Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

CORKSCREW BIO 6.5

Facility

$609.00

Service Code	HCPCS C1713
Hospital Charge Code	8026414
Hospital Revenue Code	278
Min. Negotiated Rate	$274.05
Max. Negotiated Rate	$548.10
Rate for Payer: Aetna of IA Commercial	$548.10
Rate for Payer: Aetna of IA Medical Rental Products	$548.10
Rate for Payer: Aetna of IA Medicare	$347.13
Rate for Payer: Amerigroup Medicaid	$351.27
Rate for Payer: Amerigroup Medicare	$276.79
Rate for Payer: Cash Price	$487.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$456.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$274.05
Rate for Payer: Iowa Total Care Managed Medicaid	$347.86
Rate for Payer: Medical Associates Commercial	$456.75
Rate for Payer: Medical Associates Managed Medicare	$274.05
Rate for Payer: Midlands Choice Commercial	$426.30
Rate for Payer: Molina Healthcare Managed Medicaid	$352.98
Rate for Payer: Partners Health Alliance Commercial	$315.16
Rate for Payer: United Healthcare Commercial	$548.10
Rate for Payer: United Healthcare Managed Medicare	$359.31

CORKSCREW BIO 6.5

Facility

$609.00

Service Code	HCPCS C1713
Hospital Charge Code	8026414
Hospital Revenue Code	278
Min. Negotiated Rate	$426.30
Max. Negotiated Rate	$548.10
Rate for Payer: Aetna of IA Commercial	$548.10
Rate for Payer: Aetna of IA Medical Rental Products	$548.10
Rate for Payer: Cash Price	$487.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$456.75
Rate for Payer: Medical Associates Commercial	$456.75
Rate for Payer: Midlands Choice Commercial	$426.30
Rate for Payer: United Healthcare Commercial	$548.10

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$60,925.49

Service Code	MSDRG 233
Min. Negotiated Rate	$60,042.48
Max. Negotiated Rate	$60,925.49
Rate for Payer: Amerigroup Medicaid	$60,631.14
Rate for Payer: Iowa Total Care Managed Medicaid	$60,042.48
Rate for Payer: Molina Healthcare Managed Medicaid	$60,925.49

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$53,633.66

Service Code	MSDRG 234
Min. Negotiated Rate	$52,856.34
Max. Negotiated Rate	$53,633.66
Rate for Payer: Amerigroup Medicaid	$53,374.54
Rate for Payer: Iowa Total Care Managed Medicaid	$52,856.34
Rate for Payer: Molina Healthcare Managed Medicaid	$53,633.66

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$50,363.83

Service Code	MSDRG 235
Min. Negotiated Rate	$49,633.89
Max. Negotiated Rate	$50,363.83
Rate for Payer: Amerigroup Medicaid	$50,120.50
Rate for Payer: Iowa Total Care Managed Medicaid	$49,633.89
Rate for Payer: Molina Healthcare Managed Medicaid	$50,363.83

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$41,625.12

Service Code	MSDRG 236
Min. Negotiated Rate	$41,021.84
Max. Negotiated Rate	$41,625.12
Rate for Payer: Amerigroup Medicaid	$41,424.01
Rate for Payer: Iowa Total Care Managed Medicaid	$41,021.84
Rate for Payer: Molina Healthcare Managed Medicaid	$41,625.12

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$71,626.77

Service Code	MSDRG 231
Min. Negotiated Rate	$70,588.67
Max. Negotiated Rate	$71,626.77
Rate for Payer: Amerigroup Medicaid	$71,280.72
Rate for Payer: Iowa Total Care Managed Medicaid	$70,588.67
Rate for Payer: Molina Healthcare Managed Medicaid	$71,626.77

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$69,806.07

Service Code	MSDRG 232
Min. Negotiated Rate	$68,794.36
Max. Negotiated Rate	$69,806.07
Rate for Payer: Amerigroup Medicaid	$69,468.81
Rate for Payer: Iowa Total Care Managed Medicaid	$68,794.36
Rate for Payer: Molina Healthcare Managed Medicaid	$69,806.07

Coronavirus 2019 Novel (SARS-CoV-2) DMCL

Facility

$338.00

Service Code	CPT 87635
Hospital Charge Code	8944439
Hospital Revenue Code	300
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.92
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42
Rate for Payer: Wellmark IA HMO WHPI	$86.50
Rate for Payer: Wellmark IA PPO	$95.28

Coronavirus 2019 Novel (SARS-CoV-2) DMCL

Facility

$338.00

Service Code	CPT 87635
Hospital Charge Code	8944439
Hospital Revenue Code	300
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

Coronavirus 2019 Novel (SARS-CoV-2) IgG Ab DMCL

Facility

$150.00

Service Code	CPT 86769
Hospital Charge Code	8788720
Hospital Revenue Code	302
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: United Healthcare Commercial	$135.00

Coronavirus 2019 Novel (SARS-CoV-2) IgG Ab DMCL

Facility

$150.00

Service Code	CPT 86769
Hospital Charge Code	8788720
Hospital Revenue Code	302
Min. Negotiated Rate	$41.83
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Aetna of IA Medicare	$85.50
Rate for Payer: Amerigroup Medicaid	$86.52
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
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	$85.68
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.94
Rate for Payer: Partners Health Alliance Commercial	$77.62
Rate for Payer: United Healthcare Commercial	$135.00
Rate for Payer: United Healthcare Managed Medicare	$88.50
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

Coronavirus 2019 Novel Screening PCR

Facility

$338.00

Service Code	CPT 87635
Hospital Charge Code	8783451
Hospital Revenue Code	306
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.92
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42
Rate for Payer: Wellmark IA HMO WHPI	$86.50
Rate for Payer: Wellmark IA PPO	$95.28

Coronavirus 2019 Novel Screening PCR

Facility

$338.00

Service Code	CPT 87635
Hospital Charge Code	8783451
Hospital Revenue Code	306
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

CORTICAL SCREW 3.5MM X 36MM

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	8924287
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Aetna of IA Medicare	$102.60
Rate for Payer: Amerigroup Medicaid	$103.82
Rate for Payer: Amerigroup Medicare	$81.81
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$81.00
Rate for Payer: Iowa Total Care Managed Medicaid	$102.82
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Medical Associates Managed Medicare	$81.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: Molina Healthcare Managed Medicaid	$104.33
Rate for Payer: Partners Health Alliance Commercial	$93.15
Rate for Payer: United Healthcare Commercial	$162.00
Rate for Payer: United Healthcare Managed Medicare	$106.20

CORTICAL SCREW 3.5MM X 36MM

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	8924287
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of IA Commercial	$162.00
Rate for Payer: Aetna of IA Medical Rental Products	$162.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$135.00
Rate for Payer: Medical Associates Commercial	$135.00
Rate for Payer: Midlands Choice Commercial	$126.00
Rate for Payer: United Healthcare Commercial	$162.00

CORTICAL SCREW 3.5MM X 42MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	9004024
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

CORTICAL SCREW 3.5MM X 42MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	9004024
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$181.69
Rate for Payer: Amerigroup Medicare	$143.17
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$141.75
Rate for Payer: Iowa Total Care Managed Medicaid	$179.93
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$141.75
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$182.57
Rate for Payer: Partners Health Alliance Commercial	$163.01
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

Cortisol AM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037517
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 AM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8037517
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
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	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
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	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

CORTISOL EA

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8093929
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
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	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
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	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

CORTISOL EA

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8093929
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 PM DMCL

Facility

$135.00

Service Code	CPT 82533
Hospital Charge Code	8519196
Hospital Revenue Code	301
Min. Negotiated Rate	$49.63
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	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
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	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

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	$49.63
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	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
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	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65
Rate for Payer: Wellmark IA HMO WHPI	$49.63
Rate for Payer: Wellmark IA PPO	$54.67

Know your out-of-pocket cost for care.

All Charges