Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

INF TX MED EA ADDL HOUR

Facility

$161.00

Service Code	CPT 96366
Hospital Charge Code	6922796
Hospital Revenue Code	260
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: United Healthcare Commercial	$144.90

INF TX MED SCHED 1ST HR

Facility

$382.00

Service Code	CPT 96365
Hospital Charge Code	8012937
Hospital Revenue Code	260
Min. Negotiated Rate	$267.40
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of IA Commercial	$343.80
Rate for Payer: Aetna of IA Medical Rental Products	$343.80
Rate for Payer: Cash Price	$305.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$286.50
Rate for Payer: Medical Associates Commercial	$286.50
Rate for Payer: Midlands Choice Commercial	$267.40
Rate for Payer: United Healthcare Commercial	$343.80

INF TX MED SCHED 1ST HR

Facility

$382.00

Service Code	CPT 96365
Hospital Charge Code	8012937
Hospital Revenue Code	260
Min. Negotiated Rate	$190.92
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$343.80
Rate for Payer: Aetna of IA Medical Rental Products	$343.80
Rate for Payer: Aetna of IA Medicare	$217.74
Rate for Payer: Amerigroup Medicaid	$192.80
Rate for Payer: Amerigroup Medicare	$192.91
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$286.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$191.00
Rate for Payer: Iowa Total Care Managed Medicaid	$190.92
Rate for Payer: Medical Associates Commercial	$286.50
Rate for Payer: Medical Associates Managed Medicare	$191.00
Rate for Payer: Midlands Choice Commercial	$267.40
Rate for Payer: Molina Healthcare Managed Medicaid	$193.86
Rate for Payer: Molina Healthcare Managed Medicare	$193.75
Rate for Payer: Oscar Health of IA Commercial	$286.50
Rate for Payer: Partners Health Alliance Commercial	$286.50
Rate for Payer: United Healthcare Commercial	$343.80
Rate for Payer: United Healthcare Managed Medicare	$225.38
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSAPORT DRAW FOR LAB

Facility

$26.00

Service Code	CPT 36591
Hospital Charge Code	7796499
Hospital Revenue Code	761
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$387.38
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$13.12
Rate for Payer: Amerigroup Medicare	$13.13
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12.99
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$13.00
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$13.20
Rate for Payer: Molina Healthcare Managed Medicare	$13.19
Rate for Payer: Oscar Health of IA Commercial	$19.50
Rate for Payer: Partners Health Alliance Commercial	$19.50
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34
Rate for Payer: Wellmark IA HMO	$352.16
Rate for Payer: Wellmark IA PPO	$387.38

INFUSAPORT DRAW FOR LAB

Facility

$26.00

Service Code	CPT 36591
Hospital Charge Code	7796499
Hospital Revenue Code	761
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

INFUSAPORT REMOVAL ER CHARGE

Professional

Both

$465.00

Hospital Charge Code	8068985
Hospital Revenue Code	981
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$348.75
Rate for Payer: Cash Price	$372.00
Rate for Payer: Medical Associates Commercial	$348.75
Rate for Payer: Midlands Choice Commercial	$325.50

INFUSION TX CONCURRENT

Facility

$57.00

Service Code	CPT 96368
Hospital Charge Code	7984744
Hospital Revenue Code	260
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: United Healthcare Commercial	$51.30

INFUSION TX CONCURRENT

Facility

$57.00

Service Code	CPT 96368
Hospital Charge Code	7984744
Hospital Revenue Code	260
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$51.30
Rate for Payer: Aetna of IA Medical Rental Products	$51.30
Rate for Payer: Aetna of IA Medicare	$32.49
Rate for Payer: Amerigroup Medicaid	$28.77
Rate for Payer: Amerigroup Medicare	$28.78
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$42.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.50
Rate for Payer: Iowa Total Care Managed Medicaid	$28.49
Rate for Payer: Medical Associates Commercial	$42.75
Rate for Payer: Medical Associates Managed Medicare	$28.50
Rate for Payer: Midlands Choice Commercial	$39.90
Rate for Payer: Molina Healthcare Managed Medicaid	$28.93
Rate for Payer: Molina Healthcare Managed Medicare	$28.91
Rate for Payer: Oscar Health of IA Commercial	$42.75
Rate for Payer: Partners Health Alliance Commercial	$42.75
Rate for Payer: United Healthcare Commercial	$51.30
Rate for Payer: United Healthcare Managed Medicare	$33.63
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX EA SEQUENTIAL INF

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	7984743
Hospital Revenue Code	260
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: United Healthcare Commercial	$207.00

INFUSION TX EA SEQUENTIAL INF

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	7984743
Hospital Revenue Code	260
Min. Negotiated Rate	$114.95
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$131.10
Rate for Payer: Amerigroup Medicaid	$116.08
Rate for Payer: Amerigroup Medicare	$116.15
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$115.00
Rate for Payer: Iowa Total Care Managed Medicaid	$114.95
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$115.00
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicaid	$116.72
Rate for Payer: Molina Healthcare Managed Medicare	$116.66
Rate for Payer: Oscar Health of IA Commercial	$172.50
Rate for Payer: Partners Health Alliance Commercial	$172.50
Rate for Payer: United Healthcare Commercial	$207.00
Rate for Payer: United Healthcare Managed Medicare	$135.70
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX HYDRATION 1ST HR

Facility

$344.00

Service Code	CPT 96360
Hospital Charge Code	7984739
Hospital Revenue Code	260
Min. Negotiated Rate	$171.93
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$309.60
Rate for Payer: Aetna of IA Medical Rental Products	$309.60
Rate for Payer: Aetna of IA Medicare	$196.08
Rate for Payer: Amerigroup Medicaid	$173.62
Rate for Payer: Amerigroup Medicare	$173.72
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cash Price	$275.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$258.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$172.00
Rate for Payer: Iowa Total Care Managed Medicaid	$171.93
Rate for Payer: Medical Associates Commercial	$258.00
Rate for Payer: Medical Associates Managed Medicare	$172.00
Rate for Payer: Midlands Choice Commercial	$240.80
Rate for Payer: Molina Healthcare Managed Medicaid	$174.58
Rate for Payer: Molina Healthcare Managed Medicare	$174.48
Rate for Payer: Oscar Health of IA Commercial	$258.00
Rate for Payer: Partners Health Alliance Commercial	$258.00
Rate for Payer: United Healthcare Commercial	$309.60
Rate for Payer: United Healthcare Managed Medicare	$202.96
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX HYDRATION 1ST HR

Facility

$344.00

Service Code	CPT 96360
Hospital Charge Code	7984739
Hospital Revenue Code	260
Min. Negotiated Rate	$240.80
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of IA Commercial	$309.60
Rate for Payer: Aetna of IA Medical Rental Products	$309.60
Rate for Payer: Cash Price	$275.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$258.00
Rate for Payer: Medical Associates Commercial	$258.00
Rate for Payer: Midlands Choice Commercial	$240.80
Rate for Payer: United Healthcare Commercial	$309.60

INFUSION TX HYDRATION EA AD HR

Facility

$152.00

Service Code	CPT 96361
Hospital Charge Code	7984740
Hospital Revenue Code	260
Min. Negotiated Rate	$75.97
Max. Negotiated Rate	$609.03
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Aetna of IA Medicare	$86.64
Rate for Payer: Amerigroup Medicaid	$76.71
Rate for Payer: Amerigroup Medicare	$76.76
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.00
Rate for Payer: Iowa Total Care Managed Medicaid	$75.97
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Medical Associates Managed Medicare	$76.00
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: Molina Healthcare Managed Medicaid	$77.14
Rate for Payer: Molina Healthcare Managed Medicare	$77.09
Rate for Payer: Oscar Health of IA Commercial	$114.00
Rate for Payer: Partners Health Alliance Commercial	$114.00
Rate for Payer: United Healthcare Commercial	$136.80
Rate for Payer: United Healthcare Managed Medicare	$89.68
Rate for Payer: Wellmark IA HMO	$553.66
Rate for Payer: Wellmark IA PPO	$609.03

INFUSION TX HYDRATION EA AD HR

Facility

$152.00

Service Code	CPT 96361
Hospital Charge Code	7984740
Hospital Revenue Code	260
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of IA Commercial	$136.80
Rate for Payer: Aetna of IA Medical Rental Products	$136.80
Rate for Payer: Cash Price	$121.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$114.00
Rate for Payer: Medical Associates Commercial	$114.00
Rate for Payer: Midlands Choice Commercial	$106.40
Rate for Payer: United Healthcare Commercial	$136.80

INFUSION TX MED ADMIN 1ST HR

Facility

$382.00

Service Code	CPT 96365
Hospital Charge Code	7984741
Hospital Revenue Code	260
Min. Negotiated Rate	$190.92
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$343.80
Rate for Payer: Aetna of IA Medical Rental Products	$343.80
Rate for Payer: Aetna of IA Medicare	$217.74
Rate for Payer: Amerigroup Medicaid	$192.80
Rate for Payer: Amerigroup Medicare	$192.91
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$286.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$191.00
Rate for Payer: Iowa Total Care Managed Medicaid	$190.92
Rate for Payer: Medical Associates Commercial	$286.50
Rate for Payer: Medical Associates Managed Medicare	$191.00
Rate for Payer: Midlands Choice Commercial	$267.40
Rate for Payer: Molina Healthcare Managed Medicaid	$193.86
Rate for Payer: Molina Healthcare Managed Medicare	$193.75
Rate for Payer: Oscar Health of IA Commercial	$286.50
Rate for Payer: Partners Health Alliance Commercial	$286.50
Rate for Payer: United Healthcare Commercial	$343.80
Rate for Payer: United Healthcare Managed Medicare	$225.38
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX MED ADMIN 1ST HR

Facility

$382.00

Service Code	CPT 96365
Hospital Charge Code	7984741
Hospital Revenue Code	260
Min. Negotiated Rate	$267.40
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of IA Commercial	$343.80
Rate for Payer: Aetna of IA Medical Rental Products	$343.80
Rate for Payer: Cash Price	$305.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$286.50
Rate for Payer: Medical Associates Commercial	$286.50
Rate for Payer: Midlands Choice Commercial	$267.40
Rate for Payer: United Healthcare Commercial	$343.80

INFUSION TX MED EA ADDL HOUR

Facility

$161.00

Service Code	CPT 96366
Hospital Charge Code	7984742
Hospital Revenue Code	260
Min. Negotiated Rate	$80.47
Max. Negotiated Rate	$609.03
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Aetna of IA Medicare	$91.77
Rate for Payer: Amerigroup Medicaid	$81.26
Rate for Payer: Amerigroup Medicare	$81.30
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$80.50
Rate for Payer: Iowa Total Care Managed Medicaid	$80.47
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Medical Associates Managed Medicare	$80.50
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Molina Healthcare Managed Medicaid	$81.71
Rate for Payer: Molina Healthcare Managed Medicare	$81.66
Rate for Payer: Oscar Health of IA Commercial	$120.75
Rate for Payer: Partners Health Alliance Commercial	$120.75
Rate for Payer: United Healthcare Commercial	$144.90
Rate for Payer: United Healthcare Managed Medicare	$94.99
Rate for Payer: Wellmark IA HMO	$553.66
Rate for Payer: Wellmark IA PPO	$609.03

INFUSION TX MED EA ADDL HOUR

Facility

$161.00

Service Code	CPT 96366
Hospital Charge Code	7984742
Hospital Revenue Code	260
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: United Healthcare Commercial	$144.90

INFUSION TX SEQENTIAL

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	4866841
Hospital Revenue Code	260
Min. Negotiated Rate	$114.95
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$131.10
Rate for Payer: Amerigroup Medicaid	$116.08
Rate for Payer: Amerigroup Medicare	$116.15
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$115.00
Rate for Payer: Iowa Total Care Managed Medicaid	$114.95
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$115.00
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicaid	$116.72
Rate for Payer: Molina Healthcare Managed Medicare	$116.66
Rate for Payer: Oscar Health of IA Commercial	$172.50
Rate for Payer: Partners Health Alliance Commercial	$172.50
Rate for Payer: United Healthcare Commercial	$207.00
Rate for Payer: United Healthcare Managed Medicare	$135.70
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX SEQENTIAL

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	6922797
Hospital Revenue Code	260
Min. Negotiated Rate	$114.95
Max. Negotiated Rate	$610.39
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Aetna of IA Medicare	$131.10
Rate for Payer: Amerigroup Medicaid	$116.08
Rate for Payer: Amerigroup Medicare	$116.15
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$115.00
Rate for Payer: Iowa Total Care Managed Medicaid	$114.95
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Medical Associates Managed Medicare	$115.00
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: Molina Healthcare Managed Medicaid	$116.72
Rate for Payer: Molina Healthcare Managed Medicare	$116.66
Rate for Payer: Oscar Health of IA Commercial	$172.50
Rate for Payer: Partners Health Alliance Commercial	$172.50
Rate for Payer: United Healthcare Commercial	$207.00
Rate for Payer: United Healthcare Managed Medicare	$135.70
Rate for Payer: Wellmark IA HMO	$554.90
Rate for Payer: Wellmark IA PPO	$610.39

INFUSION TX SEQENTIAL

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	4866841
Hospital Revenue Code	260
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: United Healthcare Commercial	$207.00

INFUSION TX SEQENTIAL

Facility

$230.00

Service Code	CPT 96367
Hospital Charge Code	6922797
Hospital Revenue Code	260
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of IA Commercial	$207.00
Rate for Payer: Aetna of IA Medical Rental Products	$207.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$172.50
Rate for Payer: Medical Associates Commercial	$172.50
Rate for Payer: Midlands Choice Commercial	$161.00
Rate for Payer: United Healthcare Commercial	$207.00

Inguinal and Femoral Hernia Procedures With CC

Facility

$11,546.14

Service Code	MS-DRG 351
Hospital Charge Code	201
Min. Negotiated Rate	$11,378.80
Max. Negotiated Rate	$11,546.14
Rate for Payer: Amerigroup Medicaid	$11,490.36
Rate for Payer: Iowa Total Care Managed Medicaid	$11,378.80
Rate for Payer: Molina Healthcare Managed Medicaid	$11,546.14

Inguinal and Femoral Hernia Procedures With MCC

Facility

$17,359.07

Service Code	MS-DRG 350
Hospital Charge Code	200
Min. Negotiated Rate	$17,107.49
Max. Negotiated Rate	$17,359.07
Rate for Payer: Amerigroup Medicaid	$17,275.21
Rate for Payer: Iowa Total Care Managed Medicaid	$17,107.49
Rate for Payer: Molina Healthcare Managed Medicaid	$17,359.07

Inguinal and Femoral Hernia Procedures Without CC/MCC

Facility

$7,914.28

Service Code	MS-DRG 352
Hospital Charge Code	202
Min. Negotiated Rate	$7,799.58
Max. Negotiated Rate	$7,914.28
Rate for Payer: Amerigroup Medicaid	$7,876.05
Rate for Payer: Iowa Total Care Managed Medicaid	$7,799.58
Rate for Payer: Molina Healthcare Managed Medicaid	$7,914.28

Know your out-of-pocket cost for care.

All Charges