Van Diest Medical Center

All Charges

Charge

Type

Price

Cardiac Defibrillator Implant With Cardiac Catheterization Without AMI, Hf or Shock Without MCC

Facility IP

$49,661.88

Service Code	MS-DRG 225
Hospital Charge Code	90
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$49,661.88
Rate for Payer: Amerigroup Medicaid	$49,421.96
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$48,942.14
Rate for Payer: Molina Healthcare Managed Medicaid	$49,661.88

Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC

Facility IP

$58,838.94

Service Code	MS-DRG 226
Hospital Charge Code	91
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$58,838.94
Rate for Payer: Amerigroup Medicaid	$58,554.70
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57,986.20
Rate for Payer: Molina Healthcare Managed Medicaid	$58,838.94

Cardiac Defibrillator Implant Without Cardiac Catheterization Without MCC

Facility IP

$40,675.75

Service Code	MS-DRG 227
Hospital Charge Code	92
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$40,675.75
Rate for Payer: Amerigroup Medicaid	$40,479.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$40,086.24
Rate for Payer: Molina Healthcare Managed Medicaid	$40,675.75

Cardiac Pacemaker Device Replacement With MCC

Facility IP

$31,516.40

Service Code	MS-DRG 258
Hospital Charge Code	120
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$31,516.40
Rate for Payer: Amerigroup Medicaid	$31,364.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$31,059.64
Rate for Payer: Molina Healthcare Managed Medicaid	$31,516.40

Cardiac Pacemaker Device Replacement Without MCC

Facility IP

$17,796.07

Service Code	MS-DRG 259
Hospital Charge Code	121
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$17,796.07
Rate for Payer: Amerigroup Medicaid	$17,710.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$17,538.16
Rate for Payer: Molina Healthcare Managed Medicaid	$17,796.07

Cardiac Pacemaker Revision Except Device Replacement With CC

Facility IP

$16,907.30

Service Code	MS-DRG 261
Hospital Charge Code	123
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$16,907.30
Rate for Payer: Amerigroup Medicaid	$16,825.63
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$16,662.27
Rate for Payer: Molina Healthcare Managed Medicaid	$16,907.30

Cardiac Pacemaker Revision Except Device Replacement With MCC

Facility IP

$27,465.26

Service Code	MS-DRG 260
Hospital Charge Code	122
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$27,465.26
Rate for Payer: Amerigroup Medicaid	$27,332.57
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$27,067.21
Rate for Payer: Molina Healthcare Managed Medicaid	$27,465.26

Cardiac Pacemaker Revision Except Device Replacement Without CC/MCC

Facility IP

$13,942.76

Service Code	MS-DRG 262
Hospital Charge Code	124
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$13,942.76
Rate for Payer: Amerigroup Medicaid	$13,875.41
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$13,740.70
Rate for Payer: Molina Healthcare Managed Medicaid	$13,942.76

CARDIAC REHAB PHASE III

Facility OP

$5.00

Hospital Charge Code	5684784
Hospital Revenue Code	943
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of IA Commercial	$4.50
Rate for Payer: Aetna of IA Medical Rental Products	$4.50
Rate for Payer: Aetna of IA Medicare	$2.85
Rate for Payer: Amerigroup Medicaid	$2.52
Rate for Payer: Amerigroup Medicare	$2.52
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2.50
Rate for Payer: Iowa Total Care Managed Medicaid	$2.50
Rate for Payer: Medical Associates Commercial	$3.75
Rate for Payer: Medical Associates Managed Medicare	$2.50
Rate for Payer: Midlands Choice Commercial	$3.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2.54
Rate for Payer: Partners Health Alliance Commercial	$3.75
Rate for Payer: United Healthcare Commercial	$4.50
Rate for Payer: United Healthcare Managed Medicare	$2.95

CARDIAC REHAB PHASE III

Facility IP

$5.00

Hospital Charge Code	5684784
Hospital Revenue Code	943
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of IA Commercial	$4.50
Rate for Payer: Aetna of IA Medical Rental Products	$4.50
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3.75
Rate for Payer: Medical Associates Commercial	$3.75
Rate for Payer: Midlands Choice Commercial	$3.50
Rate for Payer: United Healthcare Commercial	$4.50

Cardiac Valve and Other Major Cardiothoracic Procedures With Cardiac Catheterization With CC

Facility IP

$56,821.25

Service Code	MS-DRG 217
Hospital Charge Code	82
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$56,821.25
Rate for Payer: Amerigroup Medicaid	$56,546.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$55,997.76
Rate for Payer: Molina Healthcare Managed Medicaid	$56,821.25

Cardiac Valve and Other Major Cardiothoracic Procedures With Cardiac Catheterization With MCC

Facility IP

$109,929.94

Service Code	MS-DRG 216
Hospital Charge Code	81
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$109,929.94
Rate for Payer: Amerigroup Medicaid	$109,398.88
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$108,336.75
Rate for Payer: Molina Healthcare Managed Medicaid	$109,929.94

Cardiac Valve and Other Major Cardiothoracic Procedures With Cardiac Catheterization Without CC/MCC

Facility IP

$51,611.66

Service Code	MS-DRG 218
Hospital Charge Code	83
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$51,611.66
Rate for Payer: Amerigroup Medicaid	$51,362.33
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$50,863.67
Rate for Payer: Molina Healthcare Managed Medicaid	$51,611.66

Cardiac Valve and Other Major Cardiothoracic Procedures Without Cardiac Catheterization With CC

Facility IP

$46,550.69

Service Code	MS-DRG 220
Hospital Charge Code	85
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$46,550.69
Rate for Payer: Amerigroup Medicaid	$46,325.81
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$45,876.04
Rate for Payer: Molina Healthcare Managed Medicaid	$46,550.69

Cardiac Valve and Other Major Cardiothoracic Procedures Without Cardiac Catheterization With MCC

Facility IP

$57,738.56

Service Code	MS-DRG 219
Hospital Charge Code	84
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$57,738.56
Rate for Payer: Amerigroup Medicaid	$57,459.63
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$56,901.77
Rate for Payer: Molina Healthcare Managed Medicaid	$57,738.56

Cardiac Valve and Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without CC/MCC

Facility IP

$39,747.61

Service Code	MS-DRG 221
Hospital Charge Code	86
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$39,747.61
Rate for Payer: Amerigroup Medicaid	$39,555.59
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$39,171.56
Rate for Payer: Molina Healthcare Managed Medicaid	$39,747.61

CARDIOLOGY

Facility IP

$1,338.00

Service Code	CPT 93306
Hospital Charge Code	8300852
Hospital Revenue Code	480
Min. Negotiated Rate	$936.60
Max. Negotiated Rate	$1,204.20
Rate for Payer: Aetna of IA Commercial	$1,204.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,204.20
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,003.50
Rate for Payer: Medical Associates Commercial	$1,003.50
Rate for Payer: Midlands Choice Commercial	$936.60
Rate for Payer: United Healthcare Commercial	$1,204.20

CARDIOLOGY

Facility OP

$1,338.00

Service Code	CPT 93306
Hospital Charge Code	8300852
Hospital Revenue Code	480
Min. Negotiated Rate	$415.40
Max. Negotiated Rate	$1,204.20
Rate for Payer: Aetna of IA Commercial	$1,204.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,204.20
Rate for Payer: Aetna of IA Medicare	$762.66
Rate for Payer: Amerigroup Medicaid	$675.29
Rate for Payer: Amerigroup Medicare	$675.69
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,003.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$669.00
Rate for Payer: Iowa Total Care Managed Medicaid	$668.73
Rate for Payer: Medical Associates Commercial	$1,003.50
Rate for Payer: Medical Associates Managed Medicare	$669.00
Rate for Payer: Midlands Choice Commercial	$936.60
Rate for Payer: Molina Healthcare Managed Medicaid	$679.04
Rate for Payer: Partners Health Alliance Commercial	$1,003.50
Rate for Payer: United Healthcare Commercial	$1,204.20
Rate for Payer: United Healthcare Managed Medicare	$789.42
Rate for Payer: Wellmark IA HMO	$415.40
Rate for Payer: Wellmark IA PPO	$456.94

CARDIOPULMONARY RESUSITATION

Facility IP

$741.00

Service Code	CPT 92950
Hospital Charge Code	5338948
Hospital Revenue Code	480
Min. Negotiated Rate	$518.70
Max. Negotiated Rate	$666.90
Rate for Payer: Aetna of IA Commercial	$666.90
Rate for Payer: Aetna of IA Medical Rental Products	$666.90
Rate for Payer: Cash Price	$592.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$555.75
Rate for Payer: Medical Associates Commercial	$555.75
Rate for Payer: Midlands Choice Commercial	$518.70
Rate for Payer: United Healthcare Commercial	$666.90

CARDIOPULMONARY RESUSITATION

Facility OP

$741.00

Service Code	CPT 92950
Hospital Charge Code	5338948
Hospital Revenue Code	480
Min. Negotiated Rate	$370.35
Max. Negotiated Rate	$1,815.48
Rate for Payer: Aetna of IA Commercial	$666.90
Rate for Payer: Aetna of IA Medical Rental Products	$666.90
Rate for Payer: Aetna of IA Medicare	$422.37
Rate for Payer: Amerigroup Medicaid	$373.98
Rate for Payer: Amerigroup Medicare	$374.20
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$555.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$370.50
Rate for Payer: Iowa Total Care Managed Medicaid	$370.35
Rate for Payer: Medical Associates Commercial	$555.75
Rate for Payer: Medical Associates Managed Medicare	$370.50
Rate for Payer: Midlands Choice Commercial	$518.70
Rate for Payer: Molina Healthcare Managed Medicaid	$376.06
Rate for Payer: Partners Health Alliance Commercial	$555.75
Rate for Payer: United Healthcare Commercial	$666.90
Rate for Payer: United Healthcare Managed Medicare	$437.19
Rate for Payer: Wellmark IA HMO	$1,650.44
Rate for Payer: Wellmark IA PPO	$1,815.48

CARDIOVERSION ELECTRIC EXT

Facility OP

$952.00

Service Code	CPT 92960
Hospital Charge Code	4866863
Hospital Revenue Code	760
Min. Negotiated Rate	$475.81
Max. Negotiated Rate	$1,506.54
Rate for Payer: Aetna of IA Commercial	$856.80
Rate for Payer: Aetna of IA Medical Rental Products	$856.80
Rate for Payer: Aetna of IA Medicare	$542.64
Rate for Payer: Amerigroup Medicaid	$480.47
Rate for Payer: Amerigroup Medicare	$480.76
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$761.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$714.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$476.00
Rate for Payer: Iowa Total Care Managed Medicaid	$475.81
Rate for Payer: Medical Associates Commercial	$714.00
Rate for Payer: Medical Associates Managed Medicare	$476.00
Rate for Payer: Midlands Choice Commercial	$666.40
Rate for Payer: Molina Healthcare Managed Medicaid	$483.14
Rate for Payer: Partners Health Alliance Commercial	$714.00
Rate for Payer: United Healthcare Commercial	$856.80
Rate for Payer: United Healthcare Managed Medicare	$561.68
Rate for Payer: Wellmark IA HMO	$1,369.58
Rate for Payer: Wellmark IA PPO	$1,506.54

CARDIOVERSION ELECTRIC EXT

Professional

$524.00

Service Code	CPT 92960
Hospital Charge Code	7982756
Hospital Revenue Code	981
Min. Negotiated Rate	$98.53
Max. Negotiated Rate	$366.80
Rate for Payer: Aetna of IA Medicare	$98.53
Rate for Payer: Amerigroup Medicaid	$101.88
Rate for Payer: Cash Price	$419.20
Rate for Payer: Cash Price	$419.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$118.24
Rate for Payer: Iowa Total Care Managed Medicaid	$100.50
Rate for Payer: Medical Associates Commercial	$187.21
Rate for Payer: Medical Associates Managed Medicare	$98.53
Rate for Payer: Midlands Choice Commercial	$366.80
Rate for Payer: Partners Health Alliance Commercial	$147.80
Rate for Payer: Wellmark IA HMO	$203.00
Rate for Payer: Wellmark IA PPO	$239.00

CARDIOVERSION ELECTRIC EXT

Facility IP

$952.00

Service Code	CPT 92960
Hospital Charge Code	4866863
Hospital Revenue Code	760
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$856.80
Rate for Payer: Aetna of IA Commercial	$856.80
Rate for Payer: Aetna of IA Medical Rental Products	$856.80
Rate for Payer: Cash Price	$761.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$714.00
Rate for Payer: Medical Associates Commercial	$714.00
Rate for Payer: Midlands Choice Commercial	$666.40
Rate for Payer: United Healthcare Commercial	$856.80

CARD REHAB PHASE II;W.MONITOR

Facility OP

$220.00

Service Code	CPT 93798
Hospital Charge Code	8654179
Hospital Revenue Code	943
Min. Negotiated Rate	$109.96
Max. Negotiated Rate	$255.07
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Aetna of IA Medicare	$125.40
Rate for Payer: Amerigroup Medicaid	$111.03
Rate for Payer: Amerigroup Medicare	$111.10
Rate for Payer: Cash Price	$176.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$110.00
Rate for Payer: Iowa Total Care Managed Medicaid	$109.96
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Medical Associates Managed Medicare	$110.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: Molina Healthcare Managed Medicaid	$111.65
Rate for Payer: Partners Health Alliance Commercial	$165.00
Rate for Payer: United Healthcare Commercial	$198.00
Rate for Payer: United Healthcare Managed Medicare	$129.80
Rate for Payer: Wellmark IA HMO	$231.88
Rate for Payer: Wellmark IA PPO	$255.07

CARD REHAB PHASE II;W.MONITOR

Facility IP

$220.00

Service Code	CPT 93798
Hospital Charge Code	8654179
Hospital Revenue Code	943
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: United Healthcare Commercial	$198.00

Price Transparency.

All Charges