Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

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 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

Cortisol Urine Free Timed DMCL

Facility

$114.00

Service Code	CPT 82530
Hospital Charge Code	8040997
Hospital Revenue Code	301
Min. Negotiated Rate	$51.30
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	$65.76
Rate for Payer: Amerigroup Medicare	$51.81
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	$51.30
Rate for Payer: Iowa Total Care Managed Medicaid	$65.12
Rate for Payer: Medical Associates Commercial	$85.50
Rate for Payer: Medical Associates Managed Medicare	$51.30
Rate for Payer: Midlands Choice Commercial	$79.80
Rate for Payer: Molina Healthcare Managed Medicaid	$66.07
Rate for Payer: Partners Health Alliance Commercial	$59.00
Rate for Payer: United Healthcare Commercial	$102.60
Rate for Payer: United Healthcare Managed Medicare	$67.26
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

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	$41.94
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	$53.76
Rate for Payer: Amerigroup Medicare	$42.36
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	$41.94
Rate for Payer: Iowa Total Care Managed Medicaid	$53.24
Rate for Payer: Medical Associates Commercial	$69.90
Rate for Payer: Medical Associates Managed Medicare	$41.94
Rate for Payer: Midlands Choice Commercial	$65.24
Rate for Payer: Molina Healthcare Managed Medicaid	$54.02
Rate for Payer: Partners Health Alliance Commercial	$48.23
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	$61.68
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	$98.06
Rate for Payer: Amerigroup Medicare	$77.26
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	$76.50
Rate for Payer: Iowa Total Care Managed Medicaid	$97.10
Rate for Payer: Medical Associates Commercial	$127.50
Rate for Payer: Medical Associates Managed Medicare	$76.50
Rate for Payer: Midlands Choice Commercial	$119.00
Rate for Payer: Molina Healthcare Managed Medicaid	$98.53
Rate for Payer: Partners Health Alliance Commercial	$87.98
Rate for Payer: United Healthcare Commercial	$153.00
Rate for Payer: United Healthcare Managed Medicare	$100.30
Rate for Payer: Wellmark IA HMO WHPI	$61.68
Rate for Payer: Wellmark IA PPO	$67.95

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	$206.99
Max. Negotiated Rate	$753.00
Rate for Payer: Amerigroup Medicaid	$209.02
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Iowa Total Care Managed Medicaid	$206.99
Rate for Payer: Medical Associates Commercial	$753.00
Rate for Payer: Midlands Choice Commercial	$702.80
Rate for Payer: Molina Healthcare Managed Medicaid	$208.00
Rate for Payer: Partners Health Alliance Commercial	$753.00
Rate for Payer: United Healthcare Commercial	$383.08
Rate for Payer: Wellmark IA HMO WHPI	$622.30
Rate for Payer: Wellmark IA PPO	$732.10

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$17,731.89

Service Code	MSDRG 073
Min. Negotiated Rate	$17,474.89
Max. Negotiated Rate	$17,731.89
Rate for Payer: Amerigroup Medicaid	$17,646.22
Rate for Payer: Iowa Total Care Managed Medicaid	$17,474.89
Rate for Payer: Molina Healthcare Managed Medicaid	$17,731.89

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$11,183.20

Service Code	MSDRG 074
Min. Negotiated Rate	$11,021.12
Max. Negotiated Rate	$11,183.20
Rate for Payer: Amerigroup Medicaid	$11,129.17
Rate for Payer: Iowa Total Care Managed Medicaid	$11,021.12
Rate for Payer: Molina Healthcare Managed Medicaid	$11,183.20

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	$373.95
Max. Negotiated Rate	$6,395.61
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	$479.32
Rate for Payer: Amerigroup Medicare	$377.69
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	$373.95
Rate for Payer: Iowa Total Care Managed Medicaid	$474.67
Rate for Payer: Medical Associates Commercial	$623.25
Rate for Payer: Medical Associates Managed Medicare	$373.95
Rate for Payer: Midlands Choice Commercial	$581.70
Rate for Payer: Molina Healthcare Managed Medicaid	$481.65
Rate for Payer: Partners Health Alliance Commercial	$430.04
Rate for Payer: United Healthcare Commercial	$747.90
Rate for Payer: United Healthcare Managed Medicare	$490.29
Rate for Payer: Wellmark IA HMO WHPI	$5,806.00
Rate for Payer: Wellmark IA PPO	$6,395.61

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$31,004.90

Service Code	MSDRG 026
Min. Negotiated Rate	$30,555.54
Max. Negotiated Rate	$31,004.90
Rate for Payer: Amerigroup Medicaid	$30,855.11
Rate for Payer: Iowa Total Care Managed Medicaid	$30,555.54
Rate for Payer: Molina Healthcare Managed Medicaid	$31,004.90

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$42,421.18

Service Code	MSDRG 025
Min. Negotiated Rate	$41,806.37
Max. Negotiated Rate	$42,421.18
Rate for Payer: Amerigroup Medicaid	$42,216.23
Rate for Payer: Iowa Total Care Managed Medicaid	$41,806.37
Rate for Payer: Molina Healthcare Managed Medicaid	$42,421.18

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$23,022.85

Service Code	MSDRG 027
Min. Negotiated Rate	$22,689.18
Max. Negotiated Rate	$23,022.85
Rate for Payer: Amerigroup Medicaid	$22,911.62
Rate for Payer: Iowa Total Care Managed Medicaid	$22,689.18
Rate for Payer: Molina Healthcare Managed Medicaid	$23,022.85

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$62,615.58

Service Code	MSDRG 955
Min. Negotiated Rate	$61,708.08
Max. Negotiated Rate	$62,615.58
Rate for Payer: Amerigroup Medicaid	$62,313.06
Rate for Payer: Iowa Total Care Managed Medicaid	$61,708.08
Rate for Payer: Molina Healthcare Managed Medicaid	$62,615.58

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$60,463.84

Service Code	MSDRG 023
Min. Negotiated Rate	$59,587.52
Max. Negotiated Rate	$60,463.84
Rate for Payer: Amerigroup Medicaid	$60,171.72
Rate for Payer: Iowa Total Care Managed Medicaid	$59,587.52
Rate for Payer: Molina Healthcare Managed Medicaid	$60,463.84

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$38,584.98

Service Code	MSDRG 024
Min. Negotiated Rate	$38,025.76
Max. Negotiated Rate	$38,584.98
Rate for Payer: Amerigroup Medicaid	$38,398.56
Rate for Payer: Iowa Total Care Managed Medicaid	$38,025.76
Rate for Payer: Molina Healthcare Managed Medicaid	$38,584.98

C-REACTIVE PROTEIN-HIGH SENS

Facility

$123.00

Service Code	CPT 86141
Hospital Charge Code	7934763
Hospital Revenue Code	302
Min. Negotiated Rate	$41.83
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	$70.95
Rate for Payer: Amerigroup Medicare	$55.90
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	$55.35
Rate for Payer: Iowa Total Care Managed Medicaid	$70.26
Rate for Payer: Medical Associates Commercial	$92.25
Rate for Payer: Medical Associates Managed Medicare	$55.35
Rate for Payer: Midlands Choice Commercial	$86.10
Rate for Payer: Molina Healthcare Managed Medicaid	$71.29
Rate for Payer: Partners Health Alliance Commercial	$63.65
Rate for Payer: United Healthcare Commercial	$110.70
Rate for Payer: United Healthcare Managed Medicare	$72.57
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

C-REACTIVE PROTEIN-HIGH SENS

Facility

$83.00

Service Code	CPT 86140
Hospital Charge Code	1628890
Hospital Revenue Code	302
Min. Negotiated Rate	$37.35
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	$47.87
Rate for Payer: Amerigroup Medicare	$37.72
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	$37.35
Rate for Payer: Iowa Total Care Managed Medicaid	$47.41
Rate for Payer: Medical Associates Commercial	$62.25
Rate for Payer: Medical Associates Managed Medicare	$37.35
Rate for Payer: Midlands Choice Commercial	$58.10
Rate for Payer: Molina Healthcare Managed Medicaid	$48.11
Rate for Payer: Partners Health Alliance Commercial	$42.95
Rate for Payer: United Healthcare Commercial	$74.70
Rate for Payer: United Healthcare Managed Medicare	$48.97
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

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	$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 HS

Facility

$61.00

Service Code	CPT 86141
Hospital Charge Code	8519232
Hospital Revenue Code	300
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: United Healthcare Commercial	$54.90

C-Reactive Protein HS

Facility

$61.00

Service Code	CPT 86141
Hospital Charge Code	8519232
Hospital Revenue Code	300
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of IA Commercial	$54.90
Rate for Payer: Aetna of IA Medical Rental Products	$54.90
Rate for Payer: Aetna of IA Medicare	$34.77
Rate for Payer: Amerigroup Medicaid	$35.18
Rate for Payer: Amerigroup Medicare	$27.72
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.45
Rate for Payer: Iowa Total Care Managed Medicaid	$34.84
Rate for Payer: Medical Associates Commercial	$45.75
Rate for Payer: Medical Associates Managed Medicare	$27.45
Rate for Payer: Midlands Choice Commercial	$42.70
Rate for Payer: Molina Healthcare Managed Medicaid	$35.36
Rate for Payer: Partners Health Alliance Commercial	$31.57
Rate for Payer: United Healthcare Commercial	$54.90
Rate for Payer: United Healthcare Managed Medicare	$35.99
Rate for Payer: Wellmark IA HMO WHPI	$41.83
Rate for Payer: Wellmark IA PPO	$46.08

CREAT CLEARANCE

Facility

$90.00

Service Code	CPT 82575
Hospital Charge Code	633609
Hospital Revenue Code	301
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of IA Commercial	$81.00
Rate for Payer: Aetna of IA Medical Rental Products	$81.00
Rate for Payer: Aetna of IA Medicare	$51.30
Rate for Payer: Amerigroup Medicaid	$51.91
Rate for Payer: Amerigroup Medicare	$40.90
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$67.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$40.50
Rate for Payer: Iowa Total Care Managed Medicaid	$51.41
Rate for Payer: Medical Associates Commercial	$67.50
Rate for Payer: Medical Associates Managed Medicare	$40.50
Rate for Payer: Midlands Choice Commercial	$63.00
Rate for Payer: Molina Healthcare Managed Medicaid	$52.16
Rate for Payer: Partners Health Alliance Commercial	$46.58
Rate for Payer: United Healthcare Commercial	$81.00
Rate for Payer: United Healthcare Managed Medicare	$53.10
Rate for Payer: Wellmark IA HMO WHPI	$30.49
Rate for Payer: Wellmark IA PPO	$33.58

Know your out-of-pocket cost for care.

All Charges