Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW 3.5MM X 36MM

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	8924287
Hospital Revenue Code	278
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

CORTICAL SCREW 3.5MM X 36MM

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	8924287
Hospital Revenue Code	278
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: 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

CORTICAL SCREW 3.5MM X 42MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	9004024
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

CORTICAL SCREW 3.5MM X 42MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	9004024
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

Cortisol AM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037517
Hospital Revenue Code	301
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Cortisol AM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037517
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

CORTISOL EA

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8093929
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

CORTISOL EA

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8093929
Hospital Revenue Code	301
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Cortisol PM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8519196
Hospital Revenue Code	301
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Cortisol PM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8519196
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

Cortisol Stimulation 1hr DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037703
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

Cortisol Stimulation 1hr DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037703
Hospital Revenue Code	301
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Cortisol Urine Free Timed DMCL

Facility

$114.00

Service Code	CPT 82530
Hospital Charge Code	8040997
Hospital Revenue Code	301
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$58.99
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26

Cortisol Urine Free Timed DMCL

Facility

$114.00

Service Code	CPT 82530
Hospital Charge Code	8040997
Hospital Revenue Code	301
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

cosyntropin 0.25 mg SDV Inj [VDMC]

Facility

$93.20

Service Code	HCPCS J0834
Hospital Charge Code	10380050
Hospital Revenue Code	259
Min. Negotiated Rate	$41.94
Max. Negotiated Rate	$83.88
Rate for Payer: Aetna of IA Commercial	$83.88
Rate for Payer: Aetna of IA Medical Rental Products	$83.88
Rate for Payer: Aetna of IA Medicare	$53.12
Rate for Payer: Amerigroup Medicaid	$53.76
Rate for Payer: Amerigroup Medicare	$42.36
Rate for Payer: Cash Price	$74.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.94
Rate for Payer: Iowa Total Care Managed Medicaid	$53.24
Rate for Payer: Medical Associates Commercial	$69.90
Rate for Payer: Medical Associates Managed Medicare	$41.94
Rate for Payer: Midlands Choice Commercial	$65.24
Rate for Payer: Molina Healthcare Managed Medicaid	$54.02
Rate for Payer: Partners Health Alliance Commercial	$48.23
Rate for Payer: United Healthcare Commercial	$83.88
Rate for Payer: United Healthcare Managed Medicare	$54.99

cosyntropin 0.25 mg SDV Inj [VDMC]

Facility

$93.20

Service Code	HCPCS J0834
Hospital Charge Code	10380050
Hospital Revenue Code	259
Min. Negotiated Rate	$65.24
Max. Negotiated Rate	$83.88
Rate for Payer: Aetna of IA Commercial	$83.88
Rate for Payer: Aetna of IA Medical Rental Products	$83.88
Rate for Payer: Cash Price	$74.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.90
Rate for Payer: Medical Associates Commercial	$69.90
Rate for Payer: Midlands Choice Commercial	$65.24
Rate for Payer: United Healthcare Commercial	$83.88

C Peptide DMCL

Facility

$170.00

Service Code	CPT 84681
Hospital Charge Code	8037503
Hospital Revenue Code	301
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: United Healthcare Commercial	$153.00

C Peptide DMCL

Facility

$170.00

Service Code	CPT 84681
Hospital Charge Code	8037503
Hospital Revenue Code	301
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Aetna of IA Medicare	$96.90
Rate for Payer: Amerigroup Medicaid	$98.06
Rate for Payer: Amerigroup Medicare	$77.27
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.50
Rate for Payer: Iowa Total Care Managed Medicaid	$97.10
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Medical Associates Managed Medicare	$76.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: Molina Healthcare Managed Medicaid	$98.53
Rate for Payer: Partners Health Alliance Commercial	$87.97
Rate for Payer: United Healthcare Commercial	$153.00
Rate for Payer: United Healthcare Managed Medicare	$100.30

CPR - PHYSICIAN ONLY

Professional

Both

$1,004.00

Service Code	CPT 92950
Hospital Charge Code	7982758
Hospital Revenue Code	981
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$753.00
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Medical Associates Commercial	$753.00
Rate for Payer: Midlands Choice Commercial	$702.80
Rate for Payer: Partners Health Alliance Commercial	$753.00
Rate for Payer: United Healthcare Commercial	$383.08

CRANIOFACIAL MAXILLOFACIAL OP

Facility

$831.00

Service Code	CPT 21299
Hospital Charge Code	8300880
Hospital Revenue Code	450
Min. Negotiated Rate	$373.95
Max. Negotiated Rate	$747.90
Rate for Payer: Aetna of IA Commercial	$747.90
Rate for Payer: Aetna of IA Medical Rental Products	$747.90
Rate for Payer: Aetna of IA Medicare	$473.67
Rate for Payer: Amerigroup Medicaid	$479.32
Rate for Payer: Amerigroup Medicare	$377.69
Rate for Payer: Cash Price	$664.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$623.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$373.95
Rate for Payer: Iowa Total Care Managed Medicaid	$474.67
Rate for Payer: Medical Associates Commercial	$623.25
Rate for Payer: Medical Associates Managed Medicare	$373.95
Rate for Payer: Midlands Choice Commercial	$581.70
Rate for Payer: Molina Healthcare Managed Medicaid	$481.65
Rate for Payer: Partners Health Alliance Commercial	$430.04
Rate for Payer: United Healthcare Commercial	$747.90
Rate for Payer: United Healthcare Managed Medicare	$490.29

CRANIOFACIAL MAXILLOFACIAL OP

Facility

$831.00

Service Code	CPT 21299
Hospital Charge Code	8300880
Hospital Revenue Code	450
Min. Negotiated Rate	$581.70
Max. Negotiated Rate	$747.90
Rate for Payer: Aetna of IA Commercial	$747.90
Rate for Payer: Aetna of IA Medical Rental Products	$747.90
Rate for Payer: Cash Price	$664.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$623.25
Rate for Payer: Medical Associates Commercial	$623.25
Rate for Payer: Midlands Choice Commercial	$581.70
Rate for Payer: United Healthcare Commercial	$747.90

C-REACTIVE PROTEIN-HIGH SENS

Facility

$123.00

Service Code	CPT 86141
Hospital Charge Code	7934763
Hospital Revenue Code	302
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

C-REACTIVE PROTEIN-HIGH SENS

Facility

$83.00

Service Code	CPT 86140
Hospital Charge Code	1628890
Hospital Revenue Code	302
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of IA Commercial	$74.70
Rate for Payer: Aetna of IA Medical Rental Products	$74.70
Rate for Payer: Cash Price	$66.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.25
Rate for Payer: Medical Associates Commercial	$62.25
Rate for Payer: Midlands Choice Commercial	$58.10
Rate for Payer: United Healthcare Commercial	$74.70

C-REACTIVE PROTEIN-HIGH SENS

Facility

$123.00

Service Code	CPT 86141
Hospital Charge Code	7934763
Hospital Revenue Code	302
Min. Negotiated Rate	$55.35
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	$70.95
Rate for Payer: Amerigroup Medicare	$55.90
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	$55.35
Rate for Payer: Iowa Total Care Managed Medicaid	$70.26
Rate for Payer: Medical Associates Commercial	$92.25
Rate for Payer: Medical Associates Managed Medicare	$55.35
Rate for Payer: Midlands Choice Commercial	$86.10
Rate for Payer: Molina Healthcare Managed Medicaid	$71.29
Rate for Payer: Partners Health Alliance Commercial	$63.65
Rate for Payer: United Healthcare Commercial	$110.70
Rate for Payer: United Healthcare Managed Medicare	$72.57

C-REACTIVE PROTEIN-HIGH SENS

Facility

$83.00

Service Code	CPT 86140
Hospital Charge Code	1628890
Hospital Revenue Code	302
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of IA Commercial	$74.70
Rate for Payer: Aetna of IA Medical Rental Products	$74.70
Rate for Payer: Aetna of IA Medicare	$47.31
Rate for Payer: Amerigroup Medicaid	$47.87
Rate for Payer: Amerigroup Medicare	$37.72
Rate for Payer: Cash Price	$66.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$37.35
Rate for Payer: Iowa Total Care Managed Medicaid	$47.41
Rate for Payer: Medical Associates Commercial	$62.25
Rate for Payer: Medical Associates Managed Medicare	$37.35
Rate for Payer: Midlands Choice Commercial	$58.10
Rate for Payer: Molina Healthcare Managed Medicaid	$48.11
Rate for Payer: Partners Health Alliance Commercial	$42.95
Rate for Payer: United Healthcare Commercial	$74.70
Rate for Payer: United Healthcare Managed Medicare	$48.97

Know your out-of-pocket cost for care.

All Charges