Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

DRAINAGE OF PILONIDAL CYST

Facility

$1,448.00

Service Code	CPT 10081
Hospital Charge Code	4862795
Hospital Revenue Code	450
Min. Negotiated Rate	$651.60
Max. Negotiated Rate	$1,303.20
Rate for Payer: Aetna of IA Commercial	$1,303.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,303.20
Rate for Payer: Aetna of IA Medicare	$825.36
Rate for Payer: Amerigroup Medicaid	$835.21
Rate for Payer: Amerigroup Medicare	$658.12
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,086.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$651.60
Rate for Payer: Iowa Total Care Managed Medicaid	$827.10
Rate for Payer: Medical Associates Commercial	$1,086.00
Rate for Payer: Medical Associates Managed Medicare	$651.60
Rate for Payer: Midlands Choice Commercial	$1,013.60
Rate for Payer: Molina Healthcare Managed Medicaid	$839.26
Rate for Payer: Partners Health Alliance Commercial	$749.34
Rate for Payer: United Healthcare Commercial	$1,303.20
Rate for Payer: United Healthcare Managed Medicare	$854.32

DRAINAGE OF PILONIDAL CYST

Facility

$1,448.00

Service Code	CPT 10081
Hospital Charge Code	4862795
Hospital Revenue Code	450
Min. Negotiated Rate	$1,013.60
Max. Negotiated Rate	$1,303.20
Rate for Payer: Aetna of IA Commercial	$1,303.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,303.20
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,086.00
Rate for Payer: Medical Associates Commercial	$1,086.00
Rate for Payer: Midlands Choice Commercial	$1,013.60
Rate for Payer: United Healthcare Commercial	$1,303.20

DRAINAGE OF PILONIDAL CYST

Facility

$660.00

Service Code	CPT 10080
Hospital Charge Code	4862793
Hospital Revenue Code	450
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: United Healthcare Commercial	$594.00

DRAINAGE OF PILONIDAL CYST

Professional

Both

$425.00

Service Code	CPT 10080
Hospital Charge Code	7982858
Hospital Revenue Code	981
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$318.75
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Medical Associates Commercial	$318.75
Rate for Payer: Midlands Choice Commercial	$297.50
Rate for Payer: Partners Health Alliance Commercial	$318.75
Rate for Payer: United Healthcare Commercial	$314.98

DRAINAGE OF PILONIDAL CYST

Professional

Both

$890.00

Service Code	CPT 10081
Hospital Charge Code	7982857
Hospital Revenue Code	981
Min. Negotiated Rate	$456.62
Max. Negotiated Rate	$667.50
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Medical Associates Commercial	$667.50
Rate for Payer: Midlands Choice Commercial	$623.00
Rate for Payer: Partners Health Alliance Commercial	$667.50
Rate for Payer: United Healthcare Commercial	$456.62

DRAINAGE OF PILONIDAL CYST

Facility

$660.00

Service Code	CPT 10080
Hospital Charge Code	4862793
Hospital Revenue Code	450
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Aetna of IA Medicare	$376.20
Rate for Payer: Amerigroup Medicaid	$380.69
Rate for Payer: Amerigroup Medicare	$299.97
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$297.00
Rate for Payer: Iowa Total Care Managed Medicaid	$376.99
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Medical Associates Managed Medicare	$297.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: Molina Healthcare Managed Medicaid	$382.54
Rate for Payer: Partners Health Alliance Commercial	$341.55
Rate for Payer: United Healthcare Commercial	$594.00
Rate for Payer: United Healthcare Managed Medicare	$389.40

DRAINAGE OF RECTAL ABSCESS

Facility

$1,894.00

Service Code	CPT 45005
Hospital Charge Code	7982941
Hospital Revenue Code	450
Min. Negotiated Rate	$852.30
Max. Negotiated Rate	$1,704.60
Rate for Payer: Aetna of IA Commercial	$1,704.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,704.60
Rate for Payer: Aetna of IA Medicare	$1,079.58
Rate for Payer: Amerigroup Medicaid	$1,092.46
Rate for Payer: Amerigroup Medicare	$860.82
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,420.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$852.30
Rate for Payer: Iowa Total Care Managed Medicaid	$1,081.85
Rate for Payer: Medical Associates Commercial	$1,420.50
Rate for Payer: Medical Associates Managed Medicare	$852.30
Rate for Payer: Midlands Choice Commercial	$1,325.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,097.76
Rate for Payer: Partners Health Alliance Commercial	$980.14
Rate for Payer: United Healthcare Commercial	$1,704.60
Rate for Payer: United Healthcare Managed Medicare	$1,117.46

DRAINAGE OF RECTAL ABSCESS

Facility

$1,894.00

Service Code	CPT 45005
Hospital Charge Code	7982941
Hospital Revenue Code	450
Min. Negotiated Rate	$1,325.80
Max. Negotiated Rate	$1,704.60
Rate for Payer: Aetna of IA Commercial	$1,704.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,704.60
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,420.50
Rate for Payer: Medical Associates Commercial	$1,420.50
Rate for Payer: Midlands Choice Commercial	$1,325.80
Rate for Payer: United Healthcare Commercial	$1,704.60

DRAINAGE OF RECTAL ABSCESS

Professional

Both

$917.00

Service Code	CPT 45005
Hospital Charge Code	7982863
Hospital Revenue Code	981
Min. Negotiated Rate	$437.46
Max. Negotiated Rate	$687.75
Rate for Payer: Cash Price	$733.60
Rate for Payer: Cash Price	$733.60
Rate for Payer: Medical Associates Commercial	$687.75
Rate for Payer: Midlands Choice Commercial	$641.90
Rate for Payer: Partners Health Alliance Commercial	$687.75
Rate for Payer: United Healthcare Commercial	$437.46

DRAINAGE OF SKIN ABSCESS

Facility

$660.00

Service Code	CPT 10061
Hospital Charge Code	4862791
Hospital Revenue Code	450
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: United Healthcare Commercial	$594.00

DRAINAGE OF SKIN ABSCESS

Facility

$396.00

Service Code	CPT 10060
Hospital Charge Code	4860788
Hospital Revenue Code	450
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$356.40
Rate for Payer: Aetna of IA Commercial	$356.40
Rate for Payer: Aetna of IA Medical Rental Products	$356.40
Rate for Payer: Aetna of IA Medicare	$225.72
Rate for Payer: Amerigroup Medicaid	$228.41
Rate for Payer: Amerigroup Medicare	$179.98
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$297.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$178.20
Rate for Payer: Iowa Total Care Managed Medicaid	$226.20
Rate for Payer: Medical Associates Commercial	$297.00
Rate for Payer: Medical Associates Managed Medicare	$178.20
Rate for Payer: Midlands Choice Commercial	$277.20
Rate for Payer: Molina Healthcare Managed Medicaid	$229.52
Rate for Payer: Partners Health Alliance Commercial	$204.93
Rate for Payer: United Healthcare Commercial	$356.40
Rate for Payer: United Healthcare Managed Medicare	$233.64

DRAINAGE OF SKIN ABSCESS

Professional

Both

$558.00

Service Code	CPT 10061
Hospital Charge Code	7982859
Hospital Revenue Code	981
Min. Negotiated Rate	$316.90
Max. Negotiated Rate	$418.50
Rate for Payer: Cash Price	$446.40
Rate for Payer: Cash Price	$446.40
Rate for Payer: Medical Associates Commercial	$418.50
Rate for Payer: Midlands Choice Commercial	$390.60
Rate for Payer: Partners Health Alliance Commercial	$418.50
Rate for Payer: United Healthcare Commercial	$316.90

DRAINAGE OF SKIN ABSCESS

Facility

$396.00

Service Code	CPT 10060
Hospital Charge Code	4860788
Hospital Revenue Code	450
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$356.40
Rate for Payer: Aetna of IA Commercial	$356.40
Rate for Payer: Aetna of IA Medical Rental Products	$356.40
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$297.00
Rate for Payer: Medical Associates Commercial	$297.00
Rate for Payer: Midlands Choice Commercial	$277.20
Rate for Payer: United Healthcare Commercial	$356.40

DRAINAGE OF SKIN ABSCESS

Facility

$660.00

Service Code	CPT 10061
Hospital Charge Code	4862791
Hospital Revenue Code	450
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Aetna of IA Medicare	$376.20
Rate for Payer: Amerigroup Medicaid	$380.69
Rate for Payer: Amerigroup Medicare	$299.97
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$297.00
Rate for Payer: Iowa Total Care Managed Medicaid	$376.99
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Medical Associates Managed Medicare	$297.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: Molina Healthcare Managed Medicaid	$382.54
Rate for Payer: Partners Health Alliance Commercial	$341.55
Rate for Payer: United Healthcare Commercial	$594.00
Rate for Payer: United Healthcare Managed Medicare	$389.40

DRAINAGE OF TONSIL ABSCESS

Facility

$660.00

Service Code	CPT 42700
Hospital Charge Code	4864958
Hospital Revenue Code	450
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Aetna of IA Medicare	$376.20
Rate for Payer: Amerigroup Medicaid	$380.69
Rate for Payer: Amerigroup Medicare	$299.97
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$297.00
Rate for Payer: Iowa Total Care Managed Medicaid	$376.99
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Medical Associates Managed Medicare	$297.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: Molina Healthcare Managed Medicaid	$382.54
Rate for Payer: Partners Health Alliance Commercial	$341.55
Rate for Payer: United Healthcare Commercial	$594.00
Rate for Payer: United Healthcare Managed Medicare	$389.40

DRAINAGE OF TONSIL ABSCESS

Facility

$660.00

Service Code	CPT 42700
Hospital Charge Code	4864958
Hospital Revenue Code	450
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: United Healthcare Commercial	$594.00

DRAIN BLOOD FROM UNDER NAIL

Facility

$129.00

Service Code	CPT 11740
Hospital Charge Code	4863315
Hospital Revenue Code	450
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

DRAIN BLOOD FROM UNDER NAIL

Professional

Both

$163.00

Service Code	CPT 11740
Hospital Charge Code	7982848
Hospital Revenue Code	981
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$122.25
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Medical Associates Commercial	$122.25
Rate for Payer: Midlands Choice Commercial	$114.10
Rate for Payer: Partners Health Alliance Commercial	$122.25
Rate for Payer: United Healthcare Commercial	$80.75

DRAIN BLOOD FROM UNDER NAIL

Facility

$129.00

Service Code	CPT 11740
Hospital Charge Code	4863315
Hospital Revenue Code	450
Min. Negotiated Rate	$58.05
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: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11

DRAIN BL W/CATH INSERTION

Facility

$3,709.00

Service Code	CPT 51102
Hospital Charge Code	4862810
Hospital Revenue Code	450
Min. Negotiated Rate	$1,669.05
Max. Negotiated Rate	$3,338.10
Rate for Payer: Aetna of IA Commercial	$3,338.10
Rate for Payer: Aetna of IA Medical Rental Products	$3,338.10
Rate for Payer: Aetna of IA Medicare	$2,114.13
Rate for Payer: Amerigroup Medicaid	$2,139.35
Rate for Payer: Amerigroup Medicare	$1,685.74
Rate for Payer: Cash Price	$2,967.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,781.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,669.05
Rate for Payer: Iowa Total Care Managed Medicaid	$2,118.58
Rate for Payer: Medical Associates Commercial	$2,781.75
Rate for Payer: Medical Associates Managed Medicare	$1,669.05
Rate for Payer: Midlands Choice Commercial	$2,596.30
Rate for Payer: Molina Healthcare Managed Medicaid	$2,149.74
Rate for Payer: Partners Health Alliance Commercial	$1,919.41
Rate for Payer: United Healthcare Commercial	$3,338.10
Rate for Payer: United Healthcare Managed Medicare	$2,188.31

DRAIN BL W/CATH INSERTION

Facility

$3,709.00

Service Code	CPT 51102
Hospital Charge Code	4862810
Hospital Revenue Code	450
Min. Negotiated Rate	$2,596.30
Max. Negotiated Rate	$3,338.10
Rate for Payer: Aetna of IA Commercial	$3,338.10
Rate for Payer: Aetna of IA Medical Rental Products	$3,338.10
Rate for Payer: Cash Price	$2,967.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,781.75
Rate for Payer: Medical Associates Commercial	$2,781.75
Rate for Payer: Midlands Choice Commercial	$2,596.30
Rate for Payer: United Healthcare Commercial	$3,338.10

DRAIN BL W/CATH INSERTION

Professional

Both

$756.00

Service Code	CPT 51102
Hospital Charge Code	7982768
Hospital Revenue Code	981
Min. Negotiated Rate	$361.22
Max. Negotiated Rate	$567.00
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cash Price	$604.80
Rate for Payer: Medical Associates Commercial	$567.00
Rate for Payer: Midlands Choice Commercial	$529.20
Rate for Payer: Partners Health Alliance Commercial	$567.00
Rate for Payer: United Healthcare Commercial	$361.22

DRAIN CEREBRO SPINAL FLUID

Facility

$1,120.00

Service Code	CPT 62272
Hospital Charge Code	7982915
Hospital Revenue Code	761
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna of IA Commercial	$1,008.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,008.00
Rate for Payer: Cash Price	$896.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$840.00
Rate for Payer: Medical Associates Commercial	$840.00
Rate for Payer: Midlands Choice Commercial	$784.00
Rate for Payer: United Healthcare Commercial	$1,008.00

DRAIN CEREBRO SPINAL FLUID

Facility

$1,120.00

Service Code	CPT 62272
Hospital Charge Code	7982915
Hospital Revenue Code	761
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna of IA Commercial	$1,008.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,008.00
Rate for Payer: Aetna of IA Medicare	$638.40
Rate for Payer: Amerigroup Medicaid	$646.02
Rate for Payer: Amerigroup Medicare	$509.04
Rate for Payer: Cash Price	$896.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$840.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$504.00
Rate for Payer: Iowa Total Care Managed Medicaid	$639.74
Rate for Payer: Medical Associates Commercial	$840.00
Rate for Payer: Medical Associates Managed Medicare	$504.00
Rate for Payer: Midlands Choice Commercial	$784.00
Rate for Payer: Molina Healthcare Managed Medicaid	$649.15
Rate for Payer: Partners Health Alliance Commercial	$579.60
Rate for Payer: United Healthcare Commercial	$1,008.00
Rate for Payer: United Healthcare Managed Medicare	$660.80

DRAIN EXTERNAL EAR LESION

Facility

$660.00

Service Code	CPT 69000
Hospital Charge Code	4866844
Hospital Revenue Code	450
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna of IA Commercial	$594.00
Rate for Payer: Aetna of IA Medical Rental Products	$594.00
Rate for Payer: Aetna of IA Medicare	$376.20
Rate for Payer: Amerigroup Medicaid	$380.69
Rate for Payer: Amerigroup Medicare	$299.97
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$495.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$297.00
Rate for Payer: Iowa Total Care Managed Medicaid	$376.99
Rate for Payer: Medical Associates Commercial	$495.00
Rate for Payer: Medical Associates Managed Medicare	$297.00
Rate for Payer: Midlands Choice Commercial	$462.00
Rate for Payer: Molina Healthcare Managed Medicaid	$382.54
Rate for Payer: Partners Health Alliance Commercial	$341.55
Rate for Payer: United Healthcare Commercial	$594.00
Rate for Payer: United Healthcare Managed Medicare	$389.40

Know your out-of-pocket cost for care.

All Charges