Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

remdesivir 100 mg SDV Pow [VDMC]

Facility

$1,298.96

Service Code	HCPCS J0248
Hospital Charge Code	21102628
Hospital Revenue Code	250
Min. Negotiated Rate	$909.27
Max. Negotiated Rate	$1,169.06
Rate for Payer: Aetna of IA Commercial	$1,169.06
Rate for Payer: Aetna of IA Medical Rental Products	$1,169.06
Rate for Payer: Cash Price	$1,039.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$974.22
Rate for Payer: Medical Associates Commercial	$974.22
Rate for Payer: Midlands Choice Commercial	$909.27
Rate for Payer: United Healthcare Commercial	$1,169.06

remdesivir 100 mg SDV Pow [VDMC]

Facility

$1,298.96

Service Code	HCPCS J0248
Hospital Charge Code	21102628
Hospital Revenue Code	250
Min. Negotiated Rate	$649.22
Max. Negotiated Rate	$1,169.06
Rate for Payer: Aetna of IA Commercial	$1,169.06
Rate for Payer: Aetna of IA Medical Rental Products	$1,169.06
Rate for Payer: Aetna of IA Medicare	$740.41
Rate for Payer: Amerigroup Medicaid	$655.59
Rate for Payer: Amerigroup Medicare	$655.97
Rate for Payer: Cash Price	$1,039.17
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$974.22
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$649.48
Rate for Payer: Iowa Total Care Managed Medicaid	$649.22
Rate for Payer: Medical Associates Commercial	$974.22
Rate for Payer: Medical Associates Managed Medicare	$649.48
Rate for Payer: Midlands Choice Commercial	$909.27
Rate for Payer: Molina Healthcare Managed Medicaid	$659.22
Rate for Payer: Molina Healthcare Managed Medicare	$658.83
Rate for Payer: Oscar Health of IA Commercial	$974.22
Rate for Payer: Partners Health Alliance Commercial	$974.22
Rate for Payer: United Healthcare Commercial	$1,169.06
Rate for Payer: United Healthcare Managed Medicare	$766.39

Remote Services Individual Psychotherapy

Facility

$181.00

Service Code	CPT C7900
Hospital Charge Code	8945619
Hospital Revenue Code	914
Min. Negotiated Rate	$90.46
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of IA Commercial	$162.90
Rate for Payer: Aetna of IA Medical Rental Products	$162.90
Rate for Payer: Aetna of IA Medicare	$103.17
Rate for Payer: Amerigroup Medicaid	$91.35
Rate for Payer: Amerigroup Medicare	$91.40
Rate for Payer: Cash Price	$144.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.50
Rate for Payer: Iowa Total Care Managed Medicaid	$90.46
Rate for Payer: Medical Associates Commercial	$135.75
Rate for Payer: Medical Associates Managed Medicare	$90.50
Rate for Payer: Midlands Choice Commercial	$126.70
Rate for Payer: Molina Healthcare Managed Medicaid	$91.86
Rate for Payer: Molina Healthcare Managed Medicare	$91.80
Rate for Payer: Oscar Health of IA Commercial	$135.75
Rate for Payer: Partners Health Alliance Commercial	$135.75
Rate for Payer: United Healthcare Commercial	$162.90
Rate for Payer: United Healthcare Managed Medicare	$106.79

Remote Services Individual Psychotherapy

Facility

$181.00

Service Code	CPT C7900
Hospital Charge Code	8945619
Hospital Revenue Code	914
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of IA Commercial	$162.90
Rate for Payer: Aetna of IA Medical Rental Products	$162.90
Rate for Payer: Cash Price	$144.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.75
Rate for Payer: Medical Associates Commercial	$135.75
Rate for Payer: Midlands Choice Commercial	$126.70
Rate for Payer: United Healthcare Commercial	$162.90

REMOVAL FOREIGN BODY FOOT SUBQ

Professional

Both

$868.00

Service Code	CPT 28190
Hospital Charge Code	8825540
Hospital Revenue Code	975
Min. Negotiated Rate	$122.32
Max. Negotiated Rate	$607.60
Rate for Payer: Aetna of IA Medicare	$122.32
Rate for Payer: Amerigroup Medicaid	$126.48
Rate for Payer: Cash Price	$694.40
Rate for Payer: Cash Price	$694.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$146.78
Rate for Payer: Iowa Total Care Managed Medicaid	$124.77
Rate for Payer: Medical Associates Commercial	$232.41
Rate for Payer: Medical Associates Managed Medicare	$122.32
Rate for Payer: Midlands Choice Commercial	$607.60
Rate for Payer: Oscar Health of IA Commercial	$211.61
Rate for Payer: Partners Health Alliance Commercial	$183.48

REMOVAL OF FOOT FOREIGN BODY

Professional

Both

$865.00

Service Code	CPT 28190
Hospital Charge Code	7982793
Hospital Revenue Code	981
Min. Negotiated Rate	$122.32
Max. Negotiated Rate	$605.50
Rate for Payer: Aetna of IA Medicare	$122.32
Rate for Payer: Amerigroup Medicaid	$126.48
Rate for Payer: Cash Price	$692.00
Rate for Payer: Cash Price	$692.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$146.78
Rate for Payer: Iowa Total Care Managed Medicaid	$124.77
Rate for Payer: Medical Associates Commercial	$220.18
Rate for Payer: Medical Associates Managed Medicare	$122.32
Rate for Payer: Midlands Choice Commercial	$605.50
Rate for Payer: Oscar Health of IA Commercial	$211.61
Rate for Payer: Partners Health Alliance Commercial	$183.48

Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

Facility

$3,847.84

Service Code	CPT 20680
Hospital Revenue Code	490
Min. Negotiated Rate	$3,498.04
Max. Negotiated Rate	$3,847.84
Rate for Payer: Wellmark IA HMO	$3,498.04
Rate for Payer: Wellmark IA PPO	$3,847.84

REMOVAL OF NAIL BED

Professional

Both

$350.00

Service Code	CPT 11750
Hospital Charge Code	7982847
Hospital Revenue Code	981
Min. Negotiated Rate	$94.04
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna of IA Medicare	$94.04
Rate for Payer: Amerigroup Medicaid	$97.24
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.85
Rate for Payer: Iowa Total Care Managed Medicaid	$95.92
Rate for Payer: Medical Associates Commercial	$169.27
Rate for Payer: Medical Associates Managed Medicare	$94.04
Rate for Payer: Midlands Choice Commercial	$245.00
Rate for Payer: Oscar Health of IA Commercial	$162.69
Rate for Payer: Partners Health Alliance Commercial	$141.06

REMOVAL OF NAIL PLATE

Professional

Both

$270.00

Service Code	CPT 11730
Hospital Charge Code	7982849
Hospital Revenue Code	981
Min. Negotiated Rate	$49.48
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of IA Medicare	$49.48
Rate for Payer: Amerigroup Medicaid	$51.16
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$59.38
Rate for Payer: Iowa Total Care Managed Medicaid	$50.47
Rate for Payer: Medical Associates Commercial	$89.06
Rate for Payer: Medical Associates Managed Medicare	$49.48
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Oscar Health of IA Commercial	$85.60
Rate for Payer: Partners Health Alliance Commercial	$74.22

REMOVAL/REVISION OF CAST

Professional

Both

$210.00

Service Code	CPT 29700
Hospital Charge Code	7982784
Hospital Revenue Code	981
Min. Negotiated Rate	$29.73
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna of IA Medicare	$29.73
Rate for Payer: Amerigroup Medicaid	$30.74
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$35.68
Rate for Payer: Iowa Total Care Managed Medicaid	$30.32
Rate for Payer: Medical Associates Commercial	$53.51
Rate for Payer: Medical Associates Managed Medicare	$29.73
Rate for Payer: Midlands Choice Commercial	$147.00
Rate for Payer: Oscar Health of IA Commercial	$51.43
Rate for Payer: Partners Health Alliance Commercial	$44.60

REMOVAL TNL CV CATH CHARGE

Professional

Both

$465.00

Service Code	CPT 36589
Hospital Charge Code	8068937
Hospital Revenue Code	987
Min. Negotiated Rate	$121.90
Max. Negotiated Rate	$348.75
Rate for Payer: Aetna of IA Medicare	$121.90
Rate for Payer: Amerigroup Medicaid	$126.04
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$146.28
Rate for Payer: Iowa Total Care Managed Medicaid	$124.34
Rate for Payer: Medical Associates Commercial	$348.75
Rate for Payer: Medical Associates Managed Medicare	$121.90
Rate for Payer: Midlands Choice Commercial	$325.50
Rate for Payer: Oscar Health of IA Commercial	$210.89
Rate for Payer: Partners Health Alliance Commercial	$182.85

REMOVE FOREIGN BODY FROM EYE

Professional

Both

$161.00

Service Code	CPT 65220
Hospital Charge Code	7982762
Hospital Revenue Code	981
Min. Negotiated Rate	$37.45
Max. Negotiated Rate	$112.70
Rate for Payer: Aetna of IA Medicare	$37.45
Rate for Payer: Amerigroup Medicaid	$38.72
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$44.94
Rate for Payer: Iowa Total Care Managed Medicaid	$38.20
Rate for Payer: Medical Associates Commercial	$67.41
Rate for Payer: Medical Associates Managed Medicare	$37.45
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Oscar Health of IA Commercial	$64.79
Rate for Payer: Partners Health Alliance Commercial	$56.18

REMOVE FOREIGN BODY FROM EYE

Professional

Both

$148.00

Service Code	CPT 65205
Hospital Charge Code	7982763
Hospital Revenue Code	981
Min. Negotiated Rate	$26.66
Max. Negotiated Rate	$103.60
Rate for Payer: Aetna of IA Medicare	$26.66
Rate for Payer: Amerigroup Medicaid	$27.57
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$31.99
Rate for Payer: Iowa Total Care Managed Medicaid	$27.19
Rate for Payer: Medical Associates Commercial	$47.99
Rate for Payer: Medical Associates Managed Medicare	$26.66
Rate for Payer: Midlands Choice Commercial	$103.60
Rate for Payer: Oscar Health of IA Commercial	$46.12
Rate for Payer: Partners Health Alliance Commercial	$39.99

REMOVE SPINE ELTRD PERQ ARAY

Professional

Both

$1,929.00

Service Code	CPT 63661
Hospital Charge Code	8015896
Hospital Revenue Code	975
Min. Negotiated Rate	$296.70
Max. Negotiated Rate	$1,350.30
Rate for Payer: Aetna of IA Medicare	$296.70
Rate for Payer: Amerigroup Medicaid	$306.79
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$356.04
Rate for Payer: Iowa Total Care Managed Medicaid	$302.63
Rate for Payer: Medical Associates Commercial	$563.73
Rate for Payer: Medical Associates Managed Medicare	$296.70
Rate for Payer: Midlands Choice Commercial	$1,350.30
Rate for Payer: Oscar Health of IA Commercial	$513.29
Rate for Payer: Partners Health Alliance Commercial	$445.05

REMOVE SPINE ELTRD PLATE

Professional

Both

$2,838.00

Service Code	CPT 63662
Hospital Charge Code	8015894
Hospital Revenue Code	975
Min. Negotiated Rate	$749.64
Max. Negotiated Rate	$1,986.60
Rate for Payer: Aetna of IA Medicare	$749.64
Rate for Payer: Amerigroup Medicaid	$775.13
Rate for Payer: Cash Price	$2,270.40
Rate for Payer: Cash Price	$2,270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$899.57
Rate for Payer: Iowa Total Care Managed Medicaid	$764.63
Rate for Payer: Medical Associates Commercial	$1,424.32
Rate for Payer: Medical Associates Managed Medicare	$749.64
Rate for Payer: Midlands Choice Commercial	$1,986.60
Rate for Payer: Oscar Health of IA Commercial	$1,296.88
Rate for Payer: Partners Health Alliance Commercial	$1,124.46

Renal Failure With CC

Facility

$6,979.25

Service Code	MS-DRG 683
Hospital Charge Code	459
Min. Negotiated Rate	$6,878.10
Max. Negotiated Rate	$6,979.25
Rate for Payer: Amerigroup Medicaid	$6,945.54
Rate for Payer: Iowa Total Care Managed Medicaid	$6,878.10
Rate for Payer: Molina Healthcare Managed Medicaid	$6,979.25

Renal Failure With MCC

Facility

$11,483.15

Service Code	MS-DRG 682
Hospital Charge Code	458
Min. Negotiated Rate	$11,316.73
Max. Negotiated Rate	$11,483.15
Rate for Payer: Amerigroup Medicaid	$11,427.67
Rate for Payer: Iowa Total Care Managed Medicaid	$11,316.73
Rate for Payer: Molina Healthcare Managed Medicaid	$11,483.15

Renal Failure Without CC/MCC

Facility

$4,719.43

Service Code	MS-DRG 684
Hospital Charge Code	460
Min. Negotiated Rate	$4,651.04
Max. Negotiated Rate	$4,719.43
Rate for Payer: Amerigroup Medicaid	$4,696.64
Rate for Payer: Iowa Total Care Managed Medicaid	$4,651.04
Rate for Payer: Molina Healthcare Managed Medicaid	$4,719.43

RENAL PROFILE

Facility

$162.00

Service Code	CPT 80069
Hospital Charge Code	1634883
Hospital Revenue Code	301
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Aetna of IA Medicare	$92.34
Rate for Payer: Amerigroup Medicaid	$81.76
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$80.97
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: Molina Healthcare Managed Medicaid	$82.22
Rate for Payer: Molina Healthcare Managed Medicare	$82.17
Rate for Payer: Oscar Health of IA Commercial	$121.50
Rate for Payer: Partners Health Alliance Commercial	$121.50
Rate for Payer: United Healthcare Commercial	$145.80
Rate for Payer: United Healthcare Managed Medicare	$95.58
Rate for Payer: Wellmark IA HMO	$52.08
Rate for Payer: Wellmark IA PPO	$57.29

RENAL PROFILE

Facility

$162.00

Service Code	CPT 80069
Hospital Charge Code	1634883
Hospital Revenue Code	301
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: United Healthcare Commercial	$145.80

Renin Direct DMCL

Facility

$180.00

Service Code	CPT 84244
Hospital Charge Code	8037795
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$90.85
Rate for Payer: Amerigroup Medicare	$90.90
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.00
Rate for Payer: Iowa Total Care Managed Medicaid	$89.96
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$90.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$91.35
Rate for Payer: Molina Healthcare Managed Medicare	$91.30
Rate for Payer: Oscar Health of IA Commercial	$135.00
Rate for Payer: Partners Health Alliance Commercial	$135.00
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Renin Direct DMCL

Facility

$180.00

Service Code	CPT 84244
Hospital Charge Code	8037795
Hospital Revenue Code	301
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

repaglinide 1 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	17838257
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Aetna of IA Medicare	$0.87
Rate for Payer: Amerigroup Medicaid	$0.77
Rate for Payer: Amerigroup Medicare	$0.77
Rate for Payer: Cash Price	$1.21
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.76
Rate for Payer: Iowa Total Care Managed Medicaid	$0.76
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Medical Associates Managed Medicare	$0.76
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: Molina Healthcare Managed Medicaid	$0.77
Rate for Payer: Molina Healthcare Managed Medicare	$0.77
Rate for Payer: Oscar Health of IA Commercial	$1.14
Rate for Payer: Partners Health Alliance Commercial	$1.14
Rate for Payer: United Healthcare Commercial	$1.37
Rate for Payer: United Healthcare Managed Medicare	$0.90

repaglinide 1 mg Tab [VDMC]

Facility

$1.52

Service Code	HCPCS A9270
Hospital Charge Code	17838257
Hospital Revenue Code	259
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of IA Commercial	$1.37
Rate for Payer: Aetna of IA Medical Rental Products	$1.37
Rate for Payer: Cash Price	$1.21
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.14
Rate for Payer: Medical Associates Commercial	$1.14
Rate for Payer: Midlands Choice Commercial	$1.06
Rate for Payer: United Healthcare Commercial	$1.37

Repair, complex, trunk; 2.6 cm to 7.5 cm

Facility

$1,060.51

Service Code	CPT 13101
Hospital Revenue Code	360
Min. Negotiated Rate	$964.10
Max. Negotiated Rate	$1,060.51
Rate for Payer: Wellmark IA HMO	$964.10
Rate for Payer: Wellmark IA PPO	$1,060.51

Know your out-of-pocket cost for care.

All Charges