Van Diest Medical Center

All Charges

Charge

Type

Price

HAMMER TOE IMPLANT 2.6MM X 2.4MM X 12MM

Facility OP

$1,440.00

Service Code	CPT C1713
Hospital Charge Code	8757474
Hospital Revenue Code	278
Min. Negotiated Rate	$719.71
Max. Negotiated Rate	$1,296.00
Rate for Payer: Aetna of IA Commercial	$1,296.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,296.00
Rate for Payer: Aetna of IA Medicare	$820.80
Rate for Payer: Amerigroup Medicaid	$726.77
Rate for Payer: Amerigroup Medicare	$727.20
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,080.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$720.00
Rate for Payer: Iowa Total Care Managed Medicaid	$719.71
Rate for Payer: Medical Associates Commercial	$1,080.00
Rate for Payer: Medical Associates Managed Medicare	$720.00
Rate for Payer: Midlands Choice Commercial	$1,008.00
Rate for Payer: Molina Healthcare Managed Medicaid	$730.80
Rate for Payer: Partners Health Alliance Commercial	$1,080.00
Rate for Payer: United Healthcare Commercial	$1,296.00
Rate for Payer: United Healthcare Managed Medicare	$849.60

HAMMER TOE IMPLANT 2.6MM X 2.4MM X 12MM

Facility IP

$1,440.00

Service Code	CPT C1713
Hospital Charge Code	8757474
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,296.00
Rate for Payer: Aetna of IA Commercial	$1,296.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,296.00
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,080.00
Rate for Payer: Medical Associates Commercial	$1,080.00
Rate for Payer: Midlands Choice Commercial	$1,008.00
Rate for Payer: United Healthcare Commercial	$1,296.00

HAMMER TOE IMPLANT 2.6MMX2.4MMX14MM

Facility IP

$2,223.00

Service Code	CPT C1713
Hospital Charge Code	8865233
Hospital Revenue Code	278
Min. Negotiated Rate	$1,556.10
Max. Negotiated Rate	$2,000.70
Rate for Payer: Aetna of IA Commercial	$2,000.70
Rate for Payer: Aetna of IA Medical Rental Products	$2,000.70
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,667.25
Rate for Payer: Medical Associates Commercial	$1,667.25
Rate for Payer: Midlands Choice Commercial	$1,556.10
Rate for Payer: United Healthcare Commercial	$2,000.70

HAMMER TOE IMPLANT 2.6MMX2.4MMX14MM

Facility OP

$2,223.00

Service Code	CPT C1713
Hospital Charge Code	8865233
Hospital Revenue Code	278
Min. Negotiated Rate	$1,111.06
Max. Negotiated Rate	$2,000.70
Rate for Payer: Aetna of IA Commercial	$2,000.70
Rate for Payer: Aetna of IA Medical Rental Products	$2,000.70
Rate for Payer: Aetna of IA Medicare	$1,267.11
Rate for Payer: Amerigroup Medicaid	$1,121.95
Rate for Payer: Amerigroup Medicare	$1,122.62
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,667.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,111.50
Rate for Payer: Iowa Total Care Managed Medicaid	$1,111.06
Rate for Payer: Medical Associates Commercial	$1,667.25
Rate for Payer: Medical Associates Managed Medicare	$1,111.50
Rate for Payer: Midlands Choice Commercial	$1,556.10
Rate for Payer: Molina Healthcare Managed Medicaid	$1,128.17
Rate for Payer: Partners Health Alliance Commercial	$1,667.25
Rate for Payer: United Healthcare Commercial	$2,000.70
Rate for Payer: United Healthcare Managed Medicare	$1,311.57

HAMMER TOE IMPLANT 2.6MM X 2.4MM X 16MM

Facility OP

$2,340.00

Service Code	CPT C1713
Hospital Charge Code	8757476
Hospital Revenue Code	278
Min. Negotiated Rate	$1,169.53
Max. Negotiated Rate	$2,106.00
Rate for Payer: Aetna of IA Commercial	$2,106.00
Rate for Payer: Aetna of IA Medical Rental Products	$2,106.00
Rate for Payer: Aetna of IA Medicare	$1,333.80
Rate for Payer: Amerigroup Medicaid	$1,181.00
Rate for Payer: Amerigroup Medicare	$1,181.70
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,755.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,170.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,169.53
Rate for Payer: Medical Associates Commercial	$1,755.00
Rate for Payer: Medical Associates Managed Medicare	$1,170.00
Rate for Payer: Midlands Choice Commercial	$1,638.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,187.55
Rate for Payer: Partners Health Alliance Commercial	$1,755.00
Rate for Payer: United Healthcare Commercial	$2,106.00
Rate for Payer: United Healthcare Managed Medicare	$1,380.60

HAMMER TOE IMPLANT 2.6MM X 2.4MM X 16MM

Facility IP

$2,340.00

Service Code	CPT C1713
Hospital Charge Code	8757476
Hospital Revenue Code	278
Min. Negotiated Rate	$1,638.00
Max. Negotiated Rate	$2,106.00
Rate for Payer: Aetna of IA Commercial	$2,106.00
Rate for Payer: Aetna of IA Medical Rental Products	$2,106.00
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,755.00
Rate for Payer: Medical Associates Commercial	$1,755.00
Rate for Payer: Midlands Choice Commercial	$1,638.00
Rate for Payer: United Healthcare Commercial	$2,106.00

Hand or Wrist Procedures, Except Major Thumb or Joint Procedures With CC/MCC

Facility IP

$11,351.26

Service Code	MS-DRG 513
Hospital Charge Code	330
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$11,351.26
Rate for Payer: Amerigroup Medicaid	$11,296.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$11,186.75
Rate for Payer: Molina Healthcare Managed Medicaid	$11,351.26

Hand or Wrist Procedures, Except Major Thumb or Joint Procedures Without CC/MCC

Facility IP

$8,512.71

Service Code	MS-DRG 514
Hospital Charge Code	331
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$8,512.71
Rate for Payer: Amerigroup Medicaid	$8,471.59
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8,389.34
Rate for Payer: Molina Healthcare Managed Medicaid	$8,512.71

Hand Procedures for Injuries

Facility IP

$17,760.64

Service Code	MS-DRG 906
Hospital Charge Code	627
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$17,760.64
Rate for Payer: Amerigroup Medicaid	$17,674.84
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$17,503.24
Rate for Payer: Molina Healthcare Managed Medicaid	$17,760.64

Haptoglobin DMCL

Facility IP

$139.00

Service Code	CPT 83010
Hospital Charge Code	8037849
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

Haptoglobin DMCL

Facility OP

$139.00

Service Code	CPT 83010
Hospital Charge Code	8037849
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
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	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
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	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

HCG FREE ALPHA SUBUNIT

Facility OP

$123.00

Service Code	CPT 84702
Hospital Charge Code	8086833
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
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	$62.08
Rate for Payer: Amerigroup Medicare	$62.12
Rate for Payer: Cash Price	$98.40
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	$61.50
Rate for Payer: Iowa Total Care Managed Medicaid	$61.48
Rate for Payer: Medical Associates Commercial	$92.25
Rate for Payer: Medical Associates Managed Medicare	$61.50
Rate for Payer: Midlands Choice Commercial	$86.10
Rate for Payer: Molina Healthcare Managed Medicaid	$62.42
Rate for Payer: Partners Health Alliance Commercial	$92.25
Rate for Payer: United Healthcare Commercial	$110.70
Rate for Payer: United Healthcare Managed Medicare	$72.57
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

HCG FREE ALPHA SUBUNIT

Facility IP

$123.00

Service Code	CPT 84702
Hospital Charge Code	8086833
Hospital Revenue Code	301
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

HDL-CHOLESTEROL

Facility OP

$67.00

Service Code	CPT 83718
Hospital Charge Code	1628889
Hospital Revenue Code	301
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of IA Commercial	$60.30
Rate for Payer: Aetna of IA Medical Rental Products	$60.30
Rate for Payer: Aetna of IA Medicare	$38.19
Rate for Payer: Amerigroup Medicaid	$33.81
Rate for Payer: Amerigroup Medicare	$33.84
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cash Price	$53.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.50
Rate for Payer: Iowa Total Care Managed Medicaid	$33.49
Rate for Payer: Medical Associates Commercial	$50.25
Rate for Payer: Medical Associates Managed Medicare	$33.50
Rate for Payer: Midlands Choice Commercial	$46.90
Rate for Payer: Molina Healthcare Managed Medicaid	$34.00
Rate for Payer: Partners Health Alliance Commercial	$50.25
Rate for Payer: United Healthcare Commercial	$60.30
Rate for Payer: United Healthcare Managed Medicare	$39.53
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

HDL-CHOLESTEROL

Facility IP

$67.00

Service Code	CPT 83718
Hospital Charge Code	1628889
Hospital Revenue Code	301
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of IA Commercial	$60.30
Rate for Payer: Aetna of IA Medical Rental Products	$60.30
Rate for Payer: Cash Price	$53.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$50.25
Rate for Payer: Medical Associates Commercial	$50.25
Rate for Payer: Midlands Choice Commercial	$46.90
Rate for Payer: United Healthcare Commercial	$60.30

Headaches With MCC

Facility IP

$11,681.96

Service Code	MS-DRG 102
Hospital Charge Code	3
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$11,681.96
Rate for Payer: Amerigroup Medicaid	$11,625.53
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$11,512.66
Rate for Payer: Molina Healthcare Managed Medicaid	$11,681.96

Headaches Without MCC

Facility IP

$6,200.73

Service Code	MS-DRG 103
Hospital Charge Code	4
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$6,200.73
Rate for Payer: Amerigroup Medicaid	$6,170.77
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,110.86
Rate for Payer: Molina Healthcare Managed Medicaid	$6,200.73

HEADED SHORT THREAD SCREW 4.5X4.0MM

Facility IP

$513.00

Service Code	CPT C1713
Hospital Charge Code	8852827
Hospital Revenue Code	278
Min. Negotiated Rate	$359.10
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of IA Commercial	$461.70
Rate for Payer: Aetna of IA Medical Rental Products	$461.70
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$384.75
Rate for Payer: Medical Associates Commercial	$384.75
Rate for Payer: Midlands Choice Commercial	$359.10
Rate for Payer: United Healthcare Commercial	$461.70

HEADED SHORT THREAD SCREW 4.5X4.0MM

Facility OP

$513.00

Service Code	CPT C1713
Hospital Charge Code	8852827
Hospital Revenue Code	278
Min. Negotiated Rate	$256.40
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of IA Commercial	$461.70
Rate for Payer: Aetna of IA Medical Rental Products	$461.70
Rate for Payer: Aetna of IA Medicare	$292.41
Rate for Payer: Amerigroup Medicaid	$258.91
Rate for Payer: Amerigroup Medicare	$259.06
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$384.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$256.50
Rate for Payer: Iowa Total Care Managed Medicaid	$256.40
Rate for Payer: Medical Associates Commercial	$384.75
Rate for Payer: Medical Associates Managed Medicare	$256.50
Rate for Payer: Midlands Choice Commercial	$359.10
Rate for Payer: Molina Healthcare Managed Medicaid	$260.35
Rate for Payer: Partners Health Alliance Commercial	$384.75
Rate for Payer: United Healthcare Commercial	$461.70
Rate for Payer: United Healthcare Managed Medicare	$302.67

Heart Failure and Shock With CC

Facility IP

$9,002.85

Service Code	MS-DRG 292
Hospital Charge Code	149
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$9,002.85
Rate for Payer: Amerigroup Medicaid	$8,959.36
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8,872.38
Rate for Payer: Molina Healthcare Managed Medicaid	$9,002.85

Heart Failure and Shock With MCC

Facility IP

$11,606.18

Service Code	MS-DRG 291
Hospital Charge Code	148
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$11,606.18
Rate for Payer: Amerigroup Medicaid	$11,550.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$11,437.97
Rate for Payer: Molina Healthcare Managed Medicaid	$11,606.18

Heart Failure and Shock Without CC/MCC

Facility IP

$6,328.67

Service Code	MS-DRG 293
Hospital Charge Code	150
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$6,328.67
Rate for Payer: Amerigroup Medicaid	$6,298.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,236.95
Rate for Payer: Molina Healthcare Managed Medicaid	$6,328.67

Heart Transplant or Implant of Heart Assist System With MCC

Facility IP

$288,810.91

Service Code	MS-DRG 001
Hospital Charge Code	692
Min. Negotiated Rate	$284,625.25
Max. Negotiated Rate	$288,810.91
Rate for Payer: Amerigroup Medicaid	$287,415.69
Rate for Payer: Iowa Total Care Managed Medicaid	$284,625.25
Rate for Payer: Molina Healthcare Managed Medicaid	$288,810.91

Heart Transplant or Implant of Heart Assist System Without MCC

Facility IP

$143,566.39

Service Code	MS-DRG 002
Hospital Charge Code	693
Min. Negotiated Rate	$141,485.72
Max. Negotiated Rate	$143,566.39
Rate for Payer: Amerigroup Medicaid	$142,872.83
Rate for Payer: Iowa Total Care Managed Medicaid	$141,485.72
Rate for Payer: Molina Healthcare Managed Medicaid	$143,566.39

Heavy Metals Blood DMCL

Facility IP

$109.00

Service Code	CPT 83825
Hospital Charge Code	8037850
Hospital Revenue Code	301
Min. Negotiated Rate	$76.30
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of IA Commercial	$98.10
Rate for Payer: Aetna of IA Medical Rental Products	$98.10
Rate for Payer: Cash Price	$87.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.75
Rate for Payer: Medical Associates Commercial	$81.75
Rate for Payer: Midlands Choice Commercial	$76.30
Rate for Payer: United Healthcare Commercial	$98.10

Price Transparency.

All Charges