Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

cefTRIAXone 500 mg Inj SDV [VDMC]

Facility

$22.02

Service Code	HCPCS J0696
Hospital Charge Code	10376345
Hospital Revenue Code	259
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$19.81
Rate for Payer: Aetna of IA Commercial	$19.81
Rate for Payer: Aetna of IA Medical Rental Products	$19.81
Rate for Payer: Aetna of IA Medicare	$12.55
Rate for Payer: Amerigroup Medicaid	$12.70
Rate for Payer: Amerigroup Medicare	$10.01
Rate for Payer: Cash Price	$17.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$16.51
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.91
Rate for Payer: Iowa Total Care Managed Medicaid	$12.58
Rate for Payer: Medical Associates Commercial	$16.51
Rate for Payer: Medical Associates Managed Medicare	$9.91
Rate for Payer: Midlands Choice Commercial	$15.41
Rate for Payer: Molina Healthcare Managed Medicaid	$12.76
Rate for Payer: Partners Health Alliance Commercial	$11.39
Rate for Payer: United Healthcare Commercial	$19.81
Rate for Payer: United Healthcare Managed Medicare	$12.99

cefuroxime 250 mg Tab [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10376483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Aetna of IA Medicare	$1.07
Rate for Payer: Amerigroup Medicaid	$1.08
Rate for Payer: Amerigroup Medicare	$0.85
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.84
Rate for Payer: Iowa Total Care Managed Medicaid	$1.07
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Medical Associates Managed Medicare	$0.84
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: Molina Healthcare Managed Medicaid	$1.08
Rate for Payer: Partners Health Alliance Commercial	$0.97
Rate for Payer: United Healthcare Commercial	$1.68
Rate for Payer: United Healthcare Managed Medicare	$1.10

cefuroxime 250 mg Tab [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10376483
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: United Healthcare Commercial	$1.68

celecoxib 100 mg Cap [VDMC]

Facility

$1.55

Service Code	HCPCS A9270
Hospital Charge Code	10376690
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of IA Commercial	$1.40
Rate for Payer: Aetna of IA Medical Rental Products	$1.40
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Midlands Choice Commercial	$1.09
Rate for Payer: United Healthcare Commercial	$1.40

celecoxib 100 mg Cap [VDMC]

Facility

$1.55

Service Code	HCPCS A9270
Hospital Charge Code	10376690
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of IA Commercial	$1.40
Rate for Payer: Aetna of IA Medical Rental Products	$1.40
Rate for Payer: Aetna of IA Medicare	$0.88
Rate for Payer: Amerigroup Medicaid	$0.90
Rate for Payer: Amerigroup Medicare	$0.71
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.70
Rate for Payer: Iowa Total Care Managed Medicaid	$0.89
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Medical Associates Managed Medicare	$0.70
Rate for Payer: Midlands Choice Commercial	$1.09
Rate for Payer: Molina Healthcare Managed Medicaid	$0.90
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.40
Rate for Payer: United Healthcare Managed Medicare	$0.92

CENTRAL LINE DRAW/LAB NO OTHR SVC

Facility

$31.00

Service Code	CPT 36591
Hospital Charge Code	7983016
Hospital Revenue Code	761
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$17.88
Rate for Payer: Amerigroup Medicare	$14.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.95
Rate for Payer: Iowa Total Care Managed Medicaid	$17.71
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$13.95
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$17.97
Rate for Payer: Partners Health Alliance Commercial	$16.04
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29

CENTRAL LINE DRAW/LAB NO OTHR SVC

Facility

$31.00

Service Code	CPT 36591
Hospital Charge Code	7983016
Hospital Revenue Code	761
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

CENTRAL LINE DRAW/LAB W/OTHR SVC

Facility

$31.00

Service Code	CPT 99211
Hospital Charge Code	4866808
Hospital Revenue Code	761
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$17.88
Rate for Payer: Amerigroup Medicare	$14.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.95
Rate for Payer: Iowa Total Care Managed Medicaid	$17.71
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$13.95
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$17.97
Rate for Payer: Partners Health Alliance Commercial	$16.04
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29

CENTRAL LINE DRAW/LAB W/OTHR SVC

Facility

$31.00

Service Code	CPT 99211
Hospital Charge Code	4866808
Hospital Revenue Code	761
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

CENTRAL LINE-PHYSICIAN CHARGE

Professional

Both

$774.00

Service Code	CPT 36556
Hospital Charge Code	7982776
Hospital Revenue Code	981
Min. Negotiated Rate	$321.70
Max. Negotiated Rate	$580.50
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Medical Associates Commercial	$580.50
Rate for Payer: Midlands Choice Commercial	$541.80
Rate for Payer: Partners Health Alliance Commercial	$580.50
Rate for Payer: United Healthcare Commercial	$321.70

cephalexin 250 mg/5 mL 100ml Oral Liq [VDMC]

Facility

$48.72

Service Code	HCPCS A9270
Hospital Charge Code	10376828
Hospital Revenue Code	259
Min. Negotiated Rate	$34.10
Max. Negotiated Rate	$43.85
Rate for Payer: Aetna of IA Commercial	$43.85
Rate for Payer: Aetna of IA Medical Rental Products	$43.85
Rate for Payer: Cash Price	$38.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.54
Rate for Payer: Medical Associates Commercial	$36.54
Rate for Payer: Midlands Choice Commercial	$34.10
Rate for Payer: United Healthcare Commercial	$43.85

cephalexin 250 mg/5 mL 100ml Oral Liq [VDMC]

Facility

$48.72

Service Code	HCPCS A9270
Hospital Charge Code	10376828
Hospital Revenue Code	259
Min. Negotiated Rate	$21.92
Max. Negotiated Rate	$43.85
Rate for Payer: Aetna of IA Commercial	$43.85
Rate for Payer: Aetna of IA Medical Rental Products	$43.85
Rate for Payer: Aetna of IA Medicare	$27.77
Rate for Payer: Amerigroup Medicaid	$28.10
Rate for Payer: Amerigroup Medicare	$22.14
Rate for Payer: Cash Price	$38.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.54
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$21.92
Rate for Payer: Iowa Total Care Managed Medicaid	$27.83
Rate for Payer: Medical Associates Commercial	$36.54
Rate for Payer: Medical Associates Managed Medicare	$21.92
Rate for Payer: Midlands Choice Commercial	$34.10
Rate for Payer: Molina Healthcare Managed Medicaid	$28.24
Rate for Payer: Partners Health Alliance Commercial	$25.21
Rate for Payer: United Healthcare Commercial	$43.85
Rate for Payer: United Healthcare Managed Medicare	$28.74

cephalexin 250 mg Cap [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10376759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.14
Rate for Payer: Aetna of IA Commercial	$1.14
Rate for Payer: Aetna of IA Medical Rental Products	$1.14
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: United Healthcare Commercial	$1.14

cephalexin 250 mg Cap [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10376759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.14
Rate for Payer: Aetna of IA Commercial	$1.14
Rate for Payer: Aetna of IA Medical Rental Products	$1.14
Rate for Payer: Aetna of IA Medicare	$0.72
Rate for Payer: Amerigroup Medicaid	$0.73
Rate for Payer: Amerigroup Medicare	$0.57
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.57
Rate for Payer: Iowa Total Care Managed Medicaid	$0.72
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Medical Associates Managed Medicare	$0.57
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: Molina Healthcare Managed Medicaid	$0.73
Rate for Payer: Partners Health Alliance Commercial	$0.65
Rate for Payer: United Healthcare Commercial	$1.14
Rate for Payer: United Healthcare Managed Medicare	$0.75

cephalexin 500 mg Cap [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10376897
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.42
Rate for Payer: Medical Associates Commercial	$1.42
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: United Healthcare Commercial	$1.70

cephalexin 500 mg Cap [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10376897
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Aetna of IA Medicare	$1.08
Rate for Payer: Amerigroup Medicaid	$1.09
Rate for Payer: Amerigroup Medicare	$0.86
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.85
Rate for Payer: Iowa Total Care Managed Medicaid	$1.08
Rate for Payer: Medical Associates Commercial	$1.42
Rate for Payer: Medical Associates Managed Medicare	$0.85
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: Molina Healthcare Managed Medicaid	$1.09
Rate for Payer: Partners Health Alliance Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.70
Rate for Payer: United Healthcare Managed Medicare	$1.11

certolizumab 200 mg Kit SDV[VDMC]

Facility

$5,819.19

Service Code	HCPCS J0717
Hospital Charge Code	12471698
Hospital Revenue Code	259
Min. Negotiated Rate	$4,073.43
Max. Negotiated Rate	$5,237.27
Rate for Payer: Aetna of IA Commercial	$5,237.27
Rate for Payer: Aetna of IA Medical Rental Products	$5,237.27
Rate for Payer: Cash Price	$4,655.35
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4,364.39
Rate for Payer: Medical Associates Commercial	$4,364.39
Rate for Payer: Midlands Choice Commercial	$4,073.43
Rate for Payer: United Healthcare Commercial	$5,237.27

certolizumab 200 mg Kit SDV[VDMC]

Facility

$5,819.19

Service Code	HCPCS J0717
Hospital Charge Code	12471698
Hospital Revenue Code	259
Min. Negotiated Rate	$2,618.64
Max. Negotiated Rate	$5,237.27
Rate for Payer: Aetna of IA Commercial	$5,237.27
Rate for Payer: Aetna of IA Medical Rental Products	$5,237.27
Rate for Payer: Aetna of IA Medicare	$3,316.94
Rate for Payer: Amerigroup Medicaid	$3,356.51
Rate for Payer: Amerigroup Medicare	$2,644.82
Rate for Payer: Cash Price	$4,655.35
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$4,364.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,618.64
Rate for Payer: Iowa Total Care Managed Medicaid	$3,323.92
Rate for Payer: Medical Associates Commercial	$4,364.39
Rate for Payer: Medical Associates Managed Medicare	$2,618.64
Rate for Payer: Midlands Choice Commercial	$4,073.43
Rate for Payer: Molina Healthcare Managed Medicaid	$3,372.80
Rate for Payer: Partners Health Alliance Commercial	$3,011.43
Rate for Payer: United Healthcare Commercial	$5,237.27
Rate for Payer: United Healthcare Managed Medicare	$3,433.32

Ceruloplasmin DMCL

Facility

$139.00

Service Code	CPT 82390
Hospital Charge Code	8037510
Hospital Revenue Code	301
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

Ceruloplasmin DMCL

Facility

$139.00

Service Code	CPT 82390
Hospital Charge Code	8037510
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

CERUMEN REMOVAL

Professional

Both

$132.00

Service Code	CPT 69210
Hospital Charge Code	7982759
Hospital Revenue Code	981
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$99.00
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Medical Associates Commercial	$99.00
Rate for Payer: Midlands Choice Commercial	$92.40
Rate for Payer: Partners Health Alliance Commercial	$99.00
Rate for Payer: United Healthcare Commercial	$72.00

cetirizine 10 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	10376958
Hospital Revenue Code	259
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Cash Price	$1.21
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: United Healthcare Commercial	$1.37

cetirizine 10 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	10376958
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Aetna of IA Medicare	$0.86
Rate for Payer: Amerigroup Medicaid	$0.87
Rate for Payer: Amerigroup Medicare	$0.69
Rate for Payer: Cash Price	$1.21
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.68
Rate for Payer: Iowa Total Care Managed Medicaid	$0.87
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Medical Associates Managed Medicare	$0.68
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: Molina Healthcare Managed Medicaid	$0.88
Rate for Payer: Partners Health Alliance Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.37
Rate for Payer: United Healthcare Managed Medicare	$0.89

cetirizine 5mg/5ml 120 ml bottle [VDMC]

Facility

$14.53

Service Code	HCPCS A9270
Hospital Charge Code	16005974
Hospital Revenue Code	259
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$13.07
Rate for Payer: Aetna of IA Commercial	$13.07
Rate for Payer: Aetna of IA Medical Rental Products	$13.07
Rate for Payer: Cash Price	$11.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.89
Rate for Payer: Medical Associates Commercial	$10.89
Rate for Payer: Midlands Choice Commercial	$10.17
Rate for Payer: United Healthcare Commercial	$13.07

cetirizine 5mg/5ml 120 ml bottle [VDMC]

Facility

$14.53

Service Code	HCPCS A9270
Hospital Charge Code	16005974
Hospital Revenue Code	259
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$13.07
Rate for Payer: Aetna of IA Commercial	$13.07
Rate for Payer: Aetna of IA Medical Rental Products	$13.07
Rate for Payer: Aetna of IA Medicare	$8.28
Rate for Payer: Amerigroup Medicaid	$8.38
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: Cash Price	$11.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.89
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.54
Rate for Payer: Iowa Total Care Managed Medicaid	$8.30
Rate for Payer: Medical Associates Commercial	$10.89
Rate for Payer: Medical Associates Managed Medicare	$6.54
Rate for Payer: Midlands Choice Commercial	$10.17
Rate for Payer: Molina Healthcare Managed Medicaid	$8.42
Rate for Payer: Partners Health Alliance Commercial	$7.52
Rate for Payer: United Healthcare Commercial	$13.07
Rate for Payer: United Healthcare Managed Medicare	$8.57

Know your out-of-pocket cost for care.

All Charges