Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

paliperidone palmitate 1560 mg/5 mL Sus [VDMC]

Facility

$37,769.90

Service Code	HCPCS J2427
Hospital Charge Code	26738572
Hospital Revenue Code	259
Min. Negotiated Rate	$26,438.93
Max. Negotiated Rate	$33,992.91
Rate for Payer: Aetna of IA Commercial	$33,992.91
Rate for Payer: Aetna of IA Medical Rental Products	$33,992.91
Rate for Payer: Cash Price	$30,215.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$28,327.42
Rate for Payer: Medical Associates Commercial	$28,327.42
Rate for Payer: Midlands Choice Commercial	$26,438.93
Rate for Payer: United Healthcare Commercial	$33,992.91

paliperidone palmitate 1560 mg/5 mL Sus [VDMC]

Facility

$37,769.90

Service Code	HCPCS J2427
Hospital Charge Code	26738572
Hospital Revenue Code	259
Min. Negotiated Rate	$16,996.46
Max. Negotiated Rate	$33,992.91
Rate for Payer: Aetna of IA Commercial	$33,992.91
Rate for Payer: Aetna of IA Medical Rental Products	$33,992.91
Rate for Payer: Aetna of IA Medicare	$21,528.84
Rate for Payer: Amerigroup Medicaid	$21,785.68
Rate for Payer: Amerigroup Medicare	$17,166.42
Rate for Payer: Cash Price	$30,215.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$28,327.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16,996.46
Rate for Payer: Iowa Total Care Managed Medicaid	$21,574.17
Rate for Payer: Medical Associates Commercial	$28,327.42
Rate for Payer: Medical Associates Managed Medicare	$16,996.46
Rate for Payer: Midlands Choice Commercial	$26,438.93
Rate for Payer: Molina Healthcare Managed Medicaid	$21,891.43
Rate for Payer: Partners Health Alliance Commercial	$19,545.92
Rate for Payer: United Healthcare Commercial	$33,992.91
Rate for Payer: United Healthcare Managed Medicare	$22,284.24

paliperidone palmitate 156 mg/mL Sus [VDMC]

Facility

$4,486.54

Service Code	HCPCS J2426
Hospital Charge Code	27990289
Hospital Revenue Code	259
Min. Negotiated Rate	$3,140.58
Max. Negotiated Rate	$4,037.89
Rate for Payer: Aetna of IA Commercial	$4,037.89
Rate for Payer: Aetna of IA Medical Rental Products	$4,037.89
Rate for Payer: Cash Price	$3,589.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,364.90
Rate for Payer: Medical Associates Commercial	$3,364.90
Rate for Payer: Midlands Choice Commercial	$3,140.58
Rate for Payer: United Healthcare Commercial	$4,037.89

paliperidone palmitate 156 mg/mL Sus [VDMC]

Facility

$4,486.54

Service Code	HCPCS J2426
Hospital Charge Code	27990289
Hospital Revenue Code	259
Min. Negotiated Rate	$2,018.94
Max. Negotiated Rate	$4,037.89
Rate for Payer: Aetna of IA Commercial	$4,037.89
Rate for Payer: Aetna of IA Medical Rental Products	$4,037.89
Rate for Payer: Aetna of IA Medicare	$2,557.33
Rate for Payer: Amerigroup Medicaid	$2,587.84
Rate for Payer: Amerigroup Medicare	$2,039.13
Rate for Payer: Cash Price	$3,589.23
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,364.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,018.94
Rate for Payer: Iowa Total Care Managed Medicaid	$2,562.71
Rate for Payer: Medical Associates Commercial	$3,364.90
Rate for Payer: Medical Associates Managed Medicare	$2,018.94
Rate for Payer: Midlands Choice Commercial	$3,140.58
Rate for Payer: Molina Healthcare Managed Medicaid	$2,600.40
Rate for Payer: Partners Health Alliance Commercial	$2,321.78
Rate for Payer: United Healthcare Commercial	$4,037.89
Rate for Payer: United Healthcare Managed Medicare	$2,647.06

palonosetron 0.25 mg/5 mL SDV [VDMC]

Facility

$65.84

Service Code	HCPCS J2469
Hospital Charge Code	13339269
Hospital Revenue Code	259
Min. Negotiated Rate	$29.63
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$59.26
Rate for Payer: Aetna of IA Medical Rental Products	$59.26
Rate for Payer: Aetna of IA Medicare	$37.53
Rate for Payer: Amerigroup Medicaid	$37.98
Rate for Payer: Amerigroup Medicare	$29.92
Rate for Payer: Cash Price	$52.67
Rate for Payer: Cash Price	$52.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.63
Rate for Payer: Iowa Total Care Managed Medicaid	$37.61
Rate for Payer: Medical Associates Commercial	$49.38
Rate for Payer: Medical Associates Managed Medicare	$29.63
Rate for Payer: Midlands Choice Commercial	$46.09
Rate for Payer: Molina Healthcare Managed Medicaid	$38.16
Rate for Payer: Partners Health Alliance Commercial	$34.07
Rate for Payer: United Healthcare Commercial	$59.26
Rate for Payer: United Healthcare Managed Medicare	$38.85
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

palonosetron 0.25 mg/5 mL SDV [VDMC]

Facility

$65.84

Service Code	HCPCS J2469
Hospital Charge Code	13339269
Hospital Revenue Code	259
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$59.26
Rate for Payer: Aetna of IA Commercial	$59.26
Rate for Payer: Aetna of IA Medical Rental Products	$59.26
Rate for Payer: Cash Price	$52.67
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.38
Rate for Payer: Medical Associates Commercial	$49.38
Rate for Payer: Midlands Choice Commercial	$46.09
Rate for Payer: United Healthcare Commercial	$59.26

pamidronate 3 mg/mL 10 ml SDV [VDMC]

Facility

$54.24

Service Code	HCPCS J2430
Hospital Charge Code	10411386
Hospital Revenue Code	259
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna of IA Commercial	$48.82
Rate for Payer: Aetna of IA Medical Rental Products	$48.82
Rate for Payer: Cash Price	$43.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.68
Rate for Payer: Medical Associates Commercial	$40.68
Rate for Payer: Midlands Choice Commercial	$37.97
Rate for Payer: United Healthcare Commercial	$48.82

pamidronate 3 mg/mL 10 ml SDV [VDMC]

Facility

$54.24

Service Code	HCPCS J2430
Hospital Charge Code	10411386
Hospital Revenue Code	259
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna of IA Commercial	$48.82
Rate for Payer: Aetna of IA Medical Rental Products	$48.82
Rate for Payer: Aetna of IA Medicare	$30.92
Rate for Payer: Amerigroup Medicaid	$31.29
Rate for Payer: Amerigroup Medicare	$24.65
Rate for Payer: Cash Price	$43.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.68
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.41
Rate for Payer: Iowa Total Care Managed Medicaid	$30.98
Rate for Payer: Medical Associates Commercial	$40.68
Rate for Payer: Medical Associates Managed Medicare	$24.41
Rate for Payer: Midlands Choice Commercial	$37.97
Rate for Payer: Molina Healthcare Managed Medicaid	$31.44
Rate for Payer: Partners Health Alliance Commercial	$28.07
Rate for Payer: United Healthcare Commercial	$48.82
Rate for Payer: United Healthcare Managed Medicare	$32.00

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$27,963.64

Service Code	MSDRG 406
Min. Negotiated Rate	$27,558.36
Max. Negotiated Rate	$27,963.64
Rate for Payer: Amerigroup Medicaid	$27,828.54
Rate for Payer: Iowa Total Care Managed Medicaid	$27,558.36
Rate for Payer: Molina Healthcare Managed Medicaid	$27,963.64

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$46,077.23

Service Code	MSDRG 405
Min. Negotiated Rate	$45,409.42
Max. Negotiated Rate	$46,077.23
Rate for Payer: Amerigroup Medicaid	$45,854.62
Rate for Payer: Iowa Total Care Managed Medicaid	$45,409.42
Rate for Payer: Molina Healthcare Managed Medicaid	$46,077.23

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$19,759.77

Service Code	MSDRG 407
Min. Negotiated Rate	$19,473.39
Max. Negotiated Rate	$19,759.77
Rate for Payer: Amerigroup Medicaid	$19,664.30
Rate for Payer: Iowa Total Care Managed Medicaid	$19,473.39
Rate for Payer: Molina Healthcare Managed Medicaid	$19,759.77

PANCREAS TRANSPLANT

Facility

$40,744.60

Service Code	MSDRG 010
Min. Negotiated Rate	$40,154.08
Max. Negotiated Rate	$40,744.60
Rate for Payer: Amerigroup Medicaid	$40,547.75
Rate for Payer: Iowa Total Care Managed Medicaid	$40,154.08
Rate for Payer: Molina Healthcare Managed Medicaid	$40,744.60

pantoprazole 20 mg Oral DR Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10411658
Hospital Revenue Code	259
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.22
Rate for Payer: Medical Associates Commercial	$1.22
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: United Healthcare Commercial	$1.47

pantoprazole 20 mg Oral DR Tab [VDMC]

Facility

$1.63

Service Code	HCPCS A9270
Hospital Charge Code	10411658
Hospital Revenue Code	259
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of IA Commercial	$1.47
Rate for Payer: Aetna of IA Medical Rental Products	$1.47
Rate for Payer: Aetna of IA Medicare	$0.93
Rate for Payer: Amerigroup Medicaid	$0.94
Rate for Payer: Amerigroup Medicare	$0.74
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.22
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.73
Rate for Payer: Iowa Total Care Managed Medicaid	$0.93
Rate for Payer: Medical Associates Commercial	$1.22
Rate for Payer: Medical Associates Managed Medicare	$0.73
Rate for Payer: Midlands Choice Commercial	$1.14
Rate for Payer: Molina Healthcare Managed Medicaid	$0.94
Rate for Payer: Partners Health Alliance Commercial	$0.84
Rate for Payer: United Healthcare Commercial	$1.47
Rate for Payer: United Healthcare Managed Medicare	$0.96

pantoprazole 40 mg IV Inj [VDMC]

Facility

$38.67

Service Code	HCPCS J2470
Hospital Charge Code	10411727
Hospital Revenue Code	259
Min. Negotiated Rate	$27.07
Max. Negotiated Rate	$34.80
Rate for Payer: Aetna of IA Commercial	$34.80
Rate for Payer: Aetna of IA Medical Rental Products	$34.80
Rate for Payer: Cash Price	$30.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.00
Rate for Payer: Medical Associates Commercial	$29.00
Rate for Payer: Midlands Choice Commercial	$27.07
Rate for Payer: United Healthcare Commercial	$34.80

pantoprazole 40 mg IV Inj [VDMC]

Facility

$38.67

Service Code	HCPCS J2470
Hospital Charge Code	10411727
Hospital Revenue Code	259
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$221.80
Rate for Payer: Aetna of IA Commercial	$34.80
Rate for Payer: Aetna of IA Medical Rental Products	$34.80
Rate for Payer: Aetna of IA Medicare	$22.04
Rate for Payer: Amerigroup Medicaid	$22.31
Rate for Payer: Amerigroup Medicare	$17.58
Rate for Payer: Cash Price	$30.94
Rate for Payer: Cash Price	$30.94
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$17.40
Rate for Payer: Iowa Total Care Managed Medicaid	$22.09
Rate for Payer: Medical Associates Commercial	$29.00
Rate for Payer: Medical Associates Managed Medicare	$17.40
Rate for Payer: Midlands Choice Commercial	$27.07
Rate for Payer: Molina Healthcare Managed Medicaid	$22.41
Rate for Payer: Partners Health Alliance Commercial	$20.01
Rate for Payer: United Healthcare Commercial	$34.80
Rate for Payer: United Healthcare Managed Medicare	$22.82
Rate for Payer: Wellmark IA HMO WHPI	$201.36
Rate for Payer: Wellmark IA PPO	$221.80

pantoprazole 40 mg Oral DR Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	10411794
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Aetna of IA Medicare	$0.80
Rate for Payer: Amerigroup Medicaid	$0.81
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.63
Rate for Payer: Iowa Total Care Managed Medicaid	$0.80
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Medical Associates Managed Medicare	$0.63
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: Molina Healthcare Managed Medicaid	$0.81
Rate for Payer: Partners Health Alliance Commercial	$0.72
Rate for Payer: United Healthcare Commercial	$1.26
Rate for Payer: United Healthcare Managed Medicare	$0.82

pantoprazole 40 mg Oral DR Tab [VDMC]

Facility

$1.40

Service Code	HCPCS A9270
Hospital Charge Code	10411794
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of IA Commercial	$1.26
Rate for Payer: Aetna of IA Medical Rental Products	$1.26
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.05
Rate for Payer: Medical Associates Commercial	$1.05
Rate for Payer: Midlands Choice Commercial	$0.98
Rate for Payer: United Healthcare Commercial	$1.26

PAP THIN PREP

Facility

$110.00

Service Code	HCPCS G0123
Hospital Charge Code	8089044
Hospital Revenue Code	309
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of IA Commercial	$99.00
Rate for Payer: Aetna of IA Medical Rental Products	$99.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$82.50
Rate for Payer: Medical Associates Commercial	$82.50
Rate for Payer: Midlands Choice Commercial	$77.00
Rate for Payer: United Healthcare Commercial	$99.00

PAP THIN PREP

Facility

$110.00

Service Code	HCPCS G0123
Hospital Charge Code	8089044
Hospital Revenue Code	309
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of IA Commercial	$99.00
Rate for Payer: Aetna of IA Medical Rental Products	$99.00
Rate for Payer: Aetna of IA Medicare	$62.70
Rate for Payer: Amerigroup Medicaid	$63.45
Rate for Payer: Amerigroup Medicare	$50.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$82.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$49.50
Rate for Payer: Iowa Total Care Managed Medicaid	$62.83
Rate for Payer: Medical Associates Commercial	$82.50
Rate for Payer: Medical Associates Managed Medicare	$49.50
Rate for Payer: Midlands Choice Commercial	$77.00
Rate for Payer: Molina Healthcare Managed Medicaid	$63.76
Rate for Payer: Partners Health Alliance Commercial	$56.92
Rate for Payer: United Healthcare Commercial	$99.00
Rate for Payer: United Healthcare Managed Medicare	$64.90
Rate for Payer: Wellmark IA HMO WHPI	$51.76
Rate for Payer: Wellmark IA PPO	$57.01

Paracentesis Procedure

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	8060784
Hospital Revenue Code	761
Min. Negotiated Rate	$309.60
Max. Negotiated Rate	$1,659.63
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Aetna of IA Medicare	$392.16
Rate for Payer: Amerigroup Medicaid	$396.84
Rate for Payer: Amerigroup Medicare	$312.70
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$309.60
Rate for Payer: Iowa Total Care Managed Medicaid	$392.99
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Medical Associates Managed Medicare	$309.60
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: Molina Healthcare Managed Medicaid	$398.76
Rate for Payer: Partners Health Alliance Commercial	$356.04
Rate for Payer: United Healthcare Commercial	$619.20
Rate for Payer: United Healthcare Managed Medicare	$405.92
Rate for Payer: Wellmark IA HMO WHPI	$1,506.63
Rate for Payer: Wellmark IA PPO	$1,659.63

Paracentesis Procedure

Facility

$688.00

Service Code	CPT 49082
Hospital Charge Code	8060784
Hospital Revenue Code	761
Min. Negotiated Rate	$481.60
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of IA Commercial	$619.20
Rate for Payer: Aetna of IA Medical Rental Products	$619.20
Rate for Payer: Cash Price	$550.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$516.00
Rate for Payer: Medical Associates Commercial	$516.00
Rate for Payer: Midlands Choice Commercial	$481.60
Rate for Payer: United Healthcare Commercial	$619.20

PARAFFIN BATH

Facility

$73.00

Service Code	CPT 97018 GO
Hospital Charge Code	1373447
Hospital Revenue Code	430
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Aetna of IA Medicare	$41.61
Rate for Payer: Amerigroup Medicaid	$42.11
Rate for Payer: Amerigroup Medicare	$33.18
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.85
Rate for Payer: Iowa Total Care Managed Medicaid	$41.70
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Medical Associates Managed Medicare	$32.85
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: Molina Healthcare Managed Medicaid	$42.31
Rate for Payer: Partners Health Alliance Commercial	$37.78
Rate for Payer: United Healthcare Commercial	$65.70
Rate for Payer: United Healthcare Managed Medicare	$43.07
Rate for Payer: Wellmark IA HMO WHPI	$73.74
Rate for Payer: Wellmark IA PPO	$81.22

PARAFFIN BATH

Facility

$73.00

Service Code	CPT 97018 GO
Hospital Charge Code	1373447
Hospital Revenue Code	430
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: United Healthcare Commercial	$65.70

PARAFFIN BATH APPLICATION

Facility

$73.00

Service Code	CPT 97018 GP
Hospital Charge Code	1373914
Hospital Revenue Code	420
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of IA Commercial	$65.70
Rate for Payer: Aetna of IA Medical Rental Products	$65.70
Rate for Payer: Cash Price	$58.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$54.75
Rate for Payer: Medical Associates Commercial	$54.75
Rate for Payer: Midlands Choice Commercial	$51.10
Rate for Payer: United Healthcare Commercial	$65.70

Know your out-of-pocket cost for care.

All Charges