Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Kidney and Urinary Tract Signs and Symptoms Without MCC

Facility

$4,282.44

Service Code	MS-DRG 696
Hospital Charge Code	469
Min. Negotiated Rate	$4,220.37
Max. Negotiated Rate	$4,282.44
Rate for Payer: Amerigroup Medicaid	$4,261.75
Rate for Payer: Iowa Total Care Managed Medicaid	$4,220.37
Rate for Payer: Molina Healthcare Managed Medicaid	$4,282.44

Kidney Transplant

Facility

$134,083.23

Service Code	MS-DRG 652
Hospital Charge Code	434
Min. Negotiated Rate	$132,139.99
Max. Negotiated Rate	$134,083.23
Rate for Payer: Amerigroup Medicaid	$133,435.48
Rate for Payer: Iowa Total Care Managed Medicaid	$132,139.99
Rate for Payer: Molina Healthcare Managed Medicaid	$134,083.23

Kidney Transplant With Hemodialysis With MCC

Facility

$95,487.17

Service Code	MS-DRG 650
Hospital Charge Code	432
Min. Negotiated Rate	$94,103.30
Max. Negotiated Rate	$95,487.17
Rate for Payer: Amerigroup Medicaid	$95,025.88
Rate for Payer: Iowa Total Care Managed Medicaid	$94,103.30
Rate for Payer: Molina Healthcare Managed Medicaid	$95,487.17

Kidney Transplant With Hemodialysis Without MCC

Facility

$36,353.94

Service Code	MS-DRG 651
Hospital Charge Code	433
Min. Negotiated Rate	$35,827.07
Max. Negotiated Rate	$36,353.94
Rate for Payer: Amerigroup Medicaid	$36,178.32
Rate for Payer: Iowa Total Care Managed Medicaid	$35,827.07
Rate for Payer: Molina Healthcare Managed Medicaid	$36,353.94

KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL

Facility

$540.00

Service Code	CPT C1713
Hospital Charge Code	8026315
Hospital Revenue Code	278
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna of IA Commercial	$486.00
Rate for Payer: Aetna of IA Medical Rental Products	$486.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$405.00
Rate for Payer: Medical Associates Commercial	$405.00
Rate for Payer: Midlands Choice Commercial	$378.00
Rate for Payer: United Healthcare Commercial	$486.00

KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL

Facility

$540.00

Service Code	CPT C1713
Hospital Charge Code	8026315
Hospital Revenue Code	278
Min. Negotiated Rate	$269.89
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna of IA Commercial	$486.00
Rate for Payer: Aetna of IA Medical Rental Products	$486.00
Rate for Payer: Aetna of IA Medicare	$307.80
Rate for Payer: Amerigroup Medicaid	$272.54
Rate for Payer: Amerigroup Medicare	$272.70
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$405.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$270.00
Rate for Payer: Iowa Total Care Managed Medicaid	$269.89
Rate for Payer: Medical Associates Commercial	$405.00
Rate for Payer: Medical Associates Managed Medicare	$270.00
Rate for Payer: Midlands Choice Commercial	$378.00
Rate for Payer: Molina Healthcare Managed Medicaid	$274.05
Rate for Payer: Molina Healthcare Managed Medicare	$273.89
Rate for Payer: Oscar Health of IA Commercial	$405.00
Rate for Payer: Partners Health Alliance Commercial	$405.00
Rate for Payer: United Healthcare Commercial	$486.00
Rate for Payer: United Healthcare Managed Medicare	$318.60

Knee Procedures Without Principal Diagnosis of Infection With CC/MCC

Facility

$18,942.71

Service Code	MS-DRG 488
Hospital Charge Code	307
Min. Negotiated Rate	$18,668.18
Max. Negotiated Rate	$18,942.71
Rate for Payer: Amerigroup Medicaid	$18,851.20
Rate for Payer: Iowa Total Care Managed Medicaid	$18,668.18
Rate for Payer: Molina Healthcare Managed Medicaid	$18,942.71

Knee Procedures Without Principal Diagnosis of Infection Without CC/MCC

Facility

$9,904.42

Service Code	MS-DRG 489
Hospital Charge Code	308
Min. Negotiated Rate	$9,760.88
Max. Negotiated Rate	$9,904.42
Rate for Payer: Amerigroup Medicaid	$9,856.57
Rate for Payer: Iowa Total Care Managed Medicaid	$9,760.88
Rate for Payer: Molina Healthcare Managed Medicaid	$9,904.42

Knee Procedures With Principal Diagnosis of Infection With CC

Facility

$19,551.96

Service Code	MS-DRG 486
Hospital Charge Code	305
Min. Negotiated Rate	$19,268.60
Max. Negotiated Rate	$19,551.96
Rate for Payer: Amerigroup Medicaid	$19,457.50
Rate for Payer: Iowa Total Care Managed Medicaid	$19,268.60
Rate for Payer: Molina Healthcare Managed Medicaid	$19,551.96

Knee Procedures With Principal Diagnosis of Infection With MCC

Facility

$23,792.07

Service Code	MS-DRG 485
Hospital Charge Code	304
Min. Negotiated Rate	$23,447.26
Max. Negotiated Rate	$23,792.07
Rate for Payer: Amerigroup Medicaid	$23,677.14
Rate for Payer: Iowa Total Care Managed Medicaid	$23,447.26
Rate for Payer: Molina Healthcare Managed Medicaid	$23,792.07

Knee Procedures With Principal Diagnosis of Infection Without CC/MCC

Facility

$13,944.73

Service Code	MS-DRG 487
Hospital Charge Code	306
Min. Negotiated Rate	$13,742.63
Max. Negotiated Rate	$13,944.73
Rate for Payer: Amerigroup Medicaid	$13,877.37
Rate for Payer: Iowa Total Care Managed Medicaid	$13,742.63
Rate for Payer: Molina Healthcare Managed Medicaid	$13,944.73

KOH PREP FUNGUS

Facility

$41.00

Service Code	CPT 87220
Hospital Charge Code	4022879
Hospital Revenue Code	306
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: United Healthcare Commercial	$36.90

KOH PREP FUNGUS

Facility

$41.00

Service Code	CPT 87220
Hospital Charge Code	4022879
Hospital Revenue Code	306
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of IA Commercial	$36.90
Rate for Payer: Aetna of IA Medical Rental Products	$36.90
Rate for Payer: Aetna of IA Medicare	$23.37
Rate for Payer: Amerigroup Medicaid	$20.69
Rate for Payer: Amerigroup Medicare	$20.70
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.50
Rate for Payer: Iowa Total Care Managed Medicaid	$20.49
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Medical Associates Managed Medicare	$20.50
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: Molina Healthcare Managed Medicaid	$20.81
Rate for Payer: Molina Healthcare Managed Medicare	$20.80
Rate for Payer: Oscar Health of IA Commercial	$30.75
Rate for Payer: Partners Health Alliance Commercial	$30.75
Rate for Payer: United Healthcare Commercial	$36.90
Rate for Payer: United Healthcare Managed Medicare	$24.19
Rate for Payer: Wellmark IA HMO	$31.00
Rate for Payer: Wellmark IA PPO	$34.10

Kools Solution Compound [VDMC]

Facility

$386.60

Service Code	HCPCS A9270GY
Hospital Charge Code	11590592
Hospital Revenue Code	259
Min. Negotiated Rate	$193.22
Max. Negotiated Rate	$347.94
Rate for Payer: Aetna of IA Commercial	$347.94
Rate for Payer: Aetna of IA Medical Rental Products	$347.94
Rate for Payer: Aetna of IA Medicare	$220.36
Rate for Payer: Amerigroup Medicaid	$195.12
Rate for Payer: Amerigroup Medicare	$195.23
Rate for Payer: Cash Price	$309.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$289.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$193.30
Rate for Payer: Iowa Total Care Managed Medicaid	$193.22
Rate for Payer: Medical Associates Commercial	$289.95
Rate for Payer: Medical Associates Managed Medicare	$193.30
Rate for Payer: Midlands Choice Commercial	$270.62
Rate for Payer: Molina Healthcare Managed Medicaid	$196.20
Rate for Payer: Molina Healthcare Managed Medicare	$196.08
Rate for Payer: Oscar Health of IA Commercial	$289.95
Rate for Payer: Partners Health Alliance Commercial	$289.95
Rate for Payer: United Healthcare Commercial	$347.94
Rate for Payer: United Healthcare Managed Medicare	$228.09

Kools Solution Compound [VDMC]

Facility

$386.60

Service Code	HCPCS A9270GY
Hospital Charge Code	11590592
Hospital Revenue Code	259
Min. Negotiated Rate	$270.62
Max. Negotiated Rate	$347.94
Rate for Payer: Aetna of IA Commercial	$347.94
Rate for Payer: Aetna of IA Medical Rental Products	$347.94
Rate for Payer: Cash Price	$309.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$289.95
Rate for Payer: Medical Associates Commercial	$289.95
Rate for Payer: Midlands Choice Commercial	$270.62
Rate for Payer: United Healthcare Commercial	$347.94

K-WIRE 0.062X6

Facility

$16.00

Service Code	CPT C1713
Hospital Charge Code	8750332
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: United Healthcare Commercial	$14.40

K-WIRE 0.062X6

Facility

$16.00

Service Code	CPT C1713
Hospital Charge Code	8750332
Hospital Revenue Code	278
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Aetna of IA Medicare	$9.12
Rate for Payer: Amerigroup Medicaid	$8.08
Rate for Payer: Amerigroup Medicare	$8.08
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Medical Associates Managed Medicare	$8.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: Molina Healthcare Managed Medicaid	$8.12
Rate for Payer: Molina Healthcare Managed Medicare	$8.12
Rate for Payer: Oscar Health of IA Commercial	$12.00
Rate for Payer: Partners Health Alliance Commercial	$12.00
Rate for Payer: United Healthcare Commercial	$14.40
Rate for Payer: United Healthcare Managed Medicare	$9.44

K-WIRE 1.0MM

Facility

$16.00

Service Code	CPT C1713
Hospital Charge Code	8046397
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: United Healthcare Commercial	$14.40

K-WIRE 1.0MM

Facility

$16.00

Service Code	CPT C1713
Hospital Charge Code	8046397
Hospital Revenue Code	278
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Aetna of IA Medicare	$9.12
Rate for Payer: Amerigroup Medicaid	$8.08
Rate for Payer: Amerigroup Medicare	$8.08
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Medical Associates Managed Medicare	$8.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: Molina Healthcare Managed Medicaid	$8.12
Rate for Payer: Molina Healthcare Managed Medicare	$8.12
Rate for Payer: Oscar Health of IA Commercial	$12.00
Rate for Payer: Partners Health Alliance Commercial	$12.00
Rate for Payer: United Healthcare Commercial	$14.40
Rate for Payer: United Healthcare Managed Medicare	$9.44

K-WIRE 1.2MM

Facility

$37.00

Service Code	CPT C1713
Hospital Charge Code	8047368
Hospital Revenue Code	278
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Aetna of IA Medicare	$21.09
Rate for Payer: Amerigroup Medicaid	$18.67
Rate for Payer: Amerigroup Medicare	$18.68
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.50
Rate for Payer: Iowa Total Care Managed Medicaid	$18.49
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Medical Associates Managed Medicare	$18.50
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: Molina Healthcare Managed Medicaid	$18.78
Rate for Payer: Molina Healthcare Managed Medicare	$18.77
Rate for Payer: Oscar Health of IA Commercial	$27.75
Rate for Payer: Partners Health Alliance Commercial	$27.75
Rate for Payer: United Healthcare Commercial	$33.30
Rate for Payer: United Healthcare Managed Medicare	$21.83

K-WIRE 1.2MM

Facility

$37.00

Service Code	CPT C1713
Hospital Charge Code	8047368
Hospital Revenue Code	278
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: United Healthcare Commercial	$33.30

K-WIRE, 1.35MM, THREADED TROCAR TIP

Facility

$36.00

Service Code	CPT C1713
Hospital Charge Code	8047151
Hospital Revenue Code	278
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$18.17
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$17.99
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$18.27
Rate for Payer: Molina Healthcare Managed Medicare	$18.26
Rate for Payer: Oscar Health of IA Commercial	$27.00
Rate for Payer: Partners Health Alliance Commercial	$27.00
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

K-WIRE, 1.35MM, THREADED TROCAR TIP

Facility

$36.00

Service Code	CPT C1713
Hospital Charge Code	8047151
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

K-WIRE, 1.35MM, TROCAR TIP

Facility

$36.00

Service Code	CPT C1713
Hospital Charge Code	8047150
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

K-WIRE, 1.35MM, TROCAR TIP

Facility

$36.00

Service Code	CPT C1713
Hospital Charge Code	8047150
Hospital Revenue Code	278
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$18.17
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$17.99
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$18.27
Rate for Payer: Molina Healthcare Managed Medicare	$18.26
Rate for Payer: Oscar Health of IA Commercial	$27.00
Rate for Payer: Partners Health Alliance Commercial	$27.00
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

Know your out-of-pocket cost for care.

All Charges