Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Urethral Procedures With CC/MCC

Facility

$17,491.95

Service Code	MS-DRG 671
Hospital Charge Code	453
Min. Negotiated Rate	$17,238.44
Max. Negotiated Rate	$17,491.95
Rate for Payer: Amerigroup Medicaid	$17,407.44
Rate for Payer: Iowa Total Care Managed Medicaid	$17,238.44
Rate for Payer: Molina Healthcare Managed Medicaid	$17,491.95

Urethral Procedures Without CC/MCC

Facility

$8,932.97

Service Code	MS-DRG 672
Hospital Charge Code	454
Min. Negotiated Rate	$8,803.51
Max. Negotiated Rate	$8,932.97
Rate for Payer: Amerigroup Medicaid	$8,889.82
Rate for Payer: Iowa Total Care Managed Medicaid	$8,803.51
Rate for Payer: Molina Healthcare Managed Medicaid	$8,932.97

Urethral Stricture

Facility

$5,815.88

Service Code	MS-DRG 697
Hospital Charge Code	470
Min. Negotiated Rate	$5,731.59
Max. Negotiated Rate	$5,815.88
Rate for Payer: Amerigroup Medicaid	$5,787.79
Rate for Payer: Iowa Total Care Managed Medicaid	$5,731.59
Rate for Payer: Molina Healthcare Managed Medicaid	$5,815.88

URIC ACID

Facility

$46.00

Service Code	CPT 84550
Hospital Charge Code	633858
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Aetna of IA Medicare	$26.22
Rate for Payer: Amerigroup Medicaid	$23.22
Rate for Payer: Amerigroup Medicare	$23.23
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$23.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.99
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Medical Associates Managed Medicare	$23.00
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: Molina Healthcare Managed Medicaid	$23.34
Rate for Payer: Molina Healthcare Managed Medicare	$23.33
Rate for Payer: Oscar Health of IA Commercial	$34.50
Rate for Payer: Partners Health Alliance Commercial	$34.50
Rate for Payer: United Healthcare Commercial	$41.40
Rate for Payer: United Healthcare Managed Medicare	$27.14
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URIC ACID

Facility

$46.00

Service Code	CPT 84550
Hospital Charge Code	633858
Hospital Revenue Code	301
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of IA Commercial	$41.40
Rate for Payer: Aetna of IA Medical Rental Products	$41.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$34.50
Rate for Payer: Medical Associates Commercial	$34.50
Rate for Payer: Midlands Choice Commercial	$32.20
Rate for Payer: United Healthcare Commercial	$41.40

Uric Acid Urine Timed DMCL

Facility

$61.00

Service Code	CPT 84560
Hospital Charge Code	8037740
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

Uric Acid Urine Timed DMCL

Facility

$61.00

Service Code	CPT 84560
Hospital Charge Code	8037740
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006795
Hospital Revenue Code	307
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$15.65
Rate for Payer: Amerigroup Medicare	$15.66
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.50
Rate for Payer: Iowa Total Care Managed Medicaid	$15.49
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$15.50
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$15.73
Rate for Payer: Molina Healthcare Managed Medicare	$15.72
Rate for Payer: Oscar Health of IA Commercial	$23.25
Rate for Payer: Partners Health Alliance Commercial	$23.25
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29
Rate for Payer: Wellmark IA HMO	$22.32
Rate for Payer: Wellmark IA PPO	$24.55

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006797
Hospital Revenue Code	307
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$15.65
Rate for Payer: Amerigroup Medicare	$15.66
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.50
Rate for Payer: Iowa Total Care Managed Medicaid	$15.49
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$15.50
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$15.73
Rate for Payer: Molina Healthcare Managed Medicare	$15.72
Rate for Payer: Oscar Health of IA Commercial	$23.25
Rate for Payer: Partners Health Alliance Commercial	$23.25
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29
Rate for Payer: Wellmark IA HMO	$22.32
Rate for Payer: Wellmark IA PPO	$24.55

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006797
Hospital Revenue Code	307
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

URINALYSIS BY DIPSTICK, AUTO W/O MICRO

Facility

$31.00

Service Code	CPT 81003
Hospital Charge Code	4006795
Hospital Revenue Code	307
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

Urinary Stones With MCC

Facility

$8,477.27

Service Code	MS-DRG 693
Hospital Charge Code	466
Min. Negotiated Rate	$8,354.41
Max. Negotiated Rate	$8,477.27
Rate for Payer: Amerigroup Medicaid	$8,436.32
Rate for Payer: Iowa Total Care Managed Medicaid	$8,354.41
Rate for Payer: Molina Healthcare Managed Medicaid	$8,477.27

Urinary Stones Without MCC

Facility

$5,644.62

Service Code	MS-DRG 694
Hospital Charge Code	467
Min. Negotiated Rate	$5,562.81
Max. Negotiated Rate	$5,644.62
Rate for Payer: Amerigroup Medicaid	$5,617.35
Rate for Payer: Iowa Total Care Managed Medicaid	$5,562.81
Rate for Payer: Molina Healthcare Managed Medicaid	$5,644.62

URINE CHLORIDE

Facility

$48.00

Service Code	CPT 82436
Hospital Charge Code	4006802
Hospital Revenue Code	301
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of IA Commercial	$43.20
Rate for Payer: Aetna of IA Medical Rental Products	$43.20
Rate for Payer: Cash Price	$38.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.00
Rate for Payer: Medical Associates Commercial	$36.00
Rate for Payer: Midlands Choice Commercial	$33.60
Rate for Payer: United Healthcare Commercial	$43.20

URINE CHLORIDE

Facility

$48.00

Service Code	CPT 82436
Hospital Charge Code	4006802
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of IA Commercial	$43.20
Rate for Payer: Aetna of IA Medical Rental Products	$43.20
Rate for Payer: Aetna of IA Medicare	$27.36
Rate for Payer: Amerigroup Medicaid	$24.23
Rate for Payer: Amerigroup Medicare	$24.24
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.00
Rate for Payer: Iowa Total Care Managed Medicaid	$23.99
Rate for Payer: Medical Associates Commercial	$36.00
Rate for Payer: Medical Associates Managed Medicare	$24.00
Rate for Payer: Midlands Choice Commercial	$33.60
Rate for Payer: Molina Healthcare Managed Medicaid	$24.36
Rate for Payer: Molina Healthcare Managed Medicare	$24.35
Rate for Payer: Oscar Health of IA Commercial	$36.00
Rate for Payer: Partners Health Alliance Commercial	$36.00
Rate for Payer: United Healthcare Commercial	$43.20
Rate for Payer: United Healthcare Managed Medicare	$28.32
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	1930782
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	8419061
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	8419061
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE CREAT

Facility

$61.00

Service Code	CPT 82570
Hospital Charge Code	1930782
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE CULTURE ID

Facility

$66.00

Service Code	CPT 87088
Hospital Charge Code	7836071
Hospital Revenue Code	306
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Aetna of IA Medicare	$37.62
Rate for Payer: Amerigroup Medicaid	$33.31
Rate for Payer: Amerigroup Medicare	$33.33
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$33.00
Rate for Payer: Iowa Total Care Managed Medicaid	$32.99
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Medical Associates Managed Medicare	$33.00
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: Molina Healthcare Managed Medicaid	$33.50
Rate for Payer: Molina Healthcare Managed Medicare	$33.48
Rate for Payer: Oscar Health of IA Commercial	$49.50
Rate for Payer: Partners Health Alliance Commercial	$49.50
Rate for Payer: United Healthcare Commercial	$59.40
Rate for Payer: United Healthcare Managed Medicare	$38.94
Rate for Payer: Wellmark IA HMO	$31.00
Rate for Payer: Wellmark IA PPO	$34.10

URINE CULTURE ID

Facility

$66.00

Service Code	CPT 87088
Hospital Charge Code	7836071
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of IA Commercial	$59.40
Rate for Payer: Aetna of IA Medical Rental Products	$59.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$49.50
Rate for Payer: Medical Associates Commercial	$49.50
Rate for Payer: Midlands Choice Commercial	$46.20
Rate for Payer: United Healthcare Commercial	$59.40

URINE K (POTASSIUM)

Facility

$61.00

Service Code	CPT 84133
Hospital Charge Code	4021240
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

URINE K (POTASSIUM)

Facility

$61.00

Service Code	CPT 84133
Hospital Charge Code	4021240
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$30.79
Rate for Payer: Amerigroup Medicare	$30.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$30.50
Rate for Payer: Iowa Total Care Managed Medicaid	$30.49
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$30.50
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$30.96
Rate for Payer: Molina Healthcare Managed Medicare	$30.94
Rate for Payer: Oscar Health of IA Commercial	$45.75
Rate for Payer: Partners Health Alliance Commercial	$45.75
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	8093947
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

URINE MICROALBUMIN

Facility

$55.00

Service Code	CPT 82043
Hospital Charge Code	4019304
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

Know your out-of-pocket cost for care.

All Charges