Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

clonazePAM 0.25 mg Dis Tab [VDMC]

Facility

$4.53

Service Code	HCPCS A9270
Hospital Charge Code	10378545
Hospital Revenue Code	259
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna of IA Commercial	$4.07
Rate for Payer: Aetna of IA Medical Rental Products	$4.07
Rate for Payer: Cash Price	$3.62
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.39
Rate for Payer: Medical Associates Commercial	$3.39
Rate for Payer: Midlands Choice Commercial	$3.17
Rate for Payer: United Healthcare Commercial	$4.07

clonazePAM 0.5 mg Tab [VDMC]

Facility

$4.92

Service Code	HCPCS A9270
Hospital Charge Code	10378614
Hospital Revenue Code	259
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$4.43
Rate for Payer: Aetna of IA Commercial	$4.43
Rate for Payer: Aetna of IA Medical Rental Products	$4.43
Rate for Payer: Cash Price	$3.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.69
Rate for Payer: Medical Associates Commercial	$3.69
Rate for Payer: Midlands Choice Commercial	$3.44
Rate for Payer: United Healthcare Commercial	$4.43

clonazePAM 0.5 mg Tab [VDMC]

Facility

$4.92

Service Code	HCPCS A9270
Hospital Charge Code	10378614
Hospital Revenue Code	259
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.43
Rate for Payer: Aetna of IA Commercial	$4.43
Rate for Payer: Aetna of IA Medical Rental Products	$4.43
Rate for Payer: Aetna of IA Medicare	$2.81
Rate for Payer: Amerigroup Medicaid	$2.84
Rate for Payer: Amerigroup Medicare	$2.24
Rate for Payer: Cash Price	$3.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.69
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.21
Rate for Payer: Iowa Total Care Managed Medicaid	$2.81
Rate for Payer: Medical Associates Commercial	$3.69
Rate for Payer: Medical Associates Managed Medicare	$2.21
Rate for Payer: Midlands Choice Commercial	$3.44
Rate for Payer: Molina Healthcare Managed Medicaid	$2.85
Rate for Payer: Partners Health Alliance Commercial	$2.55
Rate for Payer: United Healthcare Commercial	$4.43
Rate for Payer: United Healthcare Managed Medicare	$2.90

clonazePAM 1 mg Tab [VDMC]

Facility

$3.16

Service Code	HCPCS A9270
Hospital Charge Code	10378683
Hospital Revenue Code	259
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna of IA Commercial	$2.85
Rate for Payer: Aetna of IA Medical Rental Products	$2.85
Rate for Payer: Aetna of IA Medicare	$1.80
Rate for Payer: Amerigroup Medicaid	$1.82
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: Cash Price	$2.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.37
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.42
Rate for Payer: Iowa Total Care Managed Medicaid	$1.81
Rate for Payer: Medical Associates Commercial	$2.37
Rate for Payer: Medical Associates Managed Medicare	$1.42
Rate for Payer: Midlands Choice Commercial	$2.21
Rate for Payer: Molina Healthcare Managed Medicaid	$1.83
Rate for Payer: Partners Health Alliance Commercial	$1.64
Rate for Payer: United Healthcare Commercial	$2.85
Rate for Payer: United Healthcare Managed Medicare	$1.87

clonazePAM 1 mg Tab [VDMC]

Facility

$3.16

Service Code	HCPCS A9270
Hospital Charge Code	10378683
Hospital Revenue Code	259
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna of IA Commercial	$2.85
Rate for Payer: Aetna of IA Medical Rental Products	$2.85
Rate for Payer: Cash Price	$2.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.37
Rate for Payer: Medical Associates Commercial	$2.37
Rate for Payer: Midlands Choice Commercial	$2.21
Rate for Payer: United Healthcare Commercial	$2.85

cloNIDine 0.1 mg/24 hr Transderm ER Film [VDMC]

Facility

$56.80

Service Code	HCPCS A9270
Hospital Charge Code	10378821
Hospital Revenue Code	259
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$51.12
Rate for Payer: Aetna of IA Commercial	$51.12
Rate for Payer: Aetna of IA Medical Rental Products	$51.12
Rate for Payer: Aetna of IA Medicare	$32.38
Rate for Payer: Amerigroup Medicaid	$32.76
Rate for Payer: Amerigroup Medicare	$25.82
Rate for Payer: Cash Price	$45.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.60
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$25.56
Rate for Payer: Iowa Total Care Managed Medicaid	$32.44
Rate for Payer: Medical Associates Commercial	$42.60
Rate for Payer: Medical Associates Managed Medicare	$25.56
Rate for Payer: Midlands Choice Commercial	$39.76
Rate for Payer: Molina Healthcare Managed Medicaid	$32.92
Rate for Payer: Partners Health Alliance Commercial	$29.39
Rate for Payer: United Healthcare Commercial	$51.12
Rate for Payer: United Healthcare Managed Medicare	$33.51

cloNIDine 0.1 mg/24 hr Transderm ER Film [VDMC]

Facility

$56.80

Service Code	HCPCS A9270
Hospital Charge Code	10378821
Hospital Revenue Code	259
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$51.12
Rate for Payer: Aetna of IA Commercial	$51.12
Rate for Payer: Aetna of IA Medical Rental Products	$51.12
Rate for Payer: Cash Price	$45.44
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.60
Rate for Payer: Medical Associates Commercial	$42.60
Rate for Payer: Midlands Choice Commercial	$39.76
Rate for Payer: United Healthcare Commercial	$51.12

cloNIDine 0.1 mg Tab [VDMC]

Facility

$1.79

Service Code	HCPCS A9270
Hospital Charge Code	10378752
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.61
Rate for Payer: Aetna of IA Commercial	$1.61
Rate for Payer: Aetna of IA Medical Rental Products	$1.61
Rate for Payer: Aetna of IA Medicare	$1.02
Rate for Payer: Amerigroup Medicaid	$1.03
Rate for Payer: Amerigroup Medicare	$0.81
Rate for Payer: Cash Price	$1.43
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.34
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.80
Rate for Payer: Iowa Total Care Managed Medicaid	$1.02
Rate for Payer: Medical Associates Commercial	$1.34
Rate for Payer: Medical Associates Managed Medicare	$0.80
Rate for Payer: Midlands Choice Commercial	$1.25
Rate for Payer: Molina Healthcare Managed Medicaid	$1.04
Rate for Payer: Partners Health Alliance Commercial	$0.93
Rate for Payer: United Healthcare Commercial	$1.61
Rate for Payer: United Healthcare Managed Medicare	$1.06

cloNIDine 0.1 mg Tab [VDMC]

Facility

$1.79

Service Code	HCPCS A9270
Hospital Charge Code	10378752
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.61
Rate for Payer: Aetna of IA Commercial	$1.61
Rate for Payer: Aetna of IA Medical Rental Products	$1.61
Rate for Payer: Cash Price	$1.43
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.34
Rate for Payer: Medical Associates Commercial	$1.34
Rate for Payer: Midlands Choice Commercial	$1.25
Rate for Payer: United Healthcare Commercial	$1.61

cloNIDine 0.3 mg/24 hr Transderm ER Film [VDMC]

Facility

$78.33

Service Code	HCPCS A9270
Hospital Charge Code	10378886
Hospital Revenue Code	259
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna of IA Commercial	$70.50
Rate for Payer: Aetna of IA Medical Rental Products	$70.50
Rate for Payer: Cash Price	$62.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$58.75
Rate for Payer: Medical Associates Commercial	$58.75
Rate for Payer: Midlands Choice Commercial	$54.83
Rate for Payer: United Healthcare Commercial	$70.50

cloNIDine 0.3 mg/24 hr Transderm ER Film [VDMC]

Facility

$78.33

Service Code	HCPCS A9270
Hospital Charge Code	10378886
Hospital Revenue Code	259
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna of IA Commercial	$70.50
Rate for Payer: Aetna of IA Medical Rental Products	$70.50
Rate for Payer: Aetna of IA Medicare	$44.65
Rate for Payer: Amerigroup Medicaid	$45.18
Rate for Payer: Amerigroup Medicare	$35.60
Rate for Payer: Cash Price	$62.66
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$58.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$35.25
Rate for Payer: Iowa Total Care Managed Medicaid	$44.74
Rate for Payer: Medical Associates Commercial	$58.75
Rate for Payer: Medical Associates Managed Medicare	$35.25
Rate for Payer: Midlands Choice Commercial	$54.83
Rate for Payer: Molina Healthcare Managed Medicaid	$45.40
Rate for Payer: Partners Health Alliance Commercial	$40.53
Rate for Payer: United Healthcare Commercial	$70.50
Rate for Payer: United Healthcare Managed Medicare	$46.21

cloNIDine 100mcg/1mL 10mL SDV IV Sol[VDMC]

Facility

$82.56

Service Code	HCPCS J0735
Hospital Charge Code	29046892
Hospital Revenue Code	259
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$74.30
Rate for Payer: Aetna of IA Commercial	$74.30
Rate for Payer: Aetna of IA Medical Rental Products	$74.30
Rate for Payer: Aetna of IA Medicare	$47.06
Rate for Payer: Amerigroup Medicaid	$47.62
Rate for Payer: Amerigroup Medicare	$37.52
Rate for Payer: Cash Price	$66.05
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.92
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.15
Rate for Payer: Iowa Total Care Managed Medicaid	$47.16
Rate for Payer: Medical Associates Commercial	$61.92
Rate for Payer: Medical Associates Managed Medicare	$37.15
Rate for Payer: Midlands Choice Commercial	$57.79
Rate for Payer: Molina Healthcare Managed Medicaid	$47.85
Rate for Payer: Partners Health Alliance Commercial	$42.72
Rate for Payer: United Healthcare Commercial	$74.30
Rate for Payer: United Healthcare Managed Medicare	$48.71

cloNIDine 100mcg/1mL 10mL SDV IV Sol[VDMC]

Facility

$82.56

Service Code	HCPCS J0735
Hospital Charge Code	29046892
Hospital Revenue Code	259
Min. Negotiated Rate	$57.79
Max. Negotiated Rate	$74.30
Rate for Payer: Aetna of IA Commercial	$74.30
Rate for Payer: Aetna of IA Medical Rental Products	$74.30
Rate for Payer: Cash Price	$66.05
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$61.92
Rate for Payer: Medical Associates Commercial	$61.92
Rate for Payer: Midlands Choice Commercial	$57.79
Rate for Payer: United Healthcare Commercial	$74.30

clopidogrel 75 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10378951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Cash Price	$1.23
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	$1.08
Rate for Payer: United Healthcare Commercial	$1.39

clopidogrel 75 mg Tab [VDMC]

Facility

$1.54

Service Code	HCPCS A9270
Hospital Charge Code	10378951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of IA Commercial	$1.39
Rate for Payer: Aetna of IA Medical Rental Products	$1.39
Rate for Payer: Aetna of IA Medicare	$0.88
Rate for Payer: Amerigroup Medicaid	$0.89
Rate for Payer: Amerigroup Medicare	$0.70
Rate for Payer: Cash Price	$1.23
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	$0.69
Rate for Payer: Iowa Total Care Managed Medicaid	$0.88
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Medical Associates Managed Medicare	$0.69
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: Molina Healthcare Managed Medicaid	$0.89
Rate for Payer: Partners Health Alliance Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.39
Rate for Payer: United Healthcare Managed Medicare	$0.91

CLOSED REDUCTION

Professional

Both

$1,621.00

Service Code	CPT 25535
Hospital Charge Code	7982868
Hospital Revenue Code	981
Min. Negotiated Rate	$738.56
Max. Negotiated Rate	$1,215.75
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Medical Associates Commercial	$1,215.75
Rate for Payer: Midlands Choice Commercial	$1,134.70
Rate for Payer: Partners Health Alliance Commercial	$1,215.75
Rate for Payer: United Healthcare Commercial	$738.56

CLOSED TREATMENT OF CARPAL BONE FX

Professional

Both

$1,464.00

Service Code	CPT 25635
Hospital Charge Code	8822636
Hospital Revenue Code	981
Min. Negotiated Rate	$692.03
Max. Negotiated Rate	$1,098.00
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Medical Associates Commercial	$1,098.00
Rate for Payer: Midlands Choice Commercial	$1,024.80
Rate for Payer: Partners Health Alliance Commercial	$1,098.00
Rate for Payer: United Healthcare Commercial	$692.03

Clostridioides difficile Toxin by EIA DMCL

Facility

$58.00

Service Code	CPT 87324
Hospital Charge Code	8728243
Hospital Revenue Code	306
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

Clostridioides difficile Toxin by EIA DMCL

Facility

$58.00

Service Code	CPT 87324
Hospital Charge Code	8728243
Hospital Revenue Code	306
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$33.45
Rate for Payer: Amerigroup Medicare	$26.36
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$26.10
Rate for Payer: Iowa Total Care Managed Medicaid	$33.13
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$26.10
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$33.62
Rate for Payer: Partners Health Alliance Commercial	$30.02
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22

CLOSTRIDIUM DIFFICILE

Facility

$152.00

Service Code	CPT 87493
Hospital Charge Code	4022795
Hospital Revenue Code	306
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Aetna of IA Medicare	$86.64
Rate for Payer: Amerigroup Medicaid	$87.67
Rate for Payer: Amerigroup Medicare	$69.08
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$68.40
Rate for Payer: Iowa Total Care Managed Medicaid	$86.82
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Medical Associates Managed Medicare	$68.40
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: Molina Healthcare Managed Medicaid	$88.10
Rate for Payer: Partners Health Alliance Commercial	$78.66
Rate for Payer: United Healthcare Commercial	$136.80
Rate for Payer: United Healthcare Managed Medicare	$89.68

CLOSTRIDIUM DIFFICILE

Facility

$152.00

Service Code	CPT 87493
Hospital Charge Code	4022795
Hospital Revenue Code	306
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: United Healthcare Commercial	$136.80

CLOSURE OF SPLIT WOUND

Facility

$579.00

Service Code	CPT 12020
Hospital Charge Code	4863348
Hospital Revenue Code	450
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: United Healthcare Commercial	$521.10

CLOSURE OF SPLIT WOUND

Facility

$579.00

Service Code	CPT 12020
Hospital Charge Code	4863348
Hospital Revenue Code	450
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of IA Commercial	$521.10
Rate for Payer: Aetna of IA Medical Rental Products	$521.10
Rate for Payer: Aetna of IA Medicare	$330.03
Rate for Payer: Amerigroup Medicaid	$333.97
Rate for Payer: Amerigroup Medicare	$263.16
Rate for Payer: Cash Price	$463.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$434.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$260.55
Rate for Payer: Iowa Total Care Managed Medicaid	$330.72
Rate for Payer: Medical Associates Commercial	$434.25
Rate for Payer: Medical Associates Managed Medicare	$260.55
Rate for Payer: Midlands Choice Commercial	$405.30
Rate for Payer: Molina Healthcare Managed Medicaid	$335.59
Rate for Payer: Partners Health Alliance Commercial	$299.63
Rate for Payer: United Healthcare Commercial	$521.10
Rate for Payer: United Healthcare Managed Medicare	$341.61

clotrimazole 10 mg Loz [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10379022
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	$1.41
Rate for Payer: Medical Associates Commercial	$1.41
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: United Healthcare Commercial	$1.70

clotrimazole 10 mg Loz [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10379022
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	$1.41
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	$1.41
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

Know your out-of-pocket cost for care.

All Charges