Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

WIRES KIRSCHNER 1.0MM X 150MM

Facility

$191.00

Hospital Charge Code	8047027
Hospital Revenue Code	278
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of IA Commercial	$171.90
Rate for Payer: Aetna of IA Medical Rental Products	$171.90
Rate for Payer: Cash Price	$152.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$143.25
Rate for Payer: Medical Associates Commercial	$143.25
Rate for Payer: Midlands Choice Commercial	$133.70
Rate for Payer: United Healthcare Commercial	$171.90

WIRES KIRSCHNER 1.25MM

Facility

$191.00

Hospital Charge Code	8046403
Hospital Revenue Code	278
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of IA Commercial	$171.90
Rate for Payer: Aetna of IA Medical Rental Products	$171.90
Rate for Payer: Aetna of IA Medicare	$108.87
Rate for Payer: Amerigroup Medicaid	$110.17
Rate for Payer: Amerigroup Medicare	$86.81
Rate for Payer: Cash Price	$152.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$143.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$85.95
Rate for Payer: Iowa Total Care Managed Medicaid	$109.10
Rate for Payer: Medical Associates Commercial	$143.25
Rate for Payer: Medical Associates Managed Medicare	$85.95
Rate for Payer: Midlands Choice Commercial	$133.70
Rate for Payer: Molina Healthcare Managed Medicaid	$110.70
Rate for Payer: Partners Health Alliance Commercial	$98.84
Rate for Payer: United Healthcare Commercial	$171.90
Rate for Payer: United Healthcare Managed Medicare	$112.69

WIRES KIRSCHNER 1.25MM

Facility

$191.00

Hospital Charge Code	8046403
Hospital Revenue Code	278
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of IA Commercial	$171.90
Rate for Payer: Aetna of IA Medical Rental Products	$171.90
Rate for Payer: Cash Price	$152.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$143.25
Rate for Payer: Medical Associates Commercial	$143.25
Rate for Payer: Midlands Choice Commercial	$133.70
Rate for Payer: United Healthcare Commercial	$171.90

WIRES KIRSCHNER 1.25MM-1

Facility

$161.00

Hospital Charge Code	8046902
Hospital Revenue Code	278
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: United Healthcare Commercial	$144.90

WIRES KIRSCHNER 1.25MM-1

Facility

$161.00

Hospital Charge Code	8046902
Hospital Revenue Code	278
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Aetna of IA Medicare	$91.77
Rate for Payer: Amerigroup Medicaid	$92.86
Rate for Payer: Amerigroup Medicare	$73.17
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.45
Rate for Payer: Iowa Total Care Managed Medicaid	$91.96
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Medical Associates Managed Medicare	$72.45
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Molina Healthcare Managed Medicaid	$93.32
Rate for Payer: Partners Health Alliance Commercial	$83.32
Rate for Payer: United Healthcare Commercial	$144.90
Rate for Payer: United Healthcare Managed Medicare	$94.99

WIRES KIRSCHNER 1.60MM X 150MM

Facility

$19.00

Hospital Charge Code	8046972
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of IA Commercial	$17.10
Rate for Payer: Aetna of IA Medical Rental Products	$17.10
Rate for Payer: Aetna of IA Medicare	$10.83
Rate for Payer: Amerigroup Medicaid	$10.96
Rate for Payer: Amerigroup Medicare	$8.64
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.55
Rate for Payer: Iowa Total Care Managed Medicaid	$10.85
Rate for Payer: Medical Associates Commercial	$14.25
Rate for Payer: Medical Associates Managed Medicare	$8.55
Rate for Payer: Midlands Choice Commercial	$13.30
Rate for Payer: Molina Healthcare Managed Medicaid	$11.01
Rate for Payer: Partners Health Alliance Commercial	$9.83
Rate for Payer: United Healthcare Commercial	$17.10
Rate for Payer: United Healthcare Managed Medicare	$11.21

WIRES KIRSCHNER 1.60MM X 150MM

Facility

$19.00

Hospital Charge Code	8046972
Hospital Revenue Code	278
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of IA Commercial	$17.10
Rate for Payer: Aetna of IA Medical Rental Products	$17.10
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.25
Rate for Payer: Medical Associates Commercial	$14.25
Rate for Payer: Midlands Choice Commercial	$13.30
Rate for Payer: United Healthcare Commercial	$17.10

WIRES KIRSCHNER 1.6MM

Facility

$161.00

Hospital Charge Code	8046901
Hospital Revenue Code	278
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: United Healthcare Commercial	$144.90

WIRES KIRSCHNER 1.6MM

Facility

$161.00

Hospital Charge Code	8046901
Hospital Revenue Code	278
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of IA Commercial	$144.90
Rate for Payer: Aetna of IA Medical Rental Products	$144.90
Rate for Payer: Aetna of IA Medicare	$91.77
Rate for Payer: Amerigroup Medicaid	$92.86
Rate for Payer: Amerigroup Medicare	$73.17
Rate for Payer: Cash Price	$128.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.45
Rate for Payer: Iowa Total Care Managed Medicaid	$91.96
Rate for Payer: Medical Associates Commercial	$120.75
Rate for Payer: Medical Associates Managed Medicare	$72.45
Rate for Payer: Midlands Choice Commercial	$112.70
Rate for Payer: Molina Healthcare Managed Medicaid	$93.32
Rate for Payer: Partners Health Alliance Commercial	$83.32
Rate for Payer: United Healthcare Commercial	$144.90
Rate for Payer: United Healthcare Managed Medicare	$94.99

WIRES KIRSCHNER 20MM 150L

Facility

$191.00

Hospital Charge Code	8046404
Hospital Revenue Code	278
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of IA Commercial	$171.90
Rate for Payer: Aetna of IA Medical Rental Products	$171.90
Rate for Payer: Aetna of IA Medicare	$108.87
Rate for Payer: Amerigroup Medicaid	$110.17
Rate for Payer: Amerigroup Medicare	$86.81
Rate for Payer: Cash Price	$152.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$143.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$85.95
Rate for Payer: Iowa Total Care Managed Medicaid	$109.10
Rate for Payer: Medical Associates Commercial	$143.25
Rate for Payer: Medical Associates Managed Medicare	$85.95
Rate for Payer: Midlands Choice Commercial	$133.70
Rate for Payer: Molina Healthcare Managed Medicaid	$110.70
Rate for Payer: Partners Health Alliance Commercial	$98.84
Rate for Payer: United Healthcare Commercial	$171.90
Rate for Payer: United Healthcare Managed Medicare	$112.69

WIRES KIRSCHNER 20MM 150L

Facility

$191.00

Hospital Charge Code	8046404
Hospital Revenue Code	278
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of IA Commercial	$171.90
Rate for Payer: Aetna of IA Medical Rental Products	$171.90
Rate for Payer: Cash Price	$152.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$143.25
Rate for Payer: Medical Associates Commercial	$143.25
Rate for Payer: Midlands Choice Commercial	$133.70
Rate for Payer: United Healthcare Commercial	$171.90

WOUND CARE NON-SELECTIVE

Facility

$206.00

Service Code	CPT 97602
Hospital Charge Code	7438786
Hospital Revenue Code	510
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$1,127.76
Rate for Payer: Aetna of IA Commercial	$185.40
Rate for Payer: Aetna of IA Medical Rental Products	$185.40
Rate for Payer: Aetna of IA Medicare	$117.42
Rate for Payer: Amerigroup Medicaid	$118.82
Rate for Payer: Amerigroup Medicare	$93.63
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$154.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$92.70
Rate for Payer: Iowa Total Care Managed Medicaid	$117.67
Rate for Payer: Medical Associates Commercial	$154.50
Rate for Payer: Medical Associates Managed Medicare	$92.70
Rate for Payer: Midlands Choice Commercial	$144.20
Rate for Payer: Molina Healthcare Managed Medicaid	$119.40
Rate for Payer: Partners Health Alliance Commercial	$106.60
Rate for Payer: United Healthcare Commercial	$185.40
Rate for Payer: United Healthcare Managed Medicare	$121.54
Rate for Payer: Wellmark IA HMO WHPI	$1,023.80
Rate for Payer: Wellmark IA PPO	$1,127.76

WOUND CARE NON-SELECTIVE

Facility

$263.00

Service Code	CPT 97602 GP
Hospital Charge Code	5520785
Hospital Revenue Code	430
Min. Negotiated Rate	$184.10
Max. Negotiated Rate	$236.70
Rate for Payer: Aetna of IA Commercial	$236.70
Rate for Payer: Aetna of IA Medical Rental Products	$236.70
Rate for Payer: Cash Price	$210.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$197.25
Rate for Payer: Medical Associates Commercial	$197.25
Rate for Payer: Midlands Choice Commercial	$184.10
Rate for Payer: United Healthcare Commercial	$236.70

WOUND CARE NON-SELECTIVE

Professional

Both

$206.00

Service Code	CPT 97602
Hospital Charge Code	7438786
Hospital Revenue Code	983
Min. Negotiated Rate	$77.91
Max. Negotiated Rate	$154.50
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Medical Associates Commercial	$154.50
Rate for Payer: Midlands Choice Commercial	$144.20
Rate for Payer: Partners Health Alliance Commercial	$154.50
Rate for Payer: United Healthcare Commercial	$77.91
Rate for Payer: Wellmark IA HMO WHPI	$79.00
Rate for Payer: Wellmark IA PPO	$79.00

WOUND CARE NON-SELECTIVE

Facility

$263.00

Service Code	CPT 97602 GP
Hospital Charge Code	5520785
Hospital Revenue Code	430
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$1,127.76
Rate for Payer: Aetna of IA Commercial	$236.70
Rate for Payer: Aetna of IA Medical Rental Products	$236.70
Rate for Payer: Aetna of IA Medicare	$149.91
Rate for Payer: Amerigroup Medicaid	$151.70
Rate for Payer: Amerigroup Medicare	$119.53
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$197.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$118.35
Rate for Payer: Iowa Total Care Managed Medicaid	$150.23
Rate for Payer: Medical Associates Commercial	$197.25
Rate for Payer: Medical Associates Managed Medicare	$118.35
Rate for Payer: Midlands Choice Commercial	$184.10
Rate for Payer: Molina Healthcare Managed Medicaid	$152.43
Rate for Payer: Partners Health Alliance Commercial	$136.10
Rate for Payer: United Healthcare Commercial	$236.70
Rate for Payer: United Healthcare Managed Medicare	$155.17
Rate for Payer: Wellmark IA HMO WHPI	$1,023.80
Rate for Payer: Wellmark IA PPO	$1,127.76

WOUND CARE NON-SELECTIVE

Facility

$206.00

Service Code	CPT 97602
Hospital Charge Code	7438786
Hospital Revenue Code	510
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of IA Commercial	$185.40
Rate for Payer: Aetna of IA Medical Rental Products	$185.40
Rate for Payer: Cash Price	$164.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$154.50
Rate for Payer: Medical Associates Commercial	$154.50
Rate for Payer: Midlands Choice Commercial	$144.20
Rate for Payer: United Healthcare Commercial	$185.40

Wound Care Non-Selective Debride Charge

Facility

$85.00

Service Code	CPT 97602
Hospital Charge Code	752341
Hospital Revenue Code	430
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$1,127.76
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Aetna of IA Medicare	$48.45
Rate for Payer: Amerigroup Medicaid	$49.03
Rate for Payer: Amerigroup Medicare	$38.63
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.25
Rate for Payer: Iowa Total Care Managed Medicaid	$48.55
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Medical Associates Managed Medicare	$38.25
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: Molina Healthcare Managed Medicaid	$49.27
Rate for Payer: Partners Health Alliance Commercial	$43.99
Rate for Payer: United Healthcare Commercial	$76.50
Rate for Payer: United Healthcare Managed Medicare	$50.15
Rate for Payer: Wellmark IA HMO WHPI	$1,023.80
Rate for Payer: Wellmark IA PPO	$1,127.76

Wound Care Non-Selective Debride Charge

Facility

$85.00

Service Code	CPT 97602
Hospital Charge Code	752341
Hospital Revenue Code	430
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of IA Commercial	$76.50
Rate for Payer: Aetna of IA Medical Rental Products	$76.50
Rate for Payer: Cash Price	$68.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.75
Rate for Payer: Medical Associates Commercial	$63.75
Rate for Payer: Midlands Choice Commercial	$59.50
Rate for Payer: United Healthcare Commercial	$76.50

WOUND CARE SELECTIVE <20 SQ CM

Facility

$39.00

Service Code	CPT 97597 GP
Hospital Charge Code	6542806
Hospital Revenue Code	420
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of IA Commercial	$35.10
Rate for Payer: Aetna of IA Medical Rental Products	$35.10
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.25
Rate for Payer: Medical Associates Commercial	$29.25
Rate for Payer: Midlands Choice Commercial	$27.30
Rate for Payer: United Healthcare Commercial	$35.10

WOUND CARE SELECTIVE <20 SQ CM

Facility

$39.00

Service Code	CPT 97597 GP
Hospital Charge Code	6542806
Hospital Revenue Code	420
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$657.60
Rate for Payer: Aetna of IA Commercial	$35.10
Rate for Payer: Aetna of IA Medical Rental Products	$35.10
Rate for Payer: Aetna of IA Medicare	$22.23
Rate for Payer: Amerigroup Medicaid	$22.50
Rate for Payer: Amerigroup Medicare	$17.73
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$29.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$17.55
Rate for Payer: Iowa Total Care Managed Medicaid	$22.28
Rate for Payer: Medical Associates Commercial	$29.25
Rate for Payer: Medical Associates Managed Medicare	$17.55
Rate for Payer: Midlands Choice Commercial	$27.30
Rate for Payer: Molina Healthcare Managed Medicaid	$22.60
Rate for Payer: Partners Health Alliance Commercial	$20.18
Rate for Payer: United Healthcare Commercial	$35.10
Rate for Payer: United Healthcare Managed Medicare	$23.01
Rate for Payer: Wellmark IA HMO WHPI	$596.98
Rate for Payer: Wellmark IA PPO	$657.60

WOUND CARE SELECTIVE EA ADDTL 20 SQ CM

Facility

$49.00

Service Code	CPT 97598 GP
Hospital Charge Code	5907163
Hospital Revenue Code	420
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of IA Commercial	$44.10
Rate for Payer: Aetna of IA Medical Rental Products	$44.10
Rate for Payer: Cash Price	$39.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.75
Rate for Payer: Medical Associates Commercial	$36.75
Rate for Payer: Midlands Choice Commercial	$34.30
Rate for Payer: United Healthcare Commercial	$44.10

WOUND CARE SELECTIVE EA ADDTL 20 SQ CM

Facility

$49.00

Service Code	CPT 97598 GP
Hospital Charge Code	5907163
Hospital Revenue Code	420
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$4,090.88
Rate for Payer: Aetna of IA Commercial	$44.10
Rate for Payer: Aetna of IA Medical Rental Products	$44.10
Rate for Payer: Aetna of IA Medicare	$27.93
Rate for Payer: Amerigroup Medicaid	$28.26
Rate for Payer: Amerigroup Medicare	$22.27
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$36.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$22.05
Rate for Payer: Iowa Total Care Managed Medicaid	$27.99
Rate for Payer: Medical Associates Commercial	$36.75
Rate for Payer: Medical Associates Managed Medicare	$22.05
Rate for Payer: Midlands Choice Commercial	$34.30
Rate for Payer: Molina Healthcare Managed Medicaid	$28.40
Rate for Payer: Partners Health Alliance Commercial	$25.36
Rate for Payer: United Healthcare Commercial	$44.10
Rate for Payer: United Healthcare Managed Medicare	$28.91
Rate for Payer: Wellmark IA HMO WHPI	$3,713.74
Rate for Payer: Wellmark IA PPO	$4,090.88

WOUND CLOSURE BY ADHESIVE

Professional

Both

$137.00

Service Code	HCPCS G0168
Hospital Charge Code	7982743
Hospital Revenue Code	981
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$205.00
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: Partners Health Alliance Commercial	$102.75
Rate for Payer: United Healthcare Commercial	$158.69
Rate for Payer: Wellmark IA HMO WHPI	$174.20
Rate for Payer: Wellmark IA PPO	$205.00

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$27,950.13

Service Code	MSDRG 464
Min. Negotiated Rate	$27,545.04
Max. Negotiated Rate	$27,950.13
Rate for Payer: Amerigroup Medicaid	$27,815.09
Rate for Payer: Iowa Total Care Managed Medicaid	$27,545.04
Rate for Payer: Molina Healthcare Managed Medicaid	$27,950.13

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$37,726.99

Service Code	MSDRG 463
Min. Negotiated Rate	$37,180.20
Max. Negotiated Rate	$37,726.99
Rate for Payer: Amerigroup Medicaid	$37,544.71
Rate for Payer: Iowa Total Care Managed Medicaid	$37,180.20
Rate for Payer: Molina Healthcare Managed Medicaid	$37,726.99

Know your out-of-pocket cost for care.

All Charges