Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

diazepam 5 mg Tab [VDMC]

Facility

$3.16

Service Code	HCPCS A9270
Hospital Charge Code	10382305
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna of IA Commercial	$2.84
Rate for Payer: Aetna of IA Medical Rental Products	$2.84
Rate for Payer: Aetna of IA Medicare	$1.80
Rate for Payer: Amerigroup Medicaid	$1.59
Rate for Payer: Amerigroup Medicare	$1.60
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	$1.58
Rate for Payer: Iowa Total Care Managed Medicaid	$1.58
Rate for Payer: Medical Associates Commercial	$2.37
Rate for Payer: Medical Associates Managed Medicare	$1.58
Rate for Payer: Midlands Choice Commercial	$2.21
Rate for Payer: Molina Healthcare Managed Medicaid	$1.60
Rate for Payer: Molina Healthcare Managed Medicare	$1.60
Rate for Payer: Oscar Health of IA Commercial	$2.37
Rate for Payer: Partners Health Alliance Commercial	$2.37
Rate for Payer: United Healthcare Commercial	$2.84
Rate for Payer: United Healthcare Managed Medicare	$1.86

dibucaine topical 1% Oin[VDMC]

Facility

$20.16

Service Code	NDC 00536-1211-95
Hospital Charge Code	13327364
Hospital Revenue Code	259
Min. Negotiated Rate	$14.11
Max. Negotiated Rate	$18.14
Rate for Payer: Aetna of IA Commercial	$18.14
Rate for Payer: Aetna of IA Medical Rental Products	$18.14
Rate for Payer: Cash Price	$16.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.12
Rate for Payer: Medical Associates Commercial	$15.12
Rate for Payer: Midlands Choice Commercial	$14.11
Rate for Payer: United Healthcare Commercial	$18.14

dibucaine topical 1% Oin[VDMC]

Facility

$20.16

Service Code	NDC 00536-1211-95
Hospital Charge Code	13327364
Hospital Revenue Code	259
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$18.14
Rate for Payer: Aetna of IA Commercial	$18.14
Rate for Payer: Aetna of IA Medical Rental Products	$18.14
Rate for Payer: Aetna of IA Medicare	$11.49
Rate for Payer: Amerigroup Medicaid	$10.17
Rate for Payer: Amerigroup Medicare	$10.18
Rate for Payer: Cash Price	$16.13
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$15.12
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.08
Rate for Payer: Iowa Total Care Managed Medicaid	$10.08
Rate for Payer: Medical Associates Commercial	$15.12
Rate for Payer: Medical Associates Managed Medicare	$10.08
Rate for Payer: Midlands Choice Commercial	$14.11
Rate for Payer: Molina Healthcare Managed Medicaid	$10.23
Rate for Payer: Molina Healthcare Managed Medicare	$10.23
Rate for Payer: Oscar Health of IA Commercial	$15.12
Rate for Payer: Partners Health Alliance Commercial	$15.12
Rate for Payer: United Healthcare Commercial	$18.14
Rate for Payer: United Healthcare Managed Medicare	$11.89

diclofenac sodium 50 mg Oral EC Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	10382445
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Midlands Choice Commercial	$0.92
Rate for Payer: United Healthcare Commercial	$1.18

diclofenac sodium 50 mg Oral EC Tab [VDMC]

Facility

$1.31

Service Code	HCPCS A9270
Hospital Charge Code	10382445
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of IA Commercial	$1.18
Rate for Payer: Aetna of IA Medical Rental Products	$1.18
Rate for Payer: Aetna of IA Medicare	$0.75
Rate for Payer: Amerigroup Medicaid	$0.66
Rate for Payer: Amerigroup Medicare	$0.66
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.98
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.66
Rate for Payer: Iowa Total Care Managed Medicaid	$0.65
Rate for Payer: Medical Associates Commercial	$0.98
Rate for Payer: Medical Associates Managed Medicare	$0.66
Rate for Payer: Midlands Choice Commercial	$0.92
Rate for Payer: Molina Healthcare Managed Medicaid	$0.66
Rate for Payer: Molina Healthcare Managed Medicare	$0.66
Rate for Payer: Oscar Health of IA Commercial	$0.98
Rate for Payer: Partners Health Alliance Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.18
Rate for Payer: United Healthcare Managed Medicare	$0.77

diclofenac sodium 75 mg DR Oral EC Tab [VDMC]

Facility

$1.42

Service Code	HCPCS A9270
Hospital Charge Code	10382516
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of IA Commercial	$1.28
Rate for Payer: Aetna of IA Medical Rental Products	$1.28
Rate for Payer: Cash Price	$1.14
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.06
Rate for Payer: Medical Associates Commercial	$1.06
Rate for Payer: Midlands Choice Commercial	$0.99
Rate for Payer: United Healthcare Commercial	$1.28

diclofenac sodium 75 mg DR Oral EC Tab [VDMC]

Facility

$1.42

Service Code	HCPCS A9270
Hospital Charge Code	10382516
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of IA Commercial	$1.28
Rate for Payer: Aetna of IA Medical Rental Products	$1.28
Rate for Payer: Aetna of IA Medicare	$0.81
Rate for Payer: Amerigroup Medicaid	$0.72
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: Cash Price	$1.14
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.71
Rate for Payer: Iowa Total Care Managed Medicaid	$0.71
Rate for Payer: Medical Associates Commercial	$1.06
Rate for Payer: Medical Associates Managed Medicare	$0.71
Rate for Payer: Midlands Choice Commercial	$0.99
Rate for Payer: Molina Healthcare Managed Medicaid	$0.72
Rate for Payer: Molina Healthcare Managed Medicare	$0.72
Rate for Payer: Oscar Health of IA Commercial	$1.06
Rate for Payer: Partners Health Alliance Commercial	$1.06
Rate for Payer: United Healthcare Commercial	$1.28
Rate for Payer: United Healthcare Managed Medicare	$0.84

diclofenac Top 1% gel [VDMC]

Facility

$18.02

Service Code	HCPCS A9270
Hospital Charge Code	10434323
Hospital Revenue Code	259
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$16.22
Rate for Payer: Aetna of IA Commercial	$16.22
Rate for Payer: Aetna of IA Medical Rental Products	$16.22
Rate for Payer: Aetna of IA Medicare	$10.27
Rate for Payer: Amerigroup Medicaid	$9.09
Rate for Payer: Amerigroup Medicare	$9.10
Rate for Payer: Cash Price	$14.42
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.52
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9.01
Rate for Payer: Iowa Total Care Managed Medicaid	$9.01
Rate for Payer: Medical Associates Commercial	$13.52
Rate for Payer: Medical Associates Managed Medicare	$9.01
Rate for Payer: Midlands Choice Commercial	$12.61
Rate for Payer: Molina Healthcare Managed Medicaid	$9.15
Rate for Payer: Molina Healthcare Managed Medicare	$9.14
Rate for Payer: Oscar Health of IA Commercial	$13.52
Rate for Payer: Partners Health Alliance Commercial	$13.52
Rate for Payer: United Healthcare Commercial	$16.22
Rate for Payer: United Healthcare Managed Medicare	$10.63

diclofenac Top 1% gel [VDMC]

Facility

$18.02

Service Code	HCPCS A9270
Hospital Charge Code	10434323
Hospital Revenue Code	259
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$16.22
Rate for Payer: Aetna of IA Commercial	$16.22
Rate for Payer: Aetna of IA Medical Rental Products	$16.22
Rate for Payer: Cash Price	$14.42
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.52
Rate for Payer: Medical Associates Commercial	$13.52
Rate for Payer: Midlands Choice Commercial	$12.61
Rate for Payer: United Healthcare Commercial	$16.22

dicyclomine 20 mg Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10382646
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of IA Commercial	$1.30
Rate for Payer: Aetna of IA Medical Rental Products	$1.30
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: United Healthcare Commercial	$1.30

dicyclomine 20 mg Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10382646
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of IA Commercial	$1.30
Rate for Payer: Aetna of IA Medical Rental Products	$1.30
Rate for Payer: Aetna of IA Medicare	$0.82
Rate for Payer: Amerigroup Medicaid	$0.73
Rate for Payer: Amerigroup Medicare	$0.73
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.72
Rate for Payer: Iowa Total Care Managed Medicaid	$0.72
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Medical Associates Managed Medicare	$0.72
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: Molina Healthcare Managed Medicaid	$0.73
Rate for Payer: Molina Healthcare Managed Medicare	$0.73
Rate for Payer: Oscar Health of IA Commercial	$1.08
Rate for Payer: Partners Health Alliance Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.30
Rate for Payer: United Healthcare Managed Medicare	$0.85

Digestive Malignancy With CC

Facility

$10,539.26

Service Code	MS-DRG 375
Hospital Charge Code	216
Min. Negotiated Rate	$10,386.52
Max. Negotiated Rate	$10,539.26
Rate for Payer: Amerigroup Medicaid	$10,488.35
Rate for Payer: Iowa Total Care Managed Medicaid	$10,386.52
Rate for Payer: Molina Healthcare Managed Medicaid	$10,539.26

Digestive Malignancy With MCC

Facility

$15,882.71

Service Code	MS-DRG 374
Hospital Charge Code	215
Min. Negotiated Rate	$15,652.52
Max. Negotiated Rate	$15,882.71
Rate for Payer: Amerigroup Medicaid	$15,805.98
Rate for Payer: Iowa Total Care Managed Medicaid	$15,652.52
Rate for Payer: Molina Healthcare Managed Medicaid	$15,882.71

Digestive Malignancy Without CC/MCC

Facility

$7,011.73

Service Code	MS-DRG 376
Hospital Charge Code	217
Min. Negotiated Rate	$6,910.11
Max. Negotiated Rate	$7,011.73
Rate for Payer: Amerigroup Medicaid	$6,977.86
Rate for Payer: Iowa Total Care Managed Medicaid	$6,910.11
Rate for Payer: Molina Healthcare Managed Medicaid	$7,011.73

DIGIT AMPUTATION ER CHARGE

Professional

Both

$2,327.00

Hospital Charge Code	8069104
Hospital Revenue Code	981
Min. Negotiated Rate	$1,628.90
Max. Negotiated Rate	$1,745.25
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Medical Associates Commercial	$1,745.25
Rate for Payer: Midlands Choice Commercial	$1,628.90

DIGOXIN

Facility

$111.00

Service Code	CPT 80162
Hospital Charge Code	1628891
Hospital Revenue Code	301
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of IA Commercial	$99.90
Rate for Payer: Aetna of IA Medical Rental Products	$99.90
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.25
Rate for Payer: Medical Associates Commercial	$83.25
Rate for Payer: Midlands Choice Commercial	$77.70
Rate for Payer: United Healthcare Commercial	$99.90

DIGOXIN

Facility

$111.00

Service Code	CPT 80162
Hospital Charge Code	1628891
Hospital Revenue Code	301
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of IA Commercial	$99.90
Rate for Payer: Aetna of IA Medical Rental Products	$99.90
Rate for Payer: Aetna of IA Medicare	$63.27
Rate for Payer: Amerigroup Medicaid	$56.02
Rate for Payer: Amerigroup Medicare	$56.06
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$55.50
Rate for Payer: Iowa Total Care Managed Medicaid	$55.48
Rate for Payer: Medical Associates Commercial	$83.25
Rate for Payer: Medical Associates Managed Medicare	$55.50
Rate for Payer: Midlands Choice Commercial	$77.70
Rate for Payer: Molina Healthcare Managed Medicaid	$56.33
Rate for Payer: Molina Healthcare Managed Medicare	$56.30
Rate for Payer: Oscar Health of IA Commercial	$83.25
Rate for Payer: Partners Health Alliance Commercial	$83.25
Rate for Payer: United Healthcare Commercial	$99.90
Rate for Payer: United Healthcare Managed Medicare	$65.49
Rate for Payer: Wellmark IA HMO	$49.60
Rate for Payer: Wellmark IA PPO	$54.56

digoxin 125 mcg (0.125 mg) Tab [VDMC]

Facility

$2.31

Service Code	HCPCS A9270
Hospital Charge Code	10382717
Hospital Revenue Code	259
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of IA Commercial	$2.08
Rate for Payer: Aetna of IA Medical Rental Products	$2.08
Rate for Payer: Aetna of IA Medicare	$1.32
Rate for Payer: Amerigroup Medicaid	$1.17
Rate for Payer: Amerigroup Medicare	$1.17
Rate for Payer: Cash Price	$1.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.16
Rate for Payer: Iowa Total Care Managed Medicaid	$1.15
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Medical Associates Managed Medicare	$1.16
Rate for Payer: Midlands Choice Commercial	$1.62
Rate for Payer: Molina Healthcare Managed Medicaid	$1.17
Rate for Payer: Molina Healthcare Managed Medicare	$1.17
Rate for Payer: Oscar Health of IA Commercial	$1.73
Rate for Payer: Partners Health Alliance Commercial	$1.73
Rate for Payer: United Healthcare Commercial	$2.08
Rate for Payer: United Healthcare Managed Medicare	$1.36

digoxin 125 mcg (0.125 mg) Tab [VDMC]

Facility

$2.31

Service Code	HCPCS A9270
Hospital Charge Code	10382717
Hospital Revenue Code	259
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of IA Commercial	$2.08
Rate for Payer: Aetna of IA Medical Rental Products	$2.08
Rate for Payer: Cash Price	$1.85
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.73
Rate for Payer: Medical Associates Commercial	$1.73
Rate for Payer: Midlands Choice Commercial	$1.62
Rate for Payer: United Healthcare Commercial	$2.08

digoxin 250 mcg (0.25 mg) Tab [VDMC]

Facility

$2.50

Service Code	HCPCS A9270
Hospital Charge Code	10382786
Hospital Revenue Code	259
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of IA Commercial	$2.25
Rate for Payer: Aetna of IA Medical Rental Products	$2.25
Rate for Payer: Cash Price	$2.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.88
Rate for Payer: Medical Associates Commercial	$1.88
Rate for Payer: Midlands Choice Commercial	$1.75
Rate for Payer: United Healthcare Commercial	$2.25

digoxin 250 mcg (0.25 mg) Tab [VDMC]

Facility

$2.50

Service Code	HCPCS A9270
Hospital Charge Code	10382786
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of IA Commercial	$2.25
Rate for Payer: Aetna of IA Medical Rental Products	$2.25
Rate for Payer: Aetna of IA Medicare	$1.42
Rate for Payer: Amerigroup Medicaid	$1.26
Rate for Payer: Amerigroup Medicare	$1.26
Rate for Payer: Cash Price	$2.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.25
Rate for Payer: Iowa Total Care Managed Medicaid	$1.25
Rate for Payer: Medical Associates Commercial	$1.88
Rate for Payer: Medical Associates Managed Medicare	$1.25
Rate for Payer: Midlands Choice Commercial	$1.75
Rate for Payer: Molina Healthcare Managed Medicaid	$1.27
Rate for Payer: Molina Healthcare Managed Medicare	$1.27
Rate for Payer: Oscar Health of IA Commercial	$1.88
Rate for Payer: Partners Health Alliance Commercial	$1.88
Rate for Payer: United Healthcare Commercial	$2.25
Rate for Payer: United Healthcare Managed Medicare	$1.48

digoxin 250 mcg/mL (0.25 mg/mL) 2 ML SDV Inj Sol [VDMC]

Facility

$32.22

Service Code	HCPCS J1160
Hospital Charge Code	10382857
Hospital Revenue Code	259
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna of IA Commercial	$29.00
Rate for Payer: Aetna of IA Medical Rental Products	$29.00
Rate for Payer: Aetna of IA Medicare	$18.37
Rate for Payer: Amerigroup Medicaid	$16.26
Rate for Payer: Amerigroup Medicare	$16.27
Rate for Payer: Cash Price	$25.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.11
Rate for Payer: Iowa Total Care Managed Medicaid	$16.10
Rate for Payer: Medical Associates Commercial	$24.16
Rate for Payer: Medical Associates Managed Medicare	$16.11
Rate for Payer: Midlands Choice Commercial	$22.55
Rate for Payer: Molina Healthcare Managed Medicaid	$16.35
Rate for Payer: Molina Healthcare Managed Medicare	$16.34
Rate for Payer: Oscar Health of IA Commercial	$24.16
Rate for Payer: Partners Health Alliance Commercial	$24.16
Rate for Payer: United Healthcare Commercial	$29.00
Rate for Payer: United Healthcare Managed Medicare	$19.01

digoxin 250 mcg/mL (0.25 mg/mL) 2 ML SDV Inj Sol [VDMC]

Facility

$32.22

Service Code	HCPCS J1160
Hospital Charge Code	10382857
Hospital Revenue Code	259
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna of IA Commercial	$29.00
Rate for Payer: Aetna of IA Medical Rental Products	$29.00
Rate for Payer: Cash Price	$25.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.16
Rate for Payer: Medical Associates Commercial	$24.16
Rate for Payer: Midlands Choice Commercial	$22.55
Rate for Payer: United Healthcare Commercial	$29.00

digoxin 50 mcg/mL 60 ml oral sol (0.05 mg/mL) [VDMC]

Facility

$358.16

Service Code	HCPCS A9270
Hospital Charge Code	11220926
Hospital Revenue Code	259
Min. Negotiated Rate	$250.71
Max. Negotiated Rate	$322.34
Rate for Payer: Aetna of IA Commercial	$322.34
Rate for Payer: Aetna of IA Medical Rental Products	$322.34
Rate for Payer: Cash Price	$286.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$268.62
Rate for Payer: Medical Associates Commercial	$268.62
Rate for Payer: Midlands Choice Commercial	$250.71
Rate for Payer: United Healthcare Commercial	$322.34

digoxin 50 mcg/mL 60 ml oral sol (0.05 mg/mL) [VDMC]

Facility

$358.16

Service Code	HCPCS A9270
Hospital Charge Code	11220926
Hospital Revenue Code	259
Min. Negotiated Rate	$179.01
Max. Negotiated Rate	$322.34
Rate for Payer: Aetna of IA Commercial	$322.34
Rate for Payer: Aetna of IA Medical Rental Products	$322.34
Rate for Payer: Aetna of IA Medicare	$204.15
Rate for Payer: Amerigroup Medicaid	$180.76
Rate for Payer: Amerigroup Medicare	$180.87
Rate for Payer: Cash Price	$286.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$268.62
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$179.08
Rate for Payer: Iowa Total Care Managed Medicaid	$179.01
Rate for Payer: Medical Associates Commercial	$268.62
Rate for Payer: Medical Associates Managed Medicare	$179.08
Rate for Payer: Midlands Choice Commercial	$250.71
Rate for Payer: Molina Healthcare Managed Medicaid	$181.77
Rate for Payer: Molina Healthcare Managed Medicare	$181.66
Rate for Payer: Oscar Health of IA Commercial	$268.62
Rate for Payer: Partners Health Alliance Commercial	$268.62
Rate for Payer: United Healthcare Commercial	$322.34
Rate for Payer: United Healthcare Managed Medicare	$211.31

Know your out-of-pocket cost for care.

All Charges