Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

HAMMER TOE IMPLANT 2.6MM X 2.4MM X 16MM

Facility

$2,340.00

Service Code	HCPCS C1713
Hospital Charge Code	8757476
Hospital Revenue Code	278
Min. Negotiated Rate	$1,053.00
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: Aetna of IA Medicare	$1,333.80
Rate for Payer: Amerigroup Medicaid	$1,349.71
Rate for Payer: Amerigroup Medicare	$1,063.53
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	$1,053.00
Rate for Payer: Iowa Total Care Managed Medicaid	$1,336.61
Rate for Payer: Medical Associates Commercial	$1,755.00
Rate for Payer: Medical Associates Managed Medicare	$1,053.00
Rate for Payer: Midlands Choice Commercial	$1,638.00
Rate for Payer: Molina Healthcare Managed Medicaid	$1,356.26
Rate for Payer: Partners Health Alliance Commercial	$1,210.95
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

$2,340.00

Service Code	HCPCS 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

$12,985.89

Service Code	MSDRG 513
Min. Negotiated Rate	$12,797.69
Max. Negotiated Rate	$12,985.89
Rate for Payer: Amerigroup Medicaid	$12,923.15
Rate for Payer: Iowa Total Care Managed Medicaid	$12,797.69
Rate for Payer: Molina Healthcare Managed Medicaid	$12,985.89

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$9,738.58

Service Code	MSDRG 514
Min. Negotiated Rate	$9,597.43
Max. Negotiated Rate	$9,738.58
Rate for Payer: Amerigroup Medicaid	$9,691.52
Rate for Payer: Iowa Total Care Managed Medicaid	$9,597.43
Rate for Payer: Molina Healthcare Managed Medicaid	$9,738.58

HAND PROCEDURES FOR INJURIES

Facility

$20,318.25

Service Code	MSDRG 906
Min. Negotiated Rate	$20,023.78
Max. Negotiated Rate	$20,318.25
Rate for Payer: Amerigroup Medicaid	$20,220.09
Rate for Payer: Iowa Total Care Managed Medicaid	$20,023.78
Rate for Payer: Molina Healthcare Managed Medicaid	$20,318.25

Haptoglobin DMCL

Facility

$139.00

Service Code	CPT 83010
Hospital Charge Code	8037849
Hospital Revenue Code	301
Min. Negotiated Rate	$61.68
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	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
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	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Haptoglobin DMCL

Facility

$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

HCG FREE ALPHA SUBUNIT

Facility

$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

HCG FREE ALPHA SUBUNIT

Facility

$123.00

Service Code	CPT 84702
Hospital Charge Code	8086833
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
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: 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
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

HDL-CHOLESTEROL

Facility

$67.00

Service Code	CPT 83718
Hospital Charge Code	1628889
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
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	$38.65
Rate for Payer: Amerigroup Medicare	$30.45
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	$30.15
Rate for Payer: Iowa Total Care Managed Medicaid	$38.27
Rate for Payer: Medical Associates Commercial	$50.25
Rate for Payer: Medical Associates Managed Medicare	$30.15
Rate for Payer: Midlands Choice Commercial	$46.90
Rate for Payer: Molina Healthcare Managed Medicaid	$38.83
Rate for Payer: Partners Health Alliance Commercial	$34.67
Rate for Payer: United Healthcare Commercial	$60.30
Rate for Payer: United Healthcare Managed Medicare	$39.53
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

HDL-CHOLESTEROL

Facility

$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

$13,364.22

Service Code	MSDRG 102
Min. Negotiated Rate	$13,170.53
Max. Negotiated Rate	$13,364.22
Rate for Payer: Amerigroup Medicaid	$13,299.65
Rate for Payer: Iowa Total Care Managed Medicaid	$13,170.53
Rate for Payer: Molina Healthcare Managed Medicaid	$13,364.22

HEADACHES WITHOUT MCC

Facility

$7,093.66

Service Code	MSDRG 103
Min. Negotiated Rate	$6,990.85
Max. Negotiated Rate	$7,093.66
Rate for Payer: Amerigroup Medicaid	$7,059.38
Rate for Payer: Iowa Total Care Managed Medicaid	$6,990.85
Rate for Payer: Molina Healthcare Managed Medicaid	$7,093.66

HEADED SHORT THREAD SCREW 4.5X4.0MM

Facility

$513.00

Service Code	HCPCS C1713
Hospital Charge Code	8852827
Hospital Revenue Code	278
Min. Negotiated Rate	$230.85
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	$295.90
Rate for Payer: Amerigroup Medicare	$233.16
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	$230.85
Rate for Payer: Iowa Total Care Managed Medicaid	$293.03
Rate for Payer: Medical Associates Commercial	$384.75
Rate for Payer: Medical Associates Managed Medicare	$230.85
Rate for Payer: Midlands Choice Commercial	$359.10
Rate for Payer: Molina Healthcare Managed Medicaid	$297.33
Rate for Payer: Partners Health Alliance Commercial	$265.48
Rate for Payer: United Healthcare Commercial	$461.70
Rate for Payer: United Healthcare Managed Medicare	$302.67

HEADED SHORT THREAD SCREW 4.5X4.0MM

Facility

$513.00

Service Code	HCPCS 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

HEART FAILURE AND SHOCK WITH CC

Facility

$10,299.31

Service Code	MSDRG 292
Min. Negotiated Rate	$10,150.04
Max. Negotiated Rate	$10,299.31
Rate for Payer: Amerigroup Medicaid	$10,249.55
Rate for Payer: Iowa Total Care Managed Medicaid	$10,150.04
Rate for Payer: Molina Healthcare Managed Medicaid	$10,299.31

HEART FAILURE AND SHOCK WITH MCC

Facility

$13,277.52

Service Code	MSDRG 291
Min. Negotiated Rate	$13,085.09
Max. Negotiated Rate	$13,277.52
Rate for Payer: Amerigroup Medicaid	$13,213.37
Rate for Payer: Iowa Total Care Managed Medicaid	$13,085.09
Rate for Payer: Molina Healthcare Managed Medicaid	$13,277.52

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$7,240.03

Service Code	MSDRG 293
Min. Negotiated Rate	$7,135.10
Max. Negotiated Rate	$7,240.03
Rate for Payer: Amerigroup Medicaid	$7,205.05
Rate for Payer: Iowa Total Care Managed Medicaid	$7,135.10
Rate for Payer: Molina Healthcare Managed Medicaid	$7,240.03

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$330,401.06

Service Code	MSDRG 001
Min. Negotiated Rate	$325,612.50
Max. Negotiated Rate	$330,401.06
Rate for Payer: Amerigroup Medicaid	$328,804.77
Rate for Payer: Iowa Total Care Managed Medicaid	$325,612.50
Rate for Payer: Molina Healthcare Managed Medicaid	$330,401.06

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$164,240.64

Service Code	MSDRG 002
Min. Negotiated Rate	$161,860.26
Max. Negotiated Rate	$164,240.64
Rate for Payer: Amerigroup Medicaid	$163,447.13
Rate for Payer: Iowa Total Care Managed Medicaid	$161,860.26
Rate for Payer: Molina Healthcare Managed Medicaid	$164,240.64

Heavy Metals Blood DMCL

Facility

$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

Heavy Metals Blood DMCL

Facility

$109.00

Service Code	CPT 83825
Hospital Charge Code	8037850
Hospital Revenue Code	301
Min. Negotiated Rate	$30.49
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: Aetna of IA Medicare	$62.13
Rate for Payer: Amerigroup Medicaid	$62.87
Rate for Payer: Amerigroup Medicare	$49.54
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$81.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$49.05
Rate for Payer: Iowa Total Care Managed Medicaid	$62.26
Rate for Payer: Medical Associates Commercial	$81.75
Rate for Payer: Medical Associates Managed Medicare	$49.05
Rate for Payer: Midlands Choice Commercial	$76.30
Rate for Payer: Molina Healthcare Managed Medicaid	$63.18
Rate for Payer: Partners Health Alliance Commercial	$56.41
Rate for Payer: United Healthcare Commercial	$98.10
Rate for Payer: United Healthcare Managed Medicare	$64.31
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

Helicobacter pylori Antigen Stool

Facility

$118.00

Service Code	CPT 87338
Hospital Charge Code	8404856
Hospital Revenue Code	306
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of IA Commercial	$106.20
Rate for Payer: Aetna of IA Medical Rental Products	$106.20
Rate for Payer: Aetna of IA Medicare	$67.26
Rate for Payer: Amerigroup Medicaid	$68.06
Rate for Payer: Amerigroup Medicare	$53.63
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$88.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$53.10
Rate for Payer: Iowa Total Care Managed Medicaid	$67.40
Rate for Payer: Medical Associates Commercial	$88.50
Rate for Payer: Medical Associates Managed Medicare	$53.10
Rate for Payer: Midlands Choice Commercial	$82.60
Rate for Payer: Molina Healthcare Managed Medicaid	$68.39
Rate for Payer: Partners Health Alliance Commercial	$61.06
Rate for Payer: United Healthcare Commercial	$106.20
Rate for Payer: United Healthcare Managed Medicare	$69.62
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

Helicobacter pylori Antigen Stool

Facility

$118.00

Service Code	CPT 87338
Hospital Charge Code	8404856
Hospital Revenue Code	306
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of IA Commercial	$106.20
Rate for Payer: Aetna of IA Medical Rental Products	$106.20
Rate for Payer: Cash Price	$94.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$88.50
Rate for Payer: Medical Associates Commercial	$88.50
Rate for Payer: Midlands Choice Commercial	$82.60
Rate for Payer: United Healthcare Commercial	$106.20

Helicobacter pylori Antigen Stool DMCL

Facility

$147.00

Service Code	CPT 87338
Hospital Charge Code	8037856
Hospital Revenue Code	306
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of IA Commercial	$132.30
Rate for Payer: Aetna of IA Medical Rental Products	$132.30
Rate for Payer: Cash Price	$117.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$110.25
Rate for Payer: Medical Associates Commercial	$110.25
Rate for Payer: Midlands Choice Commercial	$102.90
Rate for Payer: United Healthcare Commercial	$132.30

Know your out-of-pocket cost for care.

All Charges