Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

THROMBIN TIME

Facility

$55.00

Service Code	CPT 85670
Hospital Charge Code	8093945
Hospital Revenue Code	305
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

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: United Healthcare Commercial	$117.00

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$41.83
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Aetna of IA Medicare	$74.10
Rate for Payer: Amerigroup Medicaid	$74.98
Rate for Payer: Amerigroup Medicare	$59.08
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.50
Rate for Payer: Iowa Total Care Managed Medicaid	$74.26
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Medical Associates Managed Medicare	$58.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: Molina Healthcare Managed Medicaid	$75.35
Rate for Payer: Partners Health Alliance Commercial	$67.28
Rate for Payer: United Healthcare Commercial	$117.00
Rate for Payer: United Healthcare Managed Medicare	$76.70
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.26

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna of IA Commercial	$2.94
Rate for Payer: Aetna of IA Medical Rental Products	$2.94
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.45
Rate for Payer: Medical Associates Commercial	$2.45
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: United Healthcare Commercial	$2.94

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.26

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna of IA Commercial	$2.94
Rate for Payer: Aetna of IA Medical Rental Products	$2.94
Rate for Payer: Aetna of IA Medicare	$1.86
Rate for Payer: Amerigroup Medicaid	$1.88
Rate for Payer: Amerigroup Medicare	$1.48
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.45
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.47
Rate for Payer: Iowa Total Care Managed Medicaid	$1.86
Rate for Payer: Medical Associates Commercial	$2.45
Rate for Payer: Medical Associates Managed Medicare	$1.47
Rate for Payer: Midlands Choice Commercial	$2.28
Rate for Payer: Molina Healthcare Managed Medicaid	$1.89
Rate for Payer: Partners Health Alliance Commercial	$1.69
Rate for Payer: United Healthcare Commercial	$2.94
Rate for Payer: United Healthcare Managed Medicare	$1.92

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$18,517.82

Service Code	MSDRG 626
Min. Negotiated Rate	$18,249.44
Max. Negotiated Rate	$18,517.82
Rate for Payer: Amerigroup Medicaid	$18,428.35
Rate for Payer: Iowa Total Care Managed Medicaid	$18,249.44
Rate for Payer: Molina Healthcare Managed Medicaid	$18,517.82

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$31,999.14

Service Code	MSDRG 625
Min. Negotiated Rate	$31,535.37
Max. Negotiated Rate	$31,999.14
Rate for Payer: Amerigroup Medicaid	$31,844.54
Rate for Payer: Iowa Total Care Managed Medicaid	$31,535.37
Rate for Payer: Molina Healthcare Managed Medicaid	$31,999.14

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$9,242.02

Service Code	MSDRG 627
Min. Negotiated Rate	$9,108.07
Max. Negotiated Rate	$9,242.02
Rate for Payer: Amerigroup Medicaid	$9,197.37
Rate for Payer: Iowa Total Care Managed Medicaid	$9,108.07
Rate for Payer: Molina Healthcare Managed Medicaid	$9,242.02

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$41.83
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$80.18
Rate for Payer: Amerigroup Medicare	$63.18
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.55
Rate for Payer: Iowa Total Care Managed Medicaid	$79.40
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$62.55
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$80.56
Rate for Payer: Partners Health Alliance Commercial	$71.93
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: United Healthcare Commercial	$123.30

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Aetna of IA Medicare	$78.09
Rate for Payer: Amerigroup Medicaid	$79.02
Rate for Payer: Amerigroup Medicare	$62.27
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$61.65
Rate for Payer: Iowa Total Care Managed Medicaid	$78.25
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Medical Associates Managed Medicare	$61.65
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: Molina Healthcare Managed Medicaid	$79.41
Rate for Payer: Partners Health Alliance Commercial	$70.90
Rate for Payer: United Healthcare Commercial	$123.30
Rate for Payer: United Healthcare Managed Medicare	$80.83
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Aetna of IA Medicare	$144.21
Rate for Payer: Amerigroup Medicaid	$145.93
Rate for Payer: Amerigroup Medicare	$114.99
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$113.85
Rate for Payer: Iowa Total Care Managed Medicaid	$144.51
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Medical Associates Managed Medicare	$113.85
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: Molina Healthcare Managed Medicaid	$146.64
Rate for Payer: Partners Health Alliance Commercial	$130.93
Rate for Payer: United Healthcare Commercial	$227.70
Rate for Payer: United Healthcare Managed Medicare	$149.27
Rate for Payer: Wellmark IA HMO WHPI	$82.95
Rate for Payer: Wellmark IA PPO	$91.38

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: United Healthcare Commercial	$227.70

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: United Healthcare Commercial	$25.68

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Aetna of IA Medicare	$16.26
Rate for Payer: Amerigroup Medicaid	$16.46
Rate for Payer: Amerigroup Medicare	$12.97
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.84
Rate for Payer: Iowa Total Care Managed Medicaid	$16.30
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Medical Associates Managed Medicare	$12.84
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: Molina Healthcare Managed Medicaid	$16.54
Rate for Payer: Partners Health Alliance Commercial	$14.76
Rate for Payer: United Healthcare Commercial	$25.68
Rate for Payer: United Healthcare Managed Medicare	$16.83

TIGER CANNULATED SCREW 2.0MMX10MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8788807
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

TIGER CANNULATED SCREW 2.0MMX10MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8788807
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

TIGER CANNULATED SCREW 2.0MMX12MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8788809
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

TIGER CANNULATED SCREW 2.0MMX12MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8788809
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

TIGER CANNULATED SCREW 2.0X14MM

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8852329
Hospital Revenue Code	278
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: United Healthcare Commercial	$153.90

TIGER CANNULATED SCREW 2.0X14MM

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8852329
Hospital Revenue Code	278
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Aetna of IA Medicare	$97.47
Rate for Payer: Amerigroup Medicaid	$98.63
Rate for Payer: Amerigroup Medicare	$77.72
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.95
Rate for Payer: Iowa Total Care Managed Medicaid	$97.68
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Medical Associates Managed Medicare	$76.95
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: Molina Healthcare Managed Medicaid	$99.11
Rate for Payer: Partners Health Alliance Commercial	$88.49
Rate for Payer: United Healthcare Commercial	$153.90
Rate for Payer: United Healthcare Managed Medicare	$100.89

TIGER CANNULATED SCREW 2.4MM X 18MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8783198
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

TIGER CANNULATED SCREW 2.4MM X 18MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8783198
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

TIGER CANNULATED SCREW 2.4MMX20MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	8789962
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

Know your out-of-pocket cost for care.

All Charges