Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Sterile Water Injection 1000ml bag [VDMC]

Facility

$69.60

Service Code	HCPCS A4217
Hospital Charge Code	17516196
Hospital Revenue Code	259
Min. Negotiated Rate	$48.72
Max. Negotiated Rate	$62.64
Rate for Payer: Aetna of IA Commercial	$62.64
Rate for Payer: Aetna of IA Medical Rental Products	$62.64
Rate for Payer: Cash Price	$55.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.20
Rate for Payer: Medical Associates Commercial	$52.20
Rate for Payer: Midlands Choice Commercial	$48.72
Rate for Payer: United Healthcare Commercial	$62.64

Sterile Water Injection 1000ml bag [VDMC]

Facility

$69.60

Service Code	HCPCS A4217
Hospital Charge Code	17516196
Hospital Revenue Code	259
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.64
Rate for Payer: Aetna of IA Commercial	$62.64
Rate for Payer: Aetna of IA Medical Rental Products	$62.64
Rate for Payer: Aetna of IA Medicare	$39.67
Rate for Payer: Amerigroup Medicaid	$40.15
Rate for Payer: Amerigroup Medicare	$31.63
Rate for Payer: Cash Price	$55.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$52.20
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$31.32
Rate for Payer: Iowa Total Care Managed Medicaid	$39.76
Rate for Payer: Medical Associates Commercial	$52.20
Rate for Payer: Medical Associates Managed Medicare	$31.32
Rate for Payer: Midlands Choice Commercial	$48.72
Rate for Payer: Molina Healthcare Managed Medicaid	$40.34
Rate for Payer: Partners Health Alliance Commercial	$36.02
Rate for Payer: United Healthcare Commercial	$62.64
Rate for Payer: United Healthcare Managed Medicare	$41.06

STERISHIELD II DUAL LAYER AMNION PATCH 4X4

Facility

$4,131.00

Service Code	HCPCS C1781
Hospital Charge Code	8578902
Hospital Revenue Code	278
Min. Negotiated Rate	$1,858.95
Max. Negotiated Rate	$3,717.90
Rate for Payer: Aetna of IA Commercial	$3,717.90
Rate for Payer: Aetna of IA Medical Rental Products	$3,717.90
Rate for Payer: Aetna of IA Medicare	$2,354.67
Rate for Payer: Amerigroup Medicaid	$2,382.76
Rate for Payer: Amerigroup Medicare	$1,877.54
Rate for Payer: Cash Price	$3,304.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,098.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,858.95
Rate for Payer: Iowa Total Care Managed Medicaid	$2,359.63
Rate for Payer: Medical Associates Commercial	$3,098.25
Rate for Payer: Medical Associates Managed Medicare	$1,858.95
Rate for Payer: Midlands Choice Commercial	$2,891.70
Rate for Payer: Molina Healthcare Managed Medicaid	$2,394.33
Rate for Payer: Partners Health Alliance Commercial	$2,137.79
Rate for Payer: United Healthcare Commercial	$3,717.90
Rate for Payer: United Healthcare Managed Medicare	$2,437.29

STERISHIELD II DUAL LAYER AMNION PATCH 4X4

Facility

$4,131.00

Service Code	HCPCS C1781
Hospital Charge Code	8578902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,891.70
Max. Negotiated Rate	$3,717.90
Rate for Payer: Aetna of IA Commercial	$3,717.90
Rate for Payer: Aetna of IA Medical Rental Products	$3,717.90
Rate for Payer: Cash Price	$3,304.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,098.25
Rate for Payer: Medical Associates Commercial	$3,098.25
Rate for Payer: Midlands Choice Commercial	$2,891.70
Rate for Payer: United Healthcare Commercial	$3,717.90

STIM SUP

Facility

$85.00

Service Code	HCPCS G0283 GO
Hospital Charge Code	1373552
Hospital Revenue Code	430
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: United Healthcare Commercial	$76.50

STIM SUP

Facility

$85.00

Service Code	HCPCS G0283 GO
Hospital Charge Code	1373552
Hospital Revenue Code	430
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Aetna of IA Medicare	$48.45
Rate for Payer: Amerigroup Medicaid	$49.03
Rate for Payer: Amerigroup Medicare	$38.63
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.25
Rate for Payer: Iowa Total Care Managed Medicaid	$48.55
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Medical Associates Managed Medicare	$38.25
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: Molina Healthcare Managed Medicaid	$49.27
Rate for Payer: Partners Health Alliance Commercial	$43.99
Rate for Payer: United Healthcare Commercial	$76.50
Rate for Payer: United Healthcare Managed Medicare	$50.15
Rate for Payer: Wellmark IA HMO WHPI	$73.74
Rate for Payer: Wellmark IA PPO	$81.22

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$19,719.24

Service Code	MSDRG 327
Min. Negotiated Rate	$19,433.44
Max. Negotiated Rate	$19,719.24
Rate for Payer: Amerigroup Medicaid	$19,623.96
Rate for Payer: Iowa Total Care Managed Medicaid	$19,433.44
Rate for Payer: Molina Healthcare Managed Medicaid	$19,719.24

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$37,756.26

Service Code	MSDRG 326
Min. Negotiated Rate	$37,209.05
Max. Negotiated Rate	$37,756.26
Rate for Payer: Amerigroup Medicaid	$37,573.85
Rate for Payer: Iowa Total Care Managed Medicaid	$37,209.05
Rate for Payer: Molina Healthcare Managed Medicaid	$37,756.26

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$10,852.17

Service Code	MSDRG 328
Min. Negotiated Rate	$10,694.88
Max. Negotiated Rate	$10,852.17
Rate for Payer: Amerigroup Medicaid	$10,799.74
Rate for Payer: Iowa Total Care Managed Medicaid	$10,694.88
Rate for Payer: Molina Healthcare Managed Medicaid	$10,852.17

Stone (Calculus) Analysis DMCL

Facility

$139.00

Service Code	CPT 82365
Hospital Charge Code	8505620
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

Stone (Calculus) Analysis DMCL

Facility

$139.00

Service Code	CPT 82365
Hospital Charge Code	8505620
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

STOOL CULTURE

Facility

$77.00

Service Code	CPT 87045
Hospital Charge Code	633904
Hospital Revenue Code	306
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: United Healthcare Commercial	$69.30

STOOL CULTURE

Facility

$77.00

Service Code	CPT 87045
Hospital Charge Code	633904
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Aetna of IA Medicare	$43.89
Rate for Payer: Amerigroup Medicaid	$44.41
Rate for Payer: Amerigroup Medicare	$35.00
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$34.65
Rate for Payer: Iowa Total Care Managed Medicaid	$43.98
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Medical Associates Managed Medicare	$34.65
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: Molina Healthcare Managed Medicaid	$44.63
Rate for Payer: Partners Health Alliance Commercial	$39.85
Rate for Payer: United Healthcare Commercial	$69.30
Rate for Payer: United Healthcare Managed Medicare	$45.43
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

Stool Pathogen PCR Panel

Facility

$750.00

Service Code	CPT 87507
Hospital Charge Code	7812190
Hospital Revenue Code	306
Min. Negotiated Rate	$287.85
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of IA Commercial	$675.00
Rate for Payer: Aetna of IA Medical Rental Products	$675.00
Rate for Payer: Aetna of IA Medicare	$427.50
Rate for Payer: Amerigroup Medicaid	$432.60
Rate for Payer: Amerigroup Medicare	$340.88
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$562.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$337.50
Rate for Payer: Iowa Total Care Managed Medicaid	$428.40
Rate for Payer: Medical Associates Commercial	$562.50
Rate for Payer: Medical Associates Managed Medicare	$337.50
Rate for Payer: Midlands Choice Commercial	$525.00
Rate for Payer: Molina Healthcare Managed Medicaid	$434.70
Rate for Payer: Partners Health Alliance Commercial	$388.12
Rate for Payer: United Healthcare Commercial	$675.00
Rate for Payer: United Healthcare Managed Medicare	$442.50
Rate for Payer: Wellmark IA HMO WHPI	$287.85
Rate for Payer: Wellmark IA PPO	$317.09

Stool Pathogen PCR Panel

Facility

$750.00

Service Code	CPT 87507
Hospital Charge Code	7812190
Hospital Revenue Code	306
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of IA Commercial	$675.00
Rate for Payer: Aetna of IA Medical Rental Products	$675.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$562.50
Rate for Payer: Medical Associates Commercial	$562.50
Rate for Payer: Midlands Choice Commercial	$525.00
Rate for Payer: United Healthcare Commercial	$675.00

STRAPPING ANKLE FOOT

Facility

$117.00

Service Code	CPT 29540 GP
Hospital Charge Code	6344976
Hospital Revenue Code	420
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$113.25
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$102.81
Rate for Payer: Wellmark IA PPO	$113.25

STRAPPING ANKLE FOOT

Facility

$117.00

Service Code	CPT 29540 GP
Hospital Charge Code	6344976
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

STRAPPING HAND/FINGER

Facility

$102.00

Service Code	CPT 29280 GO
Hospital Charge Code	1374354
Hospital Revenue Code	430
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of IA Commercial	$91.80
Rate for Payer: Aetna of IA Medical Rental Products	$91.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.50
Rate for Payer: Medical Associates Commercial	$76.50
Rate for Payer: Midlands Choice Commercial	$71.40
Rate for Payer: United Healthcare Commercial	$91.80

STRAPPING HAND/FINGER

Facility

$102.00

Service Code	CPT 29280 GO
Hospital Charge Code	1374354
Hospital Revenue Code	430
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna of IA Commercial	$91.80
Rate for Payer: Aetna of IA Medical Rental Products	$91.80
Rate for Payer: Aetna of IA Medicare	$58.14
Rate for Payer: Amerigroup Medicaid	$58.83
Rate for Payer: Amerigroup Medicare	$46.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$76.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.90
Rate for Payer: Iowa Total Care Managed Medicaid	$58.26
Rate for Payer: Medical Associates Commercial	$76.50
Rate for Payer: Medical Associates Managed Medicare	$45.90
Rate for Payer: Midlands Choice Commercial	$71.40
Rate for Payer: Molina Healthcare Managed Medicaid	$59.12
Rate for Payer: Partners Health Alliance Commercial	$52.78
Rate for Payer: United Healthcare Commercial	$91.80
Rate for Payer: United Healthcare Managed Medicare	$60.18
Rate for Payer: Wellmark IA HMO WHPI	$102.81
Rate for Payer: Wellmark IA PPO	$113.25

STRAPPING KNEE

Facility

$106.00

Service Code	CPT 29530 GP
Hospital Charge Code	1374356
Hospital Revenue Code	420
Min. Negotiated Rate	$74.20
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of IA Commercial	$95.40
Rate for Payer: Aetna of IA Medical Rental Products	$95.40
Rate for Payer: Cash Price	$84.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$79.50
Rate for Payer: Medical Associates Commercial	$79.50
Rate for Payer: Midlands Choice Commercial	$74.20
Rate for Payer: United Healthcare Commercial	$95.40

STRAPPING KNEE

Facility

$106.00

Service Code	CPT 29530 GP
Hospital Charge Code	1374356
Hospital Revenue Code	420
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna of IA Commercial	$95.40
Rate for Payer: Aetna of IA Medical Rental Products	$95.40
Rate for Payer: Aetna of IA Medicare	$60.42
Rate for Payer: Amerigroup Medicaid	$61.14
Rate for Payer: Amerigroup Medicare	$48.18
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$79.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$47.70
Rate for Payer: Iowa Total Care Managed Medicaid	$60.55
Rate for Payer: Medical Associates Commercial	$79.50
Rate for Payer: Medical Associates Managed Medicare	$47.70
Rate for Payer: Midlands Choice Commercial	$74.20
Rate for Payer: Molina Healthcare Managed Medicaid	$61.44
Rate for Payer: Partners Health Alliance Commercial	$54.86
Rate for Payer: United Healthcare Commercial	$95.40
Rate for Payer: United Healthcare Managed Medicare	$62.54
Rate for Payer: Wellmark IA HMO WHPI	$102.81
Rate for Payer: Wellmark IA PPO	$113.25

STRAPPING OF ANKLE AND/OR FT

Facility

$180.00

Service Code	CPT 29540
Hospital Charge Code	4864895
Hospital Revenue Code	450
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

STRAPPING OF ANKLE AND/OR FT

Facility

$180.00

Service Code	CPT 29540
Hospital Charge Code	4864895
Hospital Revenue Code	450
Min. Negotiated Rate	$81.00
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: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
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	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20
Rate for Payer: Wellmark IA HMO WHPI	$102.81
Rate for Payer: Wellmark IA PPO	$113.25

STRAPPING OF SHOULDER

Professional

Both

$76.00

Service Code	CPT 29240
Hospital Charge Code	7822785
Hospital Revenue Code	981
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$65.90
Rate for Payer: Amerigroup Medicaid	$53.82
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Iowa Total Care Managed Medicaid	$53.30
Rate for Payer: Medical Associates Commercial	$57.00
Rate for Payer: Midlands Choice Commercial	$53.20
Rate for Payer: Molina Healthcare Managed Medicaid	$53.56
Rate for Payer: Partners Health Alliance Commercial	$57.00
Rate for Payer: United Healthcare Commercial	$47.63
Rate for Payer: Wellmark IA HMO WHPI	$56.00
Rate for Payer: Wellmark IA PPO	$65.90

STRAPPING SHOULDER

Facility

$129.00

Service Code	CPT 29240 GP
Hospital Charge Code	1374352
Hospital Revenue Code	420
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

Know your out-of-pocket cost for care.

All Charges