Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Carboxyhemoglobin Venous

Facility

$117.00

Service Code	CPT 82375
Hospital Charge Code	8208908
Hospital Revenue Code	301
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of IA Commercial	$105.30
Rate for Payer: Aetna of IA Medical Rental Products	$105.30
Rate for Payer: Aetna of IA Medicare	$66.69
Rate for Payer: Amerigroup Medicaid	$67.49
Rate for Payer: Amerigroup Medicare	$53.18
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$87.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.65
Rate for Payer: Iowa Total Care Managed Medicaid	$66.83
Rate for Payer: Medical Associates Commercial	$87.75
Rate for Payer: Medical Associates Managed Medicare	$52.65
Rate for Payer: Midlands Choice Commercial	$81.90
Rate for Payer: Molina Healthcare Managed Medicaid	$67.81
Rate for Payer: Partners Health Alliance Commercial	$60.55
Rate for Payer: United Healthcare Commercial	$105.30
Rate for Payer: United Healthcare Managed Medicare	$69.03
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Carcinoembryonic Antigen DMCL

Facility

$129.00

Service Code	CPT 82378
Hospital Charge Code	8037509
Hospital Revenue Code	301
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Aetna of IA Medicare	$73.53
Rate for Payer: Amerigroup Medicaid	$74.41
Rate for Payer: Amerigroup Medicare	$58.63
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$58.05
Rate for Payer: Iowa Total Care Managed Medicaid	$73.68
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Medical Associates Managed Medicare	$58.05
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: Molina Healthcare Managed Medicaid	$74.77
Rate for Payer: Partners Health Alliance Commercial	$66.76
Rate for Payer: United Healthcare Commercial	$116.10
Rate for Payer: United Healthcare Managed Medicare	$76.11
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

Carcinoembryonic Antigen DMCL

Facility

$129.00

Service Code	CPT 82378
Hospital Charge Code	8037509
Hospital Revenue Code	301
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of IA Commercial	$116.10
Rate for Payer: Aetna of IA Medical Rental Products	$116.10
Rate for Payer: Cash Price	$103.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$96.75
Rate for Payer: Medical Associates Commercial	$96.75
Rate for Payer: Midlands Choice Commercial	$90.30
Rate for Payer: United Healthcare Commercial	$116.10

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$7,935.89

Service Code	MSDRG 297
Min. Negotiated Rate	$7,820.87
Max. Negotiated Rate	$7,935.89
Rate for Payer: Amerigroup Medicaid	$7,897.54
Rate for Payer: Iowa Total Care Managed Medicaid	$7,820.87
Rate for Payer: Molina Healthcare Managed Medicaid	$7,935.89

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$13,922.71

Service Code	MSDRG 296
Min. Negotiated Rate	$13,720.92
Max. Negotiated Rate	$13,922.71
Rate for Payer: Amerigroup Medicaid	$13,855.44
Rate for Payer: Iowa Total Care Managed Medicaid	$13,720.92
Rate for Payer: Molina Healthcare Managed Medicaid	$13,922.71

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$5,497.02

Service Code	MSDRG 298
Min. Negotiated Rate	$5,417.35
Max. Negotiated Rate	$5,497.02
Rate for Payer: Amerigroup Medicaid	$5,470.46
Rate for Payer: Iowa Total Care Managed Medicaid	$5,417.35
Rate for Payer: Molina Healthcare Managed Medicaid	$5,497.02

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$6,952.91

Service Code	MSDRG 309
Min. Negotiated Rate	$6,852.14
Max. Negotiated Rate	$6,952.91
Rate for Payer: Amerigroup Medicaid	$6,919.32
Rate for Payer: Iowa Total Care Managed Medicaid	$6,852.14
Rate for Payer: Molina Healthcare Managed Medicaid	$6,952.91

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$10,212.61

Service Code	MSDRG 308
Min. Negotiated Rate	$10,064.60
Max. Negotiated Rate	$10,212.61
Rate for Payer: Amerigroup Medicaid	$10,163.27
Rate for Payer: Iowa Total Care Managed Medicaid	$10,064.60
Rate for Payer: Molina Healthcare Managed Medicaid	$10,212.61

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$5,460.99

Service Code	MSDRG 310
Min. Negotiated Rate	$5,381.84
Max. Negotiated Rate	$5,460.99
Rate for Payer: Amerigroup Medicaid	$5,434.60
Rate for Payer: Iowa Total Care Managed Medicaid	$5,381.84
Rate for Payer: Molina Healthcare Managed Medicaid	$5,460.99

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$21,000.60

Service Code	MSDRG 306
Min. Negotiated Rate	$20,696.23
Max. Negotiated Rate	$21,000.60
Rate for Payer: Amerigroup Medicaid	$20,899.14
Rate for Payer: Iowa Total Care Managed Medicaid	$20,696.23
Rate for Payer: Molina Healthcare Managed Medicaid	$21,000.60

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$8,565.31

Service Code	MSDRG 307
Min. Negotiated Rate	$8,441.17
Max. Negotiated Rate	$8,565.31
Rate for Payer: Amerigroup Medicaid	$8,523.92
Rate for Payer: Iowa Total Care Managed Medicaid	$8,441.17
Rate for Payer: Molina Healthcare Managed Medicaid	$8,565.31

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$36,054.91

Service Code	MSDRG 258
Min. Negotiated Rate	$35,532.36
Max. Negotiated Rate	$36,054.91
Rate for Payer: Amerigroup Medicaid	$35,880.72
Rate for Payer: Iowa Total Care Managed Medicaid	$35,532.36
Rate for Payer: Molina Healthcare Managed Medicaid	$36,054.91

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$20,358.79

Service Code	MSDRG 259
Min. Negotiated Rate	$20,063.73
Max. Negotiated Rate	$20,358.79
Rate for Payer: Amerigroup Medicaid	$20,260.43
Rate for Payer: Iowa Total Care Managed Medicaid	$20,063.73
Rate for Payer: Molina Healthcare Managed Medicaid	$20,358.79

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$19,342.03

Service Code	MSDRG 261
Min. Negotiated Rate	$19,061.71
Max. Negotiated Rate	$19,342.03
Rate for Payer: Amerigroup Medicaid	$19,248.58
Rate for Payer: Iowa Total Care Managed Medicaid	$19,061.71
Rate for Payer: Molina Healthcare Managed Medicaid	$19,342.03

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$31,420.39

Service Code	MSDRG 260
Min. Negotiated Rate	$30,965.01
Max. Negotiated Rate	$31,420.39
Rate for Payer: Amerigroup Medicaid	$31,268.58
Rate for Payer: Iowa Total Care Managed Medicaid	$30,965.01
Rate for Payer: Molina Healthcare Managed Medicaid	$31,420.39

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$15,950.59

Service Code	MSDRG 262
Min. Negotiated Rate	$15,719.42
Max. Negotiated Rate	$15,950.59
Rate for Payer: Amerigroup Medicaid	$15,873.53
Rate for Payer: Iowa Total Care Managed Medicaid	$15,719.42
Rate for Payer: Molina Healthcare Managed Medicaid	$15,950.59

CARDIAC REHAB PHASE III

Facility

$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 REHAB PHASE III

Facility

$5.00

Hospital Charge Code	5684784
Hospital Revenue Code	943
Min. Negotiated Rate	$2.25
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	$2.88
Rate for Payer: Amerigroup Medicare	$2.27
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	$2.25
Rate for Payer: Iowa Total Care Managed Medicaid	$2.86
Rate for Payer: Medical Associates Commercial	$3.75
Rate for Payer: Medical Associates Managed Medicare	$2.25
Rate for Payer: Midlands Choice Commercial	$3.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2.90
Rate for Payer: Partners Health Alliance Commercial	$2.59
Rate for Payer: United Healthcare Commercial	$4.50
Rate for Payer: United Healthcare Managed Medicare	$2.95

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$65,003.78

Service Code	MSDRG 217
Min. Negotiated Rate	$64,061.67
Max. Negotiated Rate	$65,003.78
Rate for Payer: Amerigroup Medicaid	$64,689.72
Rate for Payer: Iowa Total Care Managed Medicaid	$64,061.67
Rate for Payer: Molina Healthcare Managed Medicaid	$65,003.78

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$125,760.37

Service Code	MSDRG 216
Min. Negotiated Rate	$123,937.70
Max. Negotiated Rate	$125,760.37
Rate for Payer: Amerigroup Medicaid	$125,152.78
Rate for Payer: Iowa Total Care Managed Medicaid	$123,937.70
Rate for Payer: Molina Healthcare Managed Medicaid	$125,760.37

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$59,043.98

Service Code	MSDRG 218
Min. Negotiated Rate	$58,188.25
Max. Negotiated Rate	$59,043.98
Rate for Payer: Amerigroup Medicaid	$58,758.72
Rate for Payer: Iowa Total Care Managed Medicaid	$58,188.25
Rate for Payer: Molina Healthcare Managed Medicaid	$59,043.98

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$53,254.21

Service Code	MSDRG 220
Min. Negotiated Rate	$52,482.38
Max. Negotiated Rate	$53,254.21
Rate for Payer: Amerigroup Medicaid	$52,996.92
Rate for Payer: Iowa Total Care Managed Medicaid	$52,482.38
Rate for Payer: Molina Healthcare Managed Medicaid	$53,254.21

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$66,053.19

Service Code	MSDRG 219
Min. Negotiated Rate	$65,095.87
Max. Negotiated Rate	$66,053.19
Rate for Payer: Amerigroup Medicaid	$65,734.06
Rate for Payer: Iowa Total Care Managed Medicaid	$65,095.87
Rate for Payer: Molina Healthcare Managed Medicaid	$66,053.19

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$45,471.46

Service Code	MSDRG 221
Min. Negotiated Rate	$44,812.43
Max. Negotiated Rate	$45,471.46
Rate for Payer: Amerigroup Medicaid	$45,251.77
Rate for Payer: Iowa Total Care Managed Medicaid	$44,812.43
Rate for Payer: Molina Healthcare Managed Medicaid	$45,471.46

CARDIOLOGY

Facility

$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

Know your out-of-pocket cost for care.

All Charges