CC/MCC
|
Facility
IP
|
$11,430.00
|
|
|
Service Code
|
MS-DRG 257
|
| Hospital Charge Code |
119
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,430.00 |
| Rate for Payer: Amerigroup Medicaid |
$11,374.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,264.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,430.00
|
|
|
Urea topical 20% Cream 85 gram
|
Facility
IP
|
$25.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of IA Commercial |
$23.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.29
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.41
|
| Rate for Payer: Medical Associates Commercial |
$19.41
|
| Rate for Payer: Midlands Choice Commercial |
$18.12
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
|
|
Urea topical 20% Cream 85 gram
|
Facility
OP
|
$25.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of IA Commercial |
$23.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.29
|
| Rate for Payer: Aetna of IA Medicare |
$14.75
|
| Rate for Payer: Amerigroup Medicaid |
$13.06
|
| Rate for Payer: Amerigroup Medicare |
$13.07
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.93
|
| Rate for Payer: Medical Associates Commercial |
$19.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.94
|
| Rate for Payer: Midlands Choice Commercial |
$18.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.41
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.27
|
|
|
Urethral Procedures With CC/MCC
|
Facility
IP
|
$17,491.95
|
|
|
Service Code
|
MS-DRG 671
|
| Hospital Charge Code |
453
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,491.95 |
| Rate for Payer: Amerigroup Medicaid |
$17,407.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17,238.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,491.95
|
|
|
Urethral Procedures Without CC/MCC
|
Facility
IP
|
$8,932.97
|
|
|
Service Code
|
MS-DRG 672
|
| Hospital Charge Code |
454
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,932.97 |
| Rate for Payer: Amerigroup Medicaid |
$8,889.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,803.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,932.97
|
|
|
Urethral Stricture
|
Facility
IP
|
$5,815.88
|
|
|
Service Code
|
MS-DRG 697
|
| Hospital Charge Code |
470
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,815.88 |
| Rate for Payer: Amerigroup Medicaid |
$5,787.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,731.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,815.88
|
|
|
URIC ACID
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
|
