Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$17,097.96

Service Code	MSDRG 657
Min. Negotiated Rate	$16,850.16
Max. Negotiated Rate	$17,097.96
Rate for Payer: Amerigroup Medicaid	$17,015.35
Rate for Payer: Iowa Total Care Managed Medicaid	$16,850.16
Rate for Payer: Molina Healthcare Managed Medicaid	$17,097.96

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$27,646.11

Service Code	MSDRG 656
Min. Negotiated Rate	$27,245.43
Max. Negotiated Rate	$27,646.11
Rate for Payer: Amerigroup Medicaid	$27,512.54
Rate for Payer: Iowa Total Care Managed Medicaid	$27,245.43
Rate for Payer: Molina Healthcare Managed Medicaid	$27,646.11

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$14,527.36

Service Code	MSDRG 658
Min. Negotiated Rate	$14,316.81
Max. Negotiated Rate	$14,527.36
Rate for Payer: Amerigroup Medicaid	$14,457.17
Rate for Payer: Iowa Total Care Managed Medicaid	$14,316.81
Rate for Payer: Molina Healthcare Managed Medicaid	$14,527.36

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$11,640.35

Service Code	MSDRG 660
Min. Negotiated Rate	$11,471.64
Max. Negotiated Rate	$11,640.35
Rate for Payer: Amerigroup Medicaid	$11,584.11
Rate for Payer: Iowa Total Care Managed Medicaid	$11,471.64
Rate for Payer: Molina Healthcare Managed Medicaid	$11,640.35

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$19,584.12

Service Code	MSDRG 659
Min. Negotiated Rate	$19,300.28
Max. Negotiated Rate	$19,584.12
Rate for Payer: Amerigroup Medicaid	$19,489.50
Rate for Payer: Iowa Total Care Managed Medicaid	$19,300.28
Rate for Payer: Molina Healthcare Managed Medicaid	$19,584.12

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$9,796.00

Service Code	MSDRG 661
Min. Negotiated Rate	$9,654.02
Max. Negotiated Rate	$9,796.00
Rate for Payer: Amerigroup Medicaid	$9,748.67
Rate for Payer: Iowa Total Care Managed Medicaid	$9,654.02
Rate for Payer: Molina Healthcare Managed Medicaid	$9,796.00

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$10,194.60

Service Code	MSDRG 689
Min. Negotiated Rate	$10,046.84
Max. Negotiated Rate	$10,194.60
Rate for Payer: Amerigroup Medicaid	$10,145.34
Rate for Payer: Iowa Total Care Managed Medicaid	$10,046.84
Rate for Payer: Molina Healthcare Managed Medicaid	$10,194.60

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$7,100.41

Service Code	MSDRG 690
Min. Negotiated Rate	$6,997.50
Max. Negotiated Rate	$7,100.41
Rate for Payer: Amerigroup Medicaid	$7,066.11
Rate for Payer: Iowa Total Care Managed Medicaid	$6,997.50
Rate for Payer: Molina Healthcare Managed Medicaid	$7,100.41

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$9,212.74

Service Code	MSDRG 687
Min. Negotiated Rate	$9,079.22
Max. Negotiated Rate	$9,212.74
Rate for Payer: Amerigroup Medicaid	$9,168.23
Rate for Payer: Iowa Total Care Managed Medicaid	$9,079.22
Rate for Payer: Molina Healthcare Managed Medicaid	$9,212.74

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$13,813.49

Service Code	MSDRG 686
Min. Negotiated Rate	$13,613.28
Max. Negotiated Rate	$13,813.49
Rate for Payer: Amerigroup Medicaid	$13,746.75
Rate for Payer: Iowa Total Care Managed Medicaid	$13,613.28
Rate for Payer: Molina Healthcare Managed Medicaid	$13,813.49

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$7,718.57

Service Code	MSDRG 688
Min. Negotiated Rate	$7,606.71
Max. Negotiated Rate	$7,718.57
Rate for Payer: Amerigroup Medicaid	$7,681.28
Rate for Payer: Iowa Total Care Managed Medicaid	$7,606.71
Rate for Payer: Molina Healthcare Managed Medicaid	$7,718.57

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$12,797.85

Service Code	MSDRG 695
Min. Negotiated Rate	$12,612.37
Max. Negotiated Rate	$12,797.85
Rate for Payer: Amerigroup Medicaid	$12,736.02
Rate for Payer: Iowa Total Care Managed Medicaid	$12,612.37
Rate for Payer: Molina Healthcare Managed Medicaid	$12,797.85

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$4,899.13

Service Code	MSDRG 696
Min. Negotiated Rate	$4,828.12
Max. Negotiated Rate	$4,899.13
Rate for Payer: Amerigroup Medicaid	$4,875.46
Rate for Payer: Iowa Total Care Managed Medicaid	$4,828.12
Rate for Payer: Molina Healthcare Managed Medicaid	$4,899.13

KIDNEY TRANSPLANT

Facility

$153,391.85

Service Code	MSDRG 652
Min. Negotiated Rate	$151,168.71
Max. Negotiated Rate	$153,391.85
Rate for Payer: Amerigroup Medicaid	$152,650.76
Rate for Payer: Iowa Total Care Managed Medicaid	$151,168.71
Rate for Payer: Molina Healthcare Managed Medicaid	$153,391.85

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$109,237.78

Service Code	MSDRG 650
Min. Negotiated Rate	$107,654.58
Max. Negotiated Rate	$109,237.78
Rate for Payer: Amerigroup Medicaid	$108,710.02
Rate for Payer: Iowa Total Care Managed Medicaid	$107,654.58
Rate for Payer: Molina Healthcare Managed Medicaid	$109,237.78

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$41,589.09

Service Code	MSDRG 651
Min. Negotiated Rate	$40,986.33
Max. Negotiated Rate	$41,589.09
Rate for Payer: Amerigroup Medicaid	$41,388.15
Rate for Payer: Iowa Total Care Managed Medicaid	$40,986.33
Rate for Payer: Molina Healthcare Managed Medicaid	$41,589.09

KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	8026315
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
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: Aetna of IA Medicare	$307.80
Rate for Payer: Amerigroup Medicaid	$311.47
Rate for Payer: Amerigroup Medicare	$245.43
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	$243.00
Rate for Payer: Iowa Total Care Managed Medicaid	$308.45
Rate for Payer: Medical Associates Commercial	$405.00
Rate for Payer: Medical Associates Managed Medicare	$243.00
Rate for Payer: Midlands Choice Commercial	$378.00
Rate for Payer: Molina Healthcare Managed Medicaid	$312.98
Rate for Payer: Partners Health Alliance Commercial	$279.45
Rate for Payer: United Healthcare Commercial	$486.00
Rate for Payer: United Healthcare Managed Medicare	$318.60

KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL

Facility

$540.00

Service Code	HCPCS 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

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$21,670.55

Service Code	MSDRG 488
Min. Negotiated Rate	$21,356.48
Max. Negotiated Rate	$21,670.55
Rate for Payer: Amerigroup Medicaid	$21,565.86
Rate for Payer: Iowa Total Care Managed Medicaid	$21,356.48
Rate for Payer: Molina Healthcare Managed Medicaid	$21,670.55

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$11,330.71

Service Code	MSDRG 489
Min. Negotiated Rate	$11,166.49
Max. Negotiated Rate	$11,330.71
Rate for Payer: Amerigroup Medicaid	$11,275.96
Rate for Payer: Iowa Total Care Managed Medicaid	$11,166.49
Rate for Payer: Molina Healthcare Managed Medicaid	$11,330.71

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$22,367.53

Service Code	MSDRG 486
Min. Negotiated Rate	$22,043.36
Max. Negotiated Rate	$22,367.53
Rate for Payer: Amerigroup Medicaid	$22,259.47
Rate for Payer: Iowa Total Care Managed Medicaid	$22,043.36
Rate for Payer: Molina Healthcare Managed Medicaid	$22,367.53

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$27,218.24

Service Code	MSDRG 485
Min. Negotiated Rate	$26,823.76
Max. Negotiated Rate	$27,218.24
Rate for Payer: Amerigroup Medicaid	$27,086.74
Rate for Payer: Iowa Total Care Managed Medicaid	$26,823.76
Rate for Payer: Molina Healthcare Managed Medicaid	$27,218.24

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$15,952.84

Service Code	MSDRG 487
Min. Negotiated Rate	$15,721.63
Max. Negotiated Rate	$15,952.84
Rate for Payer: Amerigroup Medicaid	$15,875.77
Rate for Payer: Iowa Total Care Managed Medicaid	$15,721.63
Rate for Payer: Molina Healthcare Managed Medicaid	$15,952.84

KOH PREP FUNGUS

Facility

$41.00

Service Code	CPT 87220
Hospital Charge Code	4022879
Hospital Revenue Code	306
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$37.49
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	$23.65
Rate for Payer: Amerigroup Medicare	$18.63
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	$18.45
Rate for Payer: Iowa Total Care Managed Medicaid	$23.42
Rate for Payer: Medical Associates Commercial	$30.75
Rate for Payer: Medical Associates Managed Medicare	$18.45
Rate for Payer: Midlands Choice Commercial	$28.70
Rate for Payer: Molina Healthcare Managed Medicaid	$23.76
Rate for Payer: Partners Health Alliance Commercial	$21.22
Rate for Payer: United Healthcare Commercial	$36.90
Rate for Payer: United Healthcare Managed Medicare	$24.19
Rate for Payer: Wellmark IA HMO WHPI	$34.03
Rate for Payer: Wellmark IA PPO	$37.49

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

Know your out-of-pocket cost for care.

All Charges