Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Cortisol PM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8519196
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Cortisol PM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8519196
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

Cortisol Stimulation 1hr DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037703
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

Cortisol Stimulation 1hr DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037703
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Cortisol Urine Free Timed DMCL

Facility

$114.00

Service Code	CPT 82530
Hospital Charge Code	8040997
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Aetna of IA Medicare	$64.98
Rate for Payer: Amerigroup Medicaid	$57.54
Rate for Payer: Amerigroup Medicare	$57.57
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$57.00
Rate for Payer: Iowa Total Care Managed Medicaid	$56.98
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$57.00
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$57.86
Rate for Payer: Molina Healthcare Managed Medicare	$57.82
Rate for Payer: Oscar Health of IA Commercial	$85.50
Rate for Payer: Partners Health Alliance Commercial	$85.50
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Cortisol Urine Free Timed DMCL

Facility

$114.00

Service Code	CPT 82530
Hospital Charge Code	8040997
Hospital Revenue Code	301
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of IA Commercial	$102.60
Rate for Payer: Aetna of IA Medical Rental Products	$102.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$85.50
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: United Healthcare Commercial	$102.60

cosyntropin 0.25 mg SDV Inj [VDMC]

Facility

$93.20

Service Code	HCPCS J0834
Hospital Charge Code	10380050
Hospital Revenue Code	259
Min. Negotiated Rate	$46.58
Max. Negotiated Rate	$83.88
Rate for Payer: Aetna of IA Commercial	$83.88
Rate for Payer: Aetna of IA Medical Rental Products	$83.88
Rate for Payer: Aetna of IA Medicare	$53.12
Rate for Payer: Amerigroup Medicaid	$47.04
Rate for Payer: Amerigroup Medicare	$47.07
Rate for Payer: Cash Price	$74.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.60
Rate for Payer: Iowa Total Care Managed Medicaid	$46.58
Rate for Payer: Medical Associates Commercial	$69.90
Rate for Payer: Medical Associates Managed Medicare	$46.60
Rate for Payer: Midlands Choice Commercial	$65.24
Rate for Payer: Molina Healthcare Managed Medicaid	$47.30
Rate for Payer: Molina Healthcare Managed Medicare	$47.27
Rate for Payer: Oscar Health of IA Commercial	$69.90
Rate for Payer: Partners Health Alliance Commercial	$69.90
Rate for Payer: United Healthcare Commercial	$83.88
Rate for Payer: United Healthcare Managed Medicare	$54.99

cosyntropin 0.25 mg SDV Inj [VDMC]

Facility

$93.20

Service Code	HCPCS J0834
Hospital Charge Code	10380050
Hospital Revenue Code	259
Min. Negotiated Rate	$65.24
Max. Negotiated Rate	$83.88
Rate for Payer: Aetna of IA Commercial	$83.88
Rate for Payer: Aetna of IA Medical Rental Products	$83.88
Rate for Payer: Cash Price	$74.56
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$69.90
Rate for Payer: Medical Associates Commercial	$69.90
Rate for Payer: Midlands Choice Commercial	$65.24
Rate for Payer: United Healthcare Commercial	$83.88

C Peptide DMCL

Facility

$170.00

Service Code	CPT 84681
Hospital Charge Code	8037503
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Aetna of IA Medicare	$96.90
Rate for Payer: Amerigroup Medicaid	$85.80
Rate for Payer: Amerigroup Medicare	$85.85
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$85.00
Rate for Payer: Iowa Total Care Managed Medicaid	$84.97
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Medical Associates Managed Medicare	$85.00
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.28
Rate for Payer: Molina Healthcare Managed Medicare	$86.22
Rate for Payer: Oscar Health of IA Commercial	$127.50
Rate for Payer: Partners Health Alliance Commercial	$127.50
Rate for Payer: United Healthcare Commercial	$153.00
Rate for Payer: United Healthcare Managed Medicare	$100.30
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

C Peptide DMCL

Facility

$170.00

Service Code	CPT 84681
Hospital Charge Code	8037503
Hospital Revenue Code	301
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of IA Commercial	$153.00
Rate for Payer: Aetna of IA Medical Rental Products	$153.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$127.50
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: United Healthcare Commercial	$153.00

CPR - PHYSICIAN ONLY

Professional

Both

$1,004.00

Service Code	CPT 92950
Hospital Charge Code	7982758
Hospital Revenue Code	981
Min. Negotiated Rate	$167.16
Max. Negotiated Rate	$702.80
Rate for Payer: Aetna of IA Medicare	$167.16
Rate for Payer: Amerigroup Medicaid	$172.84
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$200.59
Rate for Payer: Iowa Total Care Managed Medicaid	$170.50
Rate for Payer: Medical Associates Commercial	$300.89
Rate for Payer: Medical Associates Managed Medicare	$167.16
Rate for Payer: Midlands Choice Commercial	$702.80
Rate for Payer: Oscar Health of IA Commercial	$300.89
Rate for Payer: Partners Health Alliance Commercial	$250.74

Cranial and Peripheral Nerve Disorders With MCC

Facility

$15,499.84

Service Code	MS-DRG 073
Hospital Charge Code	753
Min. Negotiated Rate	$15,275.20
Max. Negotiated Rate	$15,499.84
Rate for Payer: Amerigroup Medicaid	$15,424.96
Rate for Payer: Iowa Total Care Managed Medicaid	$15,275.20
Rate for Payer: Molina Healthcare Managed Medicaid	$15,499.84

Cranial and Peripheral Nerve Disorders Without MCC

Facility

$9,775.48

Service Code	MS-DRG 074
Hospital Charge Code	754
Min. Negotiated Rate	$9,633.81
Max. Negotiated Rate	$9,775.48
Rate for Payer: Amerigroup Medicaid	$9,728.26
Rate for Payer: Iowa Total Care Managed Medicaid	$9,633.81
Rate for Payer: Molina Healthcare Managed Medicaid	$9,775.48

CRANIOFACIAL MAXILLOFACIAL OP

Facility

$831.00

Service Code	CPT 21299
Hospital Charge Code	8300880
Hospital Revenue Code	450
Min. Negotiated Rate	$581.70
Max. Negotiated Rate	$747.90
Rate for Payer: Aetna of IA Commercial	$747.90
Rate for Payer: Aetna of IA Medical Rental Products	$747.90
Rate for Payer: Cash Price	$664.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$623.25
Rate for Payer: Medical Associates Commercial	$623.25
Rate for Payer: Midlands Choice Commercial	$581.70
Rate for Payer: United Healthcare Commercial	$747.90

CRANIOFACIAL MAXILLOFACIAL OP

Facility

$831.00

Service Code	CPT 21299
Hospital Charge Code	8300880
Hospital Revenue Code	450
Min. Negotiated Rate	$415.33
Max. Negotiated Rate	$3,851.25
Rate for Payer: Aetna of IA Commercial	$747.90
Rate for Payer: Aetna of IA Medical Rental Products	$747.90
Rate for Payer: Aetna of IA Medicare	$473.67
Rate for Payer: Amerigroup Medicaid	$419.41
Rate for Payer: Amerigroup Medicare	$419.66
Rate for Payer: Cash Price	$664.80
Rate for Payer: Cash Price	$664.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$623.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$415.50
Rate for Payer: Iowa Total Care Managed Medicaid	$415.33
Rate for Payer: Medical Associates Commercial	$623.25
Rate for Payer: Medical Associates Managed Medicare	$415.50
Rate for Payer: Midlands Choice Commercial	$581.70
Rate for Payer: Molina Healthcare Managed Medicaid	$421.73
Rate for Payer: Molina Healthcare Managed Medicare	$421.48
Rate for Payer: Oscar Health of IA Commercial	$623.25
Rate for Payer: Partners Health Alliance Commercial	$623.25
Rate for Payer: United Healthcare Commercial	$747.90
Rate for Payer: United Healthcare Managed Medicare	$490.29
Rate for Payer: Wellmark IA HMO	$3,501.14
Rate for Payer: Wellmark IA PPO	$3,851.25

Craniotomy and Endovascular Intracranial Procedures With CC

Facility

$27,102.08

Service Code	MS-DRG 026
Hospital Charge Code	715
Min. Negotiated Rate	$26,709.29
Max. Negotiated Rate	$27,102.08
Rate for Payer: Amerigroup Medicaid	$26,971.15
Rate for Payer: Iowa Total Care Managed Medicaid	$26,709.29
Rate for Payer: Molina Healthcare Managed Medicaid	$27,102.08

Craniotomy and Endovascular Intracranial Procedures With MCC

Facility

$37,081.30

Service Code	MS-DRG 025
Hospital Charge Code	714
Min. Negotiated Rate	$36,543.89
Max. Negotiated Rate	$37,081.30
Rate for Payer: Amerigroup Medicaid	$36,902.16
Rate for Payer: Iowa Total Care Managed Medicaid	$36,543.89
Rate for Payer: Molina Healthcare Managed Medicaid	$37,081.30

Craniotomy and Endovascular Intracranial Procedures Without CC/MCC

Facility

$20,124.79

Service Code	MS-DRG 027
Hospital Charge Code	716
Min. Negotiated Rate	$19,833.12
Max. Negotiated Rate	$20,124.79
Rate for Payer: Amerigroup Medicaid	$20,027.57
Rate for Payer: Iowa Total Care Managed Medicaid	$19,833.12
Rate for Payer: Molina Healthcare Managed Medicaid	$20,124.79

Craniotomy for Multiple Significant Trauma

Facility

$54,733.67

Service Code	MS-DRG 955
Hospital Charge Code	658
Min. Negotiated Rate	$53,940.43
Max. Negotiated Rate	$54,733.67
Rate for Payer: Amerigroup Medicaid	$54,469.25
Rate for Payer: Iowa Total Care Managed Medicaid	$53,940.43
Rate for Payer: Molina Healthcare Managed Medicaid	$54,733.67

Craniotomy With Major Device Implant or Acute Complex CNS Principal Diagnosis With MCC or Chemotherapy Implant or Epilepsy With Neurostimulator

Facility

$52,852.78

Service Code	MS-DRG 023
Hospital Charge Code	712
Min. Negotiated Rate	$52,086.80
Max. Negotiated Rate	$52,852.78
Rate for Payer: Amerigroup Medicaid	$52,597.45
Rate for Payer: Iowa Total Care Managed Medicaid	$52,086.80
Rate for Payer: Molina Healthcare Managed Medicaid	$52,852.78

Craniotomy With Major Device Implant or Acute Complex CNS Principal Diagnosis Without MCC

Facility

$33,727.99

Service Code	MS-DRG 024
Hospital Charge Code	713
Min. Negotiated Rate	$33,239.18
Max. Negotiated Rate	$33,727.99
Rate for Payer: Amerigroup Medicaid	$33,565.05
Rate for Payer: Iowa Total Care Managed Medicaid	$33,239.18
Rate for Payer: Molina Healthcare Managed Medicaid	$33,727.99

C-REACTIVE PROTEIN-HIGH SENS

Facility

$83.00

Service Code	CPT 86140
Hospital Charge Code	1628890
Hospital Revenue Code	302
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of IA Commercial	$74.70
Rate for Payer: Aetna of IA Medical Rental Products	$74.70
Rate for Payer: Cash Price	$66.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.25
Rate for Payer: Medical Associates Commercial	$62.25
Rate for Payer: Midlands Choice Commercial	$58.10
Rate for Payer: United Healthcare Commercial	$74.70

C-REACTIVE PROTEIN-HIGH SENS

Facility

$123.00

Service Code	CPT 86141
Hospital Charge Code	7934763
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of IA Commercial	$110.70
Rate for Payer: Aetna of IA Medical Rental Products	$110.70
Rate for Payer: Aetna of IA Medicare	$70.11
Rate for Payer: Amerigroup Medicaid	$62.08
Rate for Payer: Amerigroup Medicare	$62.12
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$92.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$61.50
Rate for Payer: Iowa Total Care Managed Medicaid	$61.48
Rate for Payer: Medical Associates Commercial	$92.25
Rate for Payer: Medical Associates Managed Medicare	$61.50
Rate for Payer: Midlands Choice Commercial	$86.10
Rate for Payer: Molina Healthcare Managed Medicaid	$62.42
Rate for Payer: Molina Healthcare Managed Medicare	$62.39
Rate for Payer: Oscar Health of IA Commercial	$92.25
Rate for Payer: Partners Health Alliance Commercial	$92.25
Rate for Payer: United Healthcare Commercial	$110.70
Rate for Payer: United Healthcare Managed Medicare	$72.57
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

C-REACTIVE PROTEIN-HIGH SENS

Facility

$123.00

Service Code	CPT 86141
Hospital Charge Code	7934763
Hospital Revenue Code	302
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of IA Commercial	$110.70
Rate for Payer: Aetna of IA Medical Rental Products	$110.70
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$92.25
Rate for Payer: Medical Associates Commercial	$92.25
Rate for Payer: Midlands Choice Commercial	$86.10
Rate for Payer: United Healthcare Commercial	$110.70

C-REACTIVE PROTEIN-HIGH SENS

Facility

$83.00

Service Code	CPT 86140
Hospital Charge Code	1628890
Hospital Revenue Code	302
Min. Negotiated Rate	$41.48
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of IA Commercial	$74.70
Rate for Payer: Aetna of IA Medical Rental Products	$74.70
Rate for Payer: Aetna of IA Medicare	$47.31
Rate for Payer: Amerigroup Medicaid	$41.89
Rate for Payer: Amerigroup Medicare	$41.92
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.50
Rate for Payer: Iowa Total Care Managed Medicaid	$41.48
Rate for Payer: Medical Associates Commercial	$62.25
Rate for Payer: Medical Associates Managed Medicare	$41.50
Rate for Payer: Midlands Choice Commercial	$58.10
Rate for Payer: Molina Healthcare Managed Medicaid	$42.12
Rate for Payer: Molina Healthcare Managed Medicare	$42.10
Rate for Payer: Oscar Health of IA Commercial	$62.25
Rate for Payer: Partners Health Alliance Commercial	$62.25
Rate for Payer: United Healthcare Commercial	$74.70
Rate for Payer: United Healthcare Managed Medicare	$48.97
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Know your out-of-pocket cost for care.

All Charges