Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

venlafaxine 37.5 mg ER Cap [VDMC]

Facility

$1.20

Service Code	HCPCS A9270
Hospital Charge Code	10427797
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of IA Commercial	$1.08
Rate for Payer: Aetna of IA Medical Rental Products	$1.08
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.90
Rate for Payer: Medical Associates Commercial	$0.90
Rate for Payer: Midlands Choice Commercial	$0.84
Rate for Payer: United Healthcare Commercial	$1.08

venlafaxine 75 mg ER Cap [VDMC]

Facility

$1.22

Service Code	HCPCS A9270
Hospital Charge Code	10427868
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna of IA Commercial	$1.10
Rate for Payer: Aetna of IA Medical Rental Products	$1.10
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.92
Rate for Payer: Medical Associates Commercial	$0.92
Rate for Payer: Midlands Choice Commercial	$0.86
Rate for Payer: United Healthcare Commercial	$1.10

venlafaxine 75 mg ER Cap [VDMC]

Facility

$1.22

Service Code	HCPCS A9270
Hospital Charge Code	10427868
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna of IA Commercial	$1.10
Rate for Payer: Aetna of IA Medical Rental Products	$1.10
Rate for Payer: Aetna of IA Medicare	$0.70
Rate for Payer: Amerigroup Medicaid	$0.71
Rate for Payer: Amerigroup Medicare	$0.56
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.92
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.55
Rate for Payer: Iowa Total Care Managed Medicaid	$0.70
Rate for Payer: Medical Associates Commercial	$0.92
Rate for Payer: Medical Associates Managed Medicare	$0.55
Rate for Payer: Midlands Choice Commercial	$0.86
Rate for Payer: Molina Healthcare Managed Medicaid	$0.71
Rate for Payer: Partners Health Alliance Commercial	$0.63
Rate for Payer: United Healthcare Commercial	$1.10
Rate for Payer: United Healthcare Managed Medicare	$0.72

VENT ASSIST MGMT,INITIAL

Facility

$1,078.00

Service Code	CPT 94002
Hospital Charge Code	4770840
Hospital Revenue Code	410
Min. Negotiated Rate	$754.60
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: United Healthcare Commercial	$970.20

VENT ASSIST MGMT,INITIAL

Facility

$1,078.00

Service Code	CPT 94002
Hospital Charge Code	4770840
Hospital Revenue Code	410
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$2,692.89
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Aetna of IA Medicare	$614.46
Rate for Payer: Amerigroup Medicaid	$621.79
Rate for Payer: Amerigroup Medicare	$489.95
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$485.10
Rate for Payer: Iowa Total Care Managed Medicaid	$615.75
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Medical Associates Managed Medicare	$485.10
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: Molina Healthcare Managed Medicaid	$624.81
Rate for Payer: Partners Health Alliance Commercial	$557.86
Rate for Payer: United Healthcare Commercial	$970.20
Rate for Payer: United Healthcare Managed Medicare	$636.02
Rate for Payer: Wellmark IA HMO WHPI	$2,444.63
Rate for Payer: Wellmark IA PPO	$2,692.89

VENT ASSIST MGNT SUBSQ DAY

Facility

$1,078.00

Service Code	CPT 94003
Hospital Charge Code	4770839
Hospital Revenue Code	410
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$2,692.89
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Aetna of IA Medicare	$614.46
Rate for Payer: Amerigroup Medicaid	$621.79
Rate for Payer: Amerigroup Medicare	$489.95
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$485.10
Rate for Payer: Iowa Total Care Managed Medicaid	$615.75
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Medical Associates Managed Medicare	$485.10
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: Molina Healthcare Managed Medicaid	$624.81
Rate for Payer: Partners Health Alliance Commercial	$557.86
Rate for Payer: United Healthcare Commercial	$970.20
Rate for Payer: United Healthcare Managed Medicare	$636.02
Rate for Payer: Wellmark IA HMO WHPI	$2,444.63
Rate for Payer: Wellmark IA PPO	$2,692.89

VENT ASSIST MGNT SUBSQ DAY

Facility

$1,078.00

Service Code	CPT 94003
Hospital Charge Code	4770839
Hospital Revenue Code	410
Min. Negotiated Rate	$754.60
Max. Negotiated Rate	$970.20
Rate for Payer: Aetna of IA Commercial	$970.20
Rate for Payer: Aetna of IA Medical Rental Products	$970.20
Rate for Payer: Cash Price	$862.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$808.50
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: United Healthcare Commercial	$970.20

VENTRAL EX LARGE MESH

Facility

$1,053.00

Service Code	HCPCS C1781
Hospital Charge Code	8449030
Hospital Revenue Code	278
Min. Negotiated Rate	$737.10
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of IA Commercial	$947.70
Rate for Payer: Aetna of IA Medical Rental Products	$947.70
Rate for Payer: Cash Price	$842.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$789.75
Rate for Payer: Medical Associates Commercial	$789.75
Rate for Payer: Midlands Choice Commercial	$737.10
Rate for Payer: United Healthcare Commercial	$947.70

VENTRAL EX LARGE MESH

Facility

$1,053.00

Service Code	HCPCS C1781
Hospital Charge Code	8449030
Hospital Revenue Code	278
Min. Negotiated Rate	$473.85
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of IA Commercial	$947.70
Rate for Payer: Aetna of IA Medical Rental Products	$947.70
Rate for Payer: Aetna of IA Medicare	$600.21
Rate for Payer: Amerigroup Medicaid	$607.37
Rate for Payer: Amerigroup Medicare	$478.59
Rate for Payer: Cash Price	$842.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$789.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$473.85
Rate for Payer: Iowa Total Care Managed Medicaid	$601.47
Rate for Payer: Medical Associates Commercial	$789.75
Rate for Payer: Medical Associates Managed Medicare	$473.85
Rate for Payer: Midlands Choice Commercial	$737.10
Rate for Payer: Molina Healthcare Managed Medicaid	$610.32
Rate for Payer: Partners Health Alliance Commercial	$544.93
Rate for Payer: United Healthcare Commercial	$947.70
Rate for Payer: United Healthcare Managed Medicare	$621.27

VENTRAL EX MEDIUM MESH

Facility

$828.00

Service Code	HCPCS C1781
Hospital Charge Code	8449028
Hospital Revenue Code	278
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of IA Commercial	$745.20
Rate for Payer: Aetna of IA Medical Rental Products	$745.20
Rate for Payer: Aetna of IA Medicare	$471.96
Rate for Payer: Amerigroup Medicaid	$477.59
Rate for Payer: Amerigroup Medicare	$376.33
Rate for Payer: Cash Price	$662.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$621.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$372.60
Rate for Payer: Iowa Total Care Managed Medicaid	$472.95
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Medical Associates Managed Medicare	$372.60
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: Molina Healthcare Managed Medicaid	$479.91
Rate for Payer: Partners Health Alliance Commercial	$428.49
Rate for Payer: United Healthcare Commercial	$745.20
Rate for Payer: United Healthcare Managed Medicare	$488.52

VENTRAL EX MEDIUM MESH

Facility

$828.00

Service Code	HCPCS C1781
Hospital Charge Code	8449028
Hospital Revenue Code	278
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of IA Commercial	$745.20
Rate for Payer: Aetna of IA Medical Rental Products	$745.20
Rate for Payer: Cash Price	$662.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$621.00
Rate for Payer: Medical Associates Commercial	$621.00
Rate for Payer: Midlands Choice Commercial	$579.60
Rate for Payer: United Healthcare Commercial	$745.20

VENTRAL EX SMALL MESH

Facility

$693.00

Service Code	HCPCS C1781
Hospital Charge Code	8463903
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: United Healthcare Commercial	$623.70

VENTRAL EX SMALL MESH

Facility

$693.00

Service Code	HCPCS C1781
Hospital Charge Code	8463903
Hospital Revenue Code	278
Min. Negotiated Rate	$311.85
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of IA Commercial	$623.70
Rate for Payer: Aetna of IA Medical Rental Products	$623.70
Rate for Payer: Aetna of IA Medicare	$395.01
Rate for Payer: Amerigroup Medicaid	$399.72
Rate for Payer: Amerigroup Medicare	$314.97
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$519.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$311.85
Rate for Payer: Iowa Total Care Managed Medicaid	$395.84
Rate for Payer: Medical Associates Commercial	$519.75
Rate for Payer: Medical Associates Managed Medicare	$311.85
Rate for Payer: Midlands Choice Commercial	$485.10
Rate for Payer: Molina Healthcare Managed Medicaid	$401.66
Rate for Payer: Partners Health Alliance Commercial	$358.63
Rate for Payer: United Healthcare Commercial	$623.70
Rate for Payer: United Healthcare Managed Medicare	$408.87

VENTRALIGHT MESH 15X20CM

Facility

$1,804.00

Service Code	HCPCS C1781
Hospital Charge Code	8481703
Hospital Revenue Code	278
Min. Negotiated Rate	$811.80
Max. Negotiated Rate	$1,623.60
Rate for Payer: Aetna of IA Commercial	$1,623.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,623.60
Rate for Payer: Aetna of IA Medicare	$1,028.28
Rate for Payer: Amerigroup Medicaid	$1,040.55
Rate for Payer: Amerigroup Medicare	$819.92
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,353.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$811.80
Rate for Payer: Iowa Total Care Managed Medicaid	$1,030.44
Rate for Payer: Medical Associates Commercial	$1,353.00
Rate for Payer: Medical Associates Managed Medicare	$811.80
Rate for Payer: Midlands Choice Commercial	$1,262.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,045.60
Rate for Payer: Partners Health Alliance Commercial	$933.57
Rate for Payer: United Healthcare Commercial	$1,623.60
Rate for Payer: United Healthcare Managed Medicare	$1,064.36

VENTRALIGHT MESH 15X20CM

Facility

$1,804.00

Service Code	HCPCS C1781
Hospital Charge Code	8481703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.80
Max. Negotiated Rate	$1,623.60
Rate for Payer: Aetna of IA Commercial	$1,623.60
Rate for Payer: Aetna of IA Medical Rental Products	$1,623.60
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,353.00
Rate for Payer: Medical Associates Commercial	$1,353.00
Rate for Payer: Midlands Choice Commercial	$1,262.80
Rate for Payer: United Healthcare Commercial	$1,623.60

VENTRALIGHT ST MESH CIRCLE 4.5

Facility

$1,272.51

Service Code	HCPCS C1713
Hospital Charge Code	8992493
Hospital Revenue Code	278
Min. Negotiated Rate	$572.63
Max. Negotiated Rate	$1,145.26
Rate for Payer: Aetna of IA Commercial	$1,145.26
Rate for Payer: Aetna of IA Medical Rental Products	$1,145.26
Rate for Payer: Aetna of IA Medicare	$725.33
Rate for Payer: Amerigroup Medicaid	$733.98
Rate for Payer: Amerigroup Medicare	$578.36
Rate for Payer: Cash Price	$1,018.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$954.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$572.63
Rate for Payer: Iowa Total Care Managed Medicaid	$726.86
Rate for Payer: Medical Associates Commercial	$954.38
Rate for Payer: Medical Associates Managed Medicare	$572.63
Rate for Payer: Midlands Choice Commercial	$890.76
Rate for Payer: Molina Healthcare Managed Medicaid	$737.55
Rate for Payer: Partners Health Alliance Commercial	$658.52
Rate for Payer: United Healthcare Commercial	$1,145.26
Rate for Payer: United Healthcare Managed Medicare	$750.78

VENTRALIGHT ST MESH CIRCLE 4.5

Facility

$1,272.51

Service Code	HCPCS C1713
Hospital Charge Code	8992493
Hospital Revenue Code	278
Min. Negotiated Rate	$890.76
Max. Negotiated Rate	$1,145.26
Rate for Payer: Aetna of IA Commercial	$1,145.26
Rate for Payer: Aetna of IA Medical Rental Products	$1,145.26
Rate for Payer: Cash Price	$1,018.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$954.38
Rate for Payer: Medical Associates Commercial	$954.38
Rate for Payer: Midlands Choice Commercial	$890.76
Rate for Payer: United Healthcare Commercial	$1,145.26

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$15,383.10

Service Code	MSDRG 032
Min. Negotiated Rate	$15,160.15
Max. Negotiated Rate	$15,383.10
Rate for Payer: Amerigroup Medicaid	$15,308.78
Rate for Payer: Iowa Total Care Managed Medicaid	$15,160.15
Rate for Payer: Molina Healthcare Managed Medicaid	$15,383.10

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$26,645.12

Service Code	MSDRG 031
Min. Negotiated Rate	$26,258.95
Max. Negotiated Rate	$26,645.12
Rate for Payer: Amerigroup Medicaid	$26,516.39
Rate for Payer: Iowa Total Care Managed Medicaid	$26,258.95
Rate for Payer: Molina Healthcare Managed Medicaid	$26,645.12

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$13,224.60

Service Code	MSDRG 033
Min. Negotiated Rate	$13,032.93
Max. Negotiated Rate	$13,224.60
Rate for Payer: Amerigroup Medicaid	$13,160.71
Rate for Payer: Iowa Total Care Managed Medicaid	$13,032.93
Rate for Payer: Molina Healthcare Managed Medicaid	$13,224.60

VENTRIO LG CIRCLE HERNIA PATCH

Facility

$1,305.00

Service Code	HCPCS C1781
Hospital Charge Code	8026204
Hospital Revenue Code	278
Min. Negotiated Rate	$587.25
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of IA Commercial	$1,174.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,174.50
Rate for Payer: Aetna of IA Medicare	$743.85
Rate for Payer: Amerigroup Medicaid	$752.72
Rate for Payer: Amerigroup Medicare	$593.12
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$978.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$587.25
Rate for Payer: Iowa Total Care Managed Medicaid	$745.42
Rate for Payer: Medical Associates Commercial	$978.75
Rate for Payer: Medical Associates Managed Medicare	$587.25
Rate for Payer: Midlands Choice Commercial	$913.50
Rate for Payer: Molina Healthcare Managed Medicaid	$756.38
Rate for Payer: Partners Health Alliance Commercial	$675.34
Rate for Payer: United Healthcare Commercial	$1,174.50
Rate for Payer: United Healthcare Managed Medicare	$769.95

VENTRIO LG CIRCLE HERNIA PATCH

Facility

$1,305.00

Service Code	HCPCS C1781
Hospital Charge Code	8026204
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of IA Commercial	$1,174.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,174.50
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$978.75
Rate for Payer: Medical Associates Commercial	$978.75
Rate for Payer: Midlands Choice Commercial	$913.50
Rate for Payer: United Healthcare Commercial	$1,174.50

VENTRIO LG OVAL HERNIA PATCH

Facility

$1,547.00

Service Code	HCPCS C1781
Hospital Charge Code	8026046
Hospital Revenue Code	278
Min. Negotiated Rate	$1,082.90
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna of IA Commercial	$1,392.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,392.30
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,160.25
Rate for Payer: Medical Associates Commercial	$1,160.25
Rate for Payer: Midlands Choice Commercial	$1,082.90
Rate for Payer: United Healthcare Commercial	$1,392.30

VENTRIO LG OVAL HERNIA PATCH

Facility

$1,547.00

Service Code	HCPCS C1781
Hospital Charge Code	8026046
Hospital Revenue Code	278
Min. Negotiated Rate	$696.15
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna of IA Commercial	$1,392.30
Rate for Payer: Aetna of IA Medical Rental Products	$1,392.30
Rate for Payer: Aetna of IA Medicare	$881.79
Rate for Payer: Amerigroup Medicaid	$892.31
Rate for Payer: Amerigroup Medicare	$703.11
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,160.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$696.15
Rate for Payer: Iowa Total Care Managed Medicaid	$883.65
Rate for Payer: Medical Associates Commercial	$1,160.25
Rate for Payer: Medical Associates Managed Medicare	$696.15
Rate for Payer: Midlands Choice Commercial	$1,082.90
Rate for Payer: Molina Healthcare Managed Medicaid	$896.64
Rate for Payer: Partners Health Alliance Commercial	$800.57
Rate for Payer: United Healthcare Commercial	$1,392.30
Rate for Payer: United Healthcare Managed Medicare	$912.73

VENTRIO MED OVAL HERNIA PATCH

Facility

$1,305.00

Service Code	HCPCS C1781
Hospital Charge Code	8026376
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of IA Commercial	$1,174.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,174.50
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$978.75
Rate for Payer: Medical Associates Commercial	$978.75
Rate for Payer: Midlands Choice Commercial	$913.50
Rate for Payer: United Healthcare Commercial	$1,174.50

Know your out-of-pocket cost for care.

All Charges