Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

REMOVAL OF FOOT FOREIGN BODY

Professional

Both

$865.00

Service Code	CPT 28190
Hospital Charge Code	7982793
Hospital Revenue Code	981
Min. Negotiated Rate	$385.70
Max. Negotiated Rate	$648.75
Rate for Payer: Cash Price	$692.00
Rate for Payer: Cash Price	$692.00
Rate for Payer: Medical Associates Commercial	$648.75
Rate for Payer: Midlands Choice Commercial	$605.50
Rate for Payer: Partners Health Alliance Commercial	$648.75
Rate for Payer: United Healthcare Commercial	$385.70

REMOVAL OF FOREIGN BODY

Facility

$652.00

Service Code	CPT 20525
Hospital Charge Code	4864793
Hospital Revenue Code	450
Min. Negotiated Rate	$293.40
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of IA Commercial	$586.80
Rate for Payer: Aetna of IA Medical Rental Products	$586.80
Rate for Payer: Aetna of IA Medicare	$371.64
Rate for Payer: Amerigroup Medicaid	$376.07
Rate for Payer: Amerigroup Medicare	$296.33
Rate for Payer: Cash Price	$521.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$489.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$293.40
Rate for Payer: Iowa Total Care Managed Medicaid	$372.42
Rate for Payer: Medical Associates Commercial	$489.00
Rate for Payer: Medical Associates Managed Medicare	$293.40
Rate for Payer: Midlands Choice Commercial	$456.40
Rate for Payer: Molina Healthcare Managed Medicaid	$377.90
Rate for Payer: Partners Health Alliance Commercial	$337.41
Rate for Payer: United Healthcare Commercial	$586.80
Rate for Payer: United Healthcare Managed Medicare	$384.68

REMOVAL OF FOREIGN BODY

Facility

$652.00

Service Code	CPT 20525
Hospital Charge Code	4864793
Hospital Revenue Code	450
Min. Negotiated Rate	$456.40
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of IA Commercial	$586.80
Rate for Payer: Aetna of IA Medical Rental Products	$586.80
Rate for Payer: Cash Price	$521.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$489.00
Rate for Payer: Medical Associates Commercial	$489.00
Rate for Payer: Midlands Choice Commercial	$456.40
Rate for Payer: United Healthcare Commercial	$586.80

REMOVAL OF FOREIGN BODY

Facility

$1,696.00

Service Code	CPT 27372
Hospital Charge Code	7982919
Hospital Revenue Code	450
Min. Negotiated Rate	$763.20
Max. Negotiated Rate	$1,526.40
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Aetna of IA Medicare	$966.72
Rate for Payer: Amerigroup Medicaid	$978.25
Rate for Payer: Amerigroup Medicare	$770.83
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$763.20
Rate for Payer: Iowa Total Care Managed Medicaid	$968.76
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Medical Associates Managed Medicare	$763.20
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: Molina Healthcare Managed Medicaid	$983.00
Rate for Payer: Partners Health Alliance Commercial	$877.68
Rate for Payer: United Healthcare Commercial	$1,526.40
Rate for Payer: United Healthcare Managed Medicare	$1,000.64

REMOVAL OF FOREIGN BODY

Facility

$1,696.00

Service Code	CPT 27372
Hospital Charge Code	7982919
Hospital Revenue Code	450
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$1,526.40
Rate for Payer: Aetna of IA Commercial	$1,526.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,526.40
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,272.00
Rate for Payer: Medical Associates Commercial	$1,272.00
Rate for Payer: Midlands Choice Commercial	$1,187.20
Rate for Payer: United Healthcare Commercial	$1,526.40

REMOVAL OF KNEE CYST

Facility

$1,985.00

Service Code	CPT 27345
Hospital Charge Code	7982951
Hospital Revenue Code	450
Min. Negotiated Rate	$893.25
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of IA Commercial	$1,786.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,786.50
Rate for Payer: Aetna of IA Medicare	$1,131.45
Rate for Payer: Amerigroup Medicaid	$1,144.95
Rate for Payer: Amerigroup Medicare	$902.18
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,488.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$893.25
Rate for Payer: Iowa Total Care Managed Medicaid	$1,133.83
Rate for Payer: Medical Associates Commercial	$1,488.75
Rate for Payer: Medical Associates Managed Medicare	$893.25
Rate for Payer: Midlands Choice Commercial	$1,389.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,150.51
Rate for Payer: Partners Health Alliance Commercial	$1,027.24
Rate for Payer: United Healthcare Commercial	$1,786.50
Rate for Payer: United Healthcare Managed Medicare	$1,171.15

REMOVAL OF KNEE CYST

Facility

$1,985.00

Service Code	CPT 27345
Hospital Charge Code	7982951
Hospital Revenue Code	450
Min. Negotiated Rate	$1,389.50
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of IA Commercial	$1,786.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,786.50
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,488.75
Rate for Payer: Medical Associates Commercial	$1,488.75
Rate for Payer: Midlands Choice Commercial	$1,389.50
Rate for Payer: United Healthcare Commercial	$1,786.50

REMOVAL OF NAIL BED

Professional

Both

$350.00

Service Code	CPT 11750
Hospital Charge Code	7982847
Hospital Revenue Code	981
Min. Negotiated Rate	$238.19
Max. Negotiated Rate	$262.50
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Medical Associates Commercial	$262.50
Rate for Payer: Midlands Choice Commercial	$245.00
Rate for Payer: Partners Health Alliance Commercial	$262.50
Rate for Payer: United Healthcare Commercial	$238.19

REMOVAL OF NAIL BED

Facility

$815.00

Service Code	CPT 11750
Hospital Charge Code	4863317
Hospital Revenue Code	450
Min. Negotiated Rate	$366.75
Max. Negotiated Rate	$733.50
Rate for Payer: Aetna of IA Commercial	$733.50
Rate for Payer: Aetna of IA Medical Rental Products	$733.50
Rate for Payer: Aetna of IA Medicare	$464.55
Rate for Payer: Amerigroup Medicaid	$470.09
Rate for Payer: Amerigroup Medicare	$370.42
Rate for Payer: Cash Price	$652.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$611.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$366.75
Rate for Payer: Iowa Total Care Managed Medicaid	$465.53
Rate for Payer: Medical Associates Commercial	$611.25
Rate for Payer: Medical Associates Managed Medicare	$366.75
Rate for Payer: Midlands Choice Commercial	$570.50
Rate for Payer: Molina Healthcare Managed Medicaid	$472.37
Rate for Payer: Partners Health Alliance Commercial	$421.76
Rate for Payer: United Healthcare Commercial	$733.50
Rate for Payer: United Healthcare Managed Medicare	$480.85

REMOVAL OF NAIL BED

Facility

$815.00

Service Code	CPT 11750
Hospital Charge Code	4863317
Hospital Revenue Code	450
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$733.50
Rate for Payer: Aetna of IA Commercial	$733.50
Rate for Payer: Aetna of IA Medical Rental Products	$733.50
Rate for Payer: Cash Price	$652.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$611.25
Rate for Payer: Medical Associates Commercial	$611.25
Rate for Payer: Midlands Choice Commercial	$570.50
Rate for Payer: United Healthcare Commercial	$733.50

REMOVAL OF NAIL PLATE

Professional

Both

$270.00

Service Code	CPT 11730
Hospital Charge Code	7982849
Hospital Revenue Code	981
Min. Negotiated Rate	$167.58
Max. Negotiated Rate	$202.50
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Partners Health Alliance Commercial	$202.50
Rate for Payer: United Healthcare Commercial	$167.58

REMOVAL OF NAIL PLATE

Facility

$274.00

Service Code	CPT 11730
Hospital Charge Code	4863312
Hospital Revenue Code	450
Min. Negotiated Rate	$191.80
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of IA Commercial	$246.60
Rate for Payer: Aetna of IA Medical Rental Products	$246.60
Rate for Payer: Cash Price	$219.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$205.50
Rate for Payer: Medical Associates Commercial	$205.50
Rate for Payer: Midlands Choice Commercial	$191.80
Rate for Payer: United Healthcare Commercial	$246.60

REMOVAL OF NAIL PLATE

Facility

$274.00

Service Code	CPT 11730
Hospital Charge Code	4863312
Hospital Revenue Code	450
Min. Negotiated Rate	$123.30
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of IA Commercial	$246.60
Rate for Payer: Aetna of IA Medical Rental Products	$246.60
Rate for Payer: Aetna of IA Medicare	$156.18
Rate for Payer: Amerigroup Medicaid	$158.04
Rate for Payer: Amerigroup Medicare	$124.53
Rate for Payer: Cash Price	$219.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$205.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.30
Rate for Payer: Iowa Total Care Managed Medicaid	$156.51
Rate for Payer: Medical Associates Commercial	$205.50
Rate for Payer: Medical Associates Managed Medicare	$123.30
Rate for Payer: Midlands Choice Commercial	$191.80
Rate for Payer: Molina Healthcare Managed Medicaid	$158.81
Rate for Payer: Partners Health Alliance Commercial	$141.79
Rate for Payer: United Healthcare Commercial	$246.60
Rate for Payer: United Healthcare Managed Medicare	$161.66

REMOVAL OF SKIN TAGS <W/15

Facility

$275.00

Service Code	CPT 11200
Hospital Charge Code	4862815
Hospital Revenue Code	450
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: United Healthcare Commercial	$247.50

REMOVAL OF SKIN TAGS <W/15

Facility

$275.00

Service Code	CPT 11200
Hospital Charge Code	4862815
Hospital Revenue Code	450
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of IA Commercial	$247.50
Rate for Payer: Aetna of IA Medical Rental Products	$247.50
Rate for Payer: Aetna of IA Medicare	$156.75
Rate for Payer: Amerigroup Medicaid	$158.62
Rate for Payer: Amerigroup Medicare	$124.99
Rate for Payer: Cash Price	$220.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$206.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$123.75
Rate for Payer: Iowa Total Care Managed Medicaid	$157.08
Rate for Payer: Medical Associates Commercial	$206.25
Rate for Payer: Medical Associates Managed Medicare	$123.75
Rate for Payer: Midlands Choice Commercial	$192.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.39
Rate for Payer: Partners Health Alliance Commercial	$142.31
Rate for Payer: United Healthcare Commercial	$247.50
Rate for Payer: United Healthcare Managed Medicare	$162.25

REMOVAL/REVISION OF CAST

Professional

Both

$210.00

Service Code	CPT 29700
Hospital Charge Code	7982784
Hospital Revenue Code	981
Min. Negotiated Rate	$93.78
Max. Negotiated Rate	$157.50
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Medical Associates Commercial	$157.50
Rate for Payer: Midlands Choice Commercial	$147.00
Rate for Payer: Partners Health Alliance Commercial	$157.50
Rate for Payer: United Healthcare Commercial	$93.78

REMOVAL/REVISION OF CAST

Facility

$197.00

Service Code	CPT 29700
Hospital Charge Code	4864898
Hospital Revenue Code	450
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

REMOVAL/REVISION OF CAST

Facility

$197.00

Service Code	CPT 29700
Hospital Charge Code	4864898
Hospital Revenue Code	450
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

REMOVAL/REVISION OF CAST

Facility

$247.00

Service Code	CPT 29705
Hospital Charge Code	7982918
Hospital Revenue Code	450
Min. Negotiated Rate	$111.15
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of IA Commercial	$222.30
Rate for Payer: Aetna of IA Medical Rental Products	$222.30
Rate for Payer: Aetna of IA Medicare	$140.79
Rate for Payer: Amerigroup Medicaid	$142.47
Rate for Payer: Amerigroup Medicare	$112.26
Rate for Payer: Cash Price	$197.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$185.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$111.15
Rate for Payer: Iowa Total Care Managed Medicaid	$141.09
Rate for Payer: Medical Associates Commercial	$185.25
Rate for Payer: Medical Associates Managed Medicare	$111.15
Rate for Payer: Midlands Choice Commercial	$172.90
Rate for Payer: Molina Healthcare Managed Medicaid	$143.16
Rate for Payer: Partners Health Alliance Commercial	$127.82
Rate for Payer: United Healthcare Commercial	$222.30
Rate for Payer: United Healthcare Managed Medicare	$145.73

REMOVAL/REVISION OF CAST

Facility

$247.00

Service Code	CPT 29705
Hospital Charge Code	7982918
Hospital Revenue Code	450
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of IA Commercial	$222.30
Rate for Payer: Aetna of IA Medical Rental Products	$222.30
Rate for Payer: Cash Price	$197.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$185.25
Rate for Payer: Medical Associates Commercial	$185.25
Rate for Payer: Midlands Choice Commercial	$172.90
Rate for Payer: United Healthcare Commercial	$222.30

REMOVAL TNL CV CATH CHARGE

Professional

Both

$465.00

Service Code	CPT 36589
Hospital Charge Code	8068937
Hospital Revenue Code	987
Min. Negotiated Rate	$252.61
Max. Negotiated Rate	$348.75
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Medical Associates Commercial	$348.75
Rate for Payer: Midlands Choice Commercial	$325.50
Rate for Payer: Partners Health Alliance Commercial	$348.75
Rate for Payer: United Healthcare Commercial	$252.61

REMOVE EYELID LESION(S)

Facility

$694.00

Service Code	CPT 67808
Hospital Charge Code	7982979
Hospital Revenue Code	450
Min. Negotiated Rate	$485.80
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of IA Commercial	$624.60
Rate for Payer: Aetna of IA Medical Rental Products	$624.60
Rate for Payer: Cash Price	$555.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$520.50
Rate for Payer: Medical Associates Commercial	$520.50
Rate for Payer: Midlands Choice Commercial	$485.80
Rate for Payer: United Healthcare Commercial	$624.60

REMOVE EYELID LESION(S)

Facility

$694.00

Service Code	CPT 67808
Hospital Charge Code	7982979
Hospital Revenue Code	450
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of IA Commercial	$624.60
Rate for Payer: Aetna of IA Medical Rental Products	$624.60
Rate for Payer: Aetna of IA Medicare	$395.58
Rate for Payer: Amerigroup Medicaid	$400.30
Rate for Payer: Amerigroup Medicare	$315.42
Rate for Payer: Cash Price	$555.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$520.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$312.30
Rate for Payer: Iowa Total Care Managed Medicaid	$396.41
Rate for Payer: Medical Associates Commercial	$520.50
Rate for Payer: Medical Associates Managed Medicare	$312.30
Rate for Payer: Midlands Choice Commercial	$485.80
Rate for Payer: Molina Healthcare Managed Medicaid	$402.24
Rate for Payer: Partners Health Alliance Commercial	$359.14
Rate for Payer: United Healthcare Commercial	$624.60
Rate for Payer: United Healthcare Managed Medicare	$409.46

REMOVE FOREIGN BODY

Facility

$629.00

Service Code	CPT 10120
Hospital Charge Code	4862797
Hospital Revenue Code	450
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$566.10
Rate for Payer: Aetna of IA Commercial	$566.10
Rate for Payer: Aetna of IA Medical Rental Products	$566.10
Rate for Payer: Cash Price	$503.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.75
Rate for Payer: Medical Associates Commercial	$471.75
Rate for Payer: Midlands Choice Commercial	$440.30
Rate for Payer: United Healthcare Commercial	$566.10

REMOVE FOREIGN BODY

Facility

$629.00

Service Code	CPT 10120
Hospital Charge Code	4862797
Hospital Revenue Code	450
Min. Negotiated Rate	$283.05
Max. Negotiated Rate	$566.10
Rate for Payer: Aetna of IA Commercial	$566.10
Rate for Payer: Aetna of IA Medical Rental Products	$566.10
Rate for Payer: Aetna of IA Medicare	$358.53
Rate for Payer: Amerigroup Medicaid	$362.81
Rate for Payer: Amerigroup Medicare	$285.88
Rate for Payer: Cash Price	$503.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$471.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$283.05
Rate for Payer: Iowa Total Care Managed Medicaid	$359.28
Rate for Payer: Medical Associates Commercial	$471.75
Rate for Payer: Medical Associates Managed Medicare	$283.05
Rate for Payer: Midlands Choice Commercial	$440.30
Rate for Payer: Molina Healthcare Managed Medicaid	$364.57
Rate for Payer: Partners Health Alliance Commercial	$325.51
Rate for Payer: United Healthcare Commercial	$566.10
Rate for Payer: United Healthcare Managed Medicare	$371.11

Know your out-of-pocket cost for care.

All Charges