Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

dapsone 25 mg Tab [VDMC]

Facility

$8.09

Service Code	HCPCS A9270
Hospital Charge Code	10380882
Hospital Revenue Code	259
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$7.28
Rate for Payer: Aetna of IA Commercial	$7.28
Rate for Payer: Aetna of IA Medical Rental Products	$7.28
Rate for Payer: Aetna of IA Medicare	$4.61
Rate for Payer: Amerigroup Medicaid	$4.08
Rate for Payer: Amerigroup Medicare	$4.09
Rate for Payer: Cash Price	$6.47
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.07
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.04
Rate for Payer: Iowa Total Care Managed Medicaid	$4.04
Rate for Payer: Medical Associates Commercial	$6.07
Rate for Payer: Medical Associates Managed Medicare	$4.04
Rate for Payer: Midlands Choice Commercial	$5.66
Rate for Payer: Molina Healthcare Managed Medicaid	$4.11
Rate for Payer: Molina Healthcare Managed Medicare	$4.10
Rate for Payer: Oscar Health of IA Commercial	$6.07
Rate for Payer: Partners Health Alliance Commercial	$6.07
Rate for Payer: United Healthcare Commercial	$7.28
Rate for Payer: United Healthcare Managed Medicare	$4.77

dapsone 25 mg Tab [VDMC]

Facility

$8.09

Service Code	HCPCS A9270
Hospital Charge Code	10380882
Hospital Revenue Code	259
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$7.28
Rate for Payer: Aetna of IA Commercial	$7.28
Rate for Payer: Aetna of IA Medical Rental Products	$7.28
Rate for Payer: Cash Price	$6.47
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.07
Rate for Payer: Medical Associates Commercial	$6.07
Rate for Payer: Midlands Choice Commercial	$5.66
Rate for Payer: United Healthcare Commercial	$7.28

DAPTOmycin 500 mg SDV IV Inj [VDMC]

Facility

$133.48

Service Code	HCPCS J0878
Hospital Charge Code	10380951
Hospital Revenue Code	259
Min. Negotiated Rate	$66.71
Max. Negotiated Rate	$120.13
Rate for Payer: Aetna of IA Commercial	$120.13
Rate for Payer: Aetna of IA Medical Rental Products	$120.13
Rate for Payer: Aetna of IA Medicare	$76.08
Rate for Payer: Amerigroup Medicaid	$67.37
Rate for Payer: Amerigroup Medicare	$67.41
Rate for Payer: Cash Price	$106.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$100.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$66.74
Rate for Payer: Iowa Total Care Managed Medicaid	$66.71
Rate for Payer: Medical Associates Commercial	$100.11
Rate for Payer: Medical Associates Managed Medicare	$66.74
Rate for Payer: Midlands Choice Commercial	$93.44
Rate for Payer: Molina Healthcare Managed Medicaid	$67.74
Rate for Payer: Molina Healthcare Managed Medicare	$67.70
Rate for Payer: Oscar Health of IA Commercial	$100.11
Rate for Payer: Partners Health Alliance Commercial	$100.11
Rate for Payer: United Healthcare Commercial	$120.13
Rate for Payer: United Healthcare Managed Medicare	$78.75

DAPTOmycin 500 mg SDV IV Inj [VDMC]

Facility

$133.48

Service Code	HCPCS J0878
Hospital Charge Code	10380951
Hospital Revenue Code	259
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$120.13
Rate for Payer: Aetna of IA Commercial	$120.13
Rate for Payer: Aetna of IA Medical Rental Products	$120.13
Rate for Payer: Cash Price	$106.78
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$100.11
Rate for Payer: Medical Associates Commercial	$100.11
Rate for Payer: Midlands Choice Commercial	$93.44
Rate for Payer: United Healthcare Commercial	$120.13

daratumumab-hyaluronidase 1800 mg-30,000 units/15 mL Sol SDV [VDMC]

Facility

$19,389.20

Service Code	HCPCS J9144
Hospital Charge Code	22278141
Hospital Revenue Code	259
Min. Negotiated Rate	$9,690.72
Max. Negotiated Rate	$17,450.28
Rate for Payer: Aetna of IA Commercial	$17,450.28
Rate for Payer: Aetna of IA Medical Rental Products	$17,450.28
Rate for Payer: Aetna of IA Medicare	$11,051.84
Rate for Payer: Amerigroup Medicaid	$9,785.73
Rate for Payer: Amerigroup Medicare	$9,791.55
Rate for Payer: Cash Price	$15,511.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,541.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$9,694.60
Rate for Payer: Iowa Total Care Managed Medicaid	$9,690.72
Rate for Payer: Medical Associates Commercial	$14,541.90
Rate for Payer: Medical Associates Managed Medicare	$9,694.60
Rate for Payer: Midlands Choice Commercial	$13,572.44
Rate for Payer: Molina Healthcare Managed Medicaid	$9,840.02
Rate for Payer: Molina Healthcare Managed Medicare	$9,834.20
Rate for Payer: Oscar Health of IA Commercial	$14,541.90
Rate for Payer: Partners Health Alliance Commercial	$14,541.90
Rate for Payer: United Healthcare Commercial	$17,450.28
Rate for Payer: United Healthcare Managed Medicare	$11,439.63

daratumumab-hyaluronidase 1800 mg-30,000 units/15 mL Sol SDV [VDMC]

Facility

$19,389.20

Service Code	HCPCS J9144
Hospital Charge Code	22278141
Hospital Revenue Code	259
Min. Negotiated Rate	$13,572.44
Max. Negotiated Rate	$17,450.28
Rate for Payer: Aetna of IA Commercial	$17,450.28
Rate for Payer: Aetna of IA Medical Rental Products	$17,450.28
Rate for Payer: Cash Price	$15,511.36
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14,541.90
Rate for Payer: Medical Associates Commercial	$14,541.90
Rate for Payer: Midlands Choice Commercial	$13,572.44
Rate for Payer: United Healthcare Commercial	$17,450.28

darbepoetin alfa 100 mcg/0.5ml PFS [VDMC]

Facility

$798.22

Service Code	HCPCS J0881
Hospital Charge Code	19999298
Hospital Revenue Code	259
Min. Negotiated Rate	$558.75
Max. Negotiated Rate	$718.40
Rate for Payer: Aetna of IA Commercial	$718.40
Rate for Payer: Aetna of IA Medical Rental Products	$718.40
Rate for Payer: Cash Price	$638.58
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$598.66
Rate for Payer: Medical Associates Commercial	$598.66
Rate for Payer: Midlands Choice Commercial	$558.75
Rate for Payer: United Healthcare Commercial	$718.40

darbepoetin alfa 100 mcg/0.5ml PFS [VDMC]

Facility

$798.22

Service Code	HCPCS J0881
Hospital Charge Code	19999298
Hospital Revenue Code	259
Min. Negotiated Rate	$398.95
Max. Negotiated Rate	$718.40
Rate for Payer: Aetna of IA Commercial	$718.40
Rate for Payer: Aetna of IA Medical Rental Products	$718.40
Rate for Payer: Aetna of IA Medicare	$454.99
Rate for Payer: Amerigroup Medicaid	$402.86
Rate for Payer: Amerigroup Medicare	$403.10
Rate for Payer: Cash Price	$638.58
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$598.66
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$399.11
Rate for Payer: Iowa Total Care Managed Medicaid	$398.95
Rate for Payer: Medical Associates Commercial	$598.66
Rate for Payer: Medical Associates Managed Medicare	$399.11
Rate for Payer: Midlands Choice Commercial	$558.75
Rate for Payer: Molina Healthcare Managed Medicaid	$405.10
Rate for Payer: Molina Healthcare Managed Medicare	$404.86
Rate for Payer: Oscar Health of IA Commercial	$598.66
Rate for Payer: Partners Health Alliance Commercial	$598.66
Rate for Payer: United Healthcare Commercial	$718.40
Rate for Payer: United Healthcare Managed Medicare	$470.95

darbepoetin alfa 200 mcg/0.4 mL SDV Inj [VDMC]

Facility

$3,084.66

Service Code	HCPCS J0881
Hospital Charge Code	10381018
Hospital Revenue Code	259
Min. Negotiated Rate	$1,541.71
Max. Negotiated Rate	$2,776.19
Rate for Payer: Aetna of IA Commercial	$2,776.19
Rate for Payer: Aetna of IA Medical Rental Products	$2,776.19
Rate for Payer: Aetna of IA Medicare	$1,758.26
Rate for Payer: Amerigroup Medicaid	$1,556.83
Rate for Payer: Amerigroup Medicare	$1,557.75
Rate for Payer: Cash Price	$2,467.73
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,313.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,542.33
Rate for Payer: Iowa Total Care Managed Medicaid	$1,541.71
Rate for Payer: Medical Associates Commercial	$2,313.50
Rate for Payer: Medical Associates Managed Medicare	$1,542.33
Rate for Payer: Midlands Choice Commercial	$2,159.26
Rate for Payer: Molina Healthcare Managed Medicaid	$1,565.46
Rate for Payer: Molina Healthcare Managed Medicare	$1,564.54
Rate for Payer: Oscar Health of IA Commercial	$2,313.50
Rate for Payer: Partners Health Alliance Commercial	$2,313.50
Rate for Payer: United Healthcare Commercial	$2,776.19
Rate for Payer: United Healthcare Managed Medicare	$1,819.95

darbepoetin alfa 200 mcg/0.4 mL SDV Inj [VDMC]

Facility

$3,084.66

Service Code	HCPCS J0881
Hospital Charge Code	10381018
Hospital Revenue Code	259
Min. Negotiated Rate	$2,159.26
Max. Negotiated Rate	$2,776.19
Rate for Payer: Aetna of IA Commercial	$2,776.19
Rate for Payer: Aetna of IA Medical Rental Products	$2,776.19
Rate for Payer: Cash Price	$2,467.73
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,313.50
Rate for Payer: Medical Associates Commercial	$2,313.50
Rate for Payer: Midlands Choice Commercial	$2,159.26
Rate for Payer: United Healthcare Commercial	$2,776.19

darbepoetin alfa 200 mcg/mL 1 ml SDV [VDMC]

Facility

$2,968.14

Service Code	HCPCS J0881
Hospital Charge Code	20854699
Hospital Revenue Code	259
Min. Negotiated Rate	$1,483.48
Max. Negotiated Rate	$2,671.33
Rate for Payer: Aetna of IA Commercial	$2,671.33
Rate for Payer: Aetna of IA Medical Rental Products	$2,671.33
Rate for Payer: Aetna of IA Medicare	$1,691.84
Rate for Payer: Amerigroup Medicaid	$1,498.02
Rate for Payer: Amerigroup Medicare	$1,498.91
Rate for Payer: Cash Price	$2,374.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,226.10
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,484.07
Rate for Payer: Iowa Total Care Managed Medicaid	$1,483.48
Rate for Payer: Medical Associates Commercial	$2,226.10
Rate for Payer: Medical Associates Managed Medicare	$1,484.07
Rate for Payer: Midlands Choice Commercial	$2,077.70
Rate for Payer: Molina Healthcare Managed Medicaid	$1,506.33
Rate for Payer: Molina Healthcare Managed Medicare	$1,505.44
Rate for Payer: Oscar Health of IA Commercial	$2,226.10
Rate for Payer: Partners Health Alliance Commercial	$2,226.10
Rate for Payer: United Healthcare Commercial	$2,671.33
Rate for Payer: United Healthcare Managed Medicare	$1,751.20

darbepoetin alfa 200 mcg/mL 1 ml SDV [VDMC]

Facility

$2,968.14

Service Code	HCPCS J0881
Hospital Charge Code	20854699
Hospital Revenue Code	259
Min. Negotiated Rate	$2,077.70
Max. Negotiated Rate	$2,671.33
Rate for Payer: Aetna of IA Commercial	$2,671.33
Rate for Payer: Aetna of IA Medical Rental Products	$2,671.33
Rate for Payer: Cash Price	$2,374.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,226.10
Rate for Payer: Medical Associates Commercial	$2,226.10
Rate for Payer: Midlands Choice Commercial	$2,077.70
Rate for Payer: United Healthcare Commercial	$2,671.33

darbepoetin alfa 300 mcg/0.6 mL SDS [VDMC]

Facility

$2,194.68

Service Code	HCPCS J0881
Hospital Charge Code	20945683
Hospital Revenue Code	259
Min. Negotiated Rate	$1,536.28
Max. Negotiated Rate	$1,975.21
Rate for Payer: Aetna of IA Commercial	$1,975.21
Rate for Payer: Aetna of IA Medical Rental Products	$1,975.21
Rate for Payer: Cash Price	$1,755.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,646.01
Rate for Payer: Medical Associates Commercial	$1,646.01
Rate for Payer: Midlands Choice Commercial	$1,536.28
Rate for Payer: United Healthcare Commercial	$1,975.21

darbepoetin alfa 300 mcg/0.6 mL SDS [VDMC]

Facility

$2,194.68

Service Code	HCPCS J0881
Hospital Charge Code	20945683
Hospital Revenue Code	259
Min. Negotiated Rate	$1,096.90
Max. Negotiated Rate	$1,975.21
Rate for Payer: Aetna of IA Commercial	$1,975.21
Rate for Payer: Aetna of IA Medical Rental Products	$1,975.21
Rate for Payer: Aetna of IA Medicare	$1,250.97
Rate for Payer: Amerigroup Medicaid	$1,107.65
Rate for Payer: Amerigroup Medicare	$1,108.31
Rate for Payer: Cash Price	$1,755.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,646.01
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,097.34
Rate for Payer: Iowa Total Care Managed Medicaid	$1,096.90
Rate for Payer: Medical Associates Commercial	$1,646.01
Rate for Payer: Medical Associates Managed Medicare	$1,097.34
Rate for Payer: Midlands Choice Commercial	$1,536.28
Rate for Payer: Molina Healthcare Managed Medicaid	$1,113.80
Rate for Payer: Molina Healthcare Managed Medicare	$1,113.14
Rate for Payer: Oscar Health of IA Commercial	$1,646.01
Rate for Payer: Partners Health Alliance Commercial	$1,646.01
Rate for Payer: United Healthcare Commercial	$1,975.21
Rate for Payer: United Healthcare Managed Medicare	$1,294.86

DAT POLY TUBE

Facility

$58.00

Service Code	CPT 86880
Hospital Charge Code	7912827
Hospital Revenue Code	302
Min. Negotiated Rate	$28.99
Max. Negotiated Rate	$107.07
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Aetna of IA Medicare	$33.06
Rate for Payer: Amerigroup Medicaid	$29.27
Rate for Payer: Amerigroup Medicare	$29.29
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$29.00
Rate for Payer: Iowa Total Care Managed Medicaid	$28.99
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Medical Associates Managed Medicare	$29.00
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: Molina Healthcare Managed Medicaid	$29.44
Rate for Payer: Molina Healthcare Managed Medicare	$29.42
Rate for Payer: Oscar Health of IA Commercial	$43.50
Rate for Payer: Partners Health Alliance Commercial	$43.50
Rate for Payer: United Healthcare Commercial	$52.20
Rate for Payer: United Healthcare Managed Medicare	$34.22
Rate for Payer: Wellmark IA HMO	$97.34
Rate for Payer: Wellmark IA PPO	$107.07

DAT POLY TUBE

Facility

$58.00

Service Code	CPT 86880
Hospital Charge Code	7912827
Hospital Revenue Code	302
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of IA Commercial	$52.20
Rate for Payer: Aetna of IA Medical Rental Products	$52.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$43.50
Rate for Payer: Medical Associates Commercial	$43.50
Rate for Payer: Midlands Choice Commercial	$40.60
Rate for Payer: United Healthcare Commercial	$52.20

DBL LOADED 4.75MM BIO-COM SWVLK

Facility

$1,073.00

Service Code	CPT C1713
Hospital Charge Code	8760621
Hospital Revenue Code	278
Min. Negotiated Rate	$751.10
Max. Negotiated Rate	$965.70
Rate for Payer: Aetna of IA Commercial	$965.70
Rate for Payer: Aetna of IA Medical Rental Products	$965.70
Rate for Payer: Cash Price	$858.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$804.75
Rate for Payer: Medical Associates Commercial	$804.75
Rate for Payer: Midlands Choice Commercial	$751.10
Rate for Payer: United Healthcare Commercial	$965.70

DBL LOADED 4.75MM BIO-COM SWVLK

Facility

$1,073.00

Service Code	CPT C1713
Hospital Charge Code	8760621
Hospital Revenue Code	278
Min. Negotiated Rate	$536.29
Max. Negotiated Rate	$965.70
Rate for Payer: Aetna of IA Commercial	$965.70
Rate for Payer: Aetna of IA Medical Rental Products	$965.70
Rate for Payer: Aetna of IA Medicare	$611.61
Rate for Payer: Amerigroup Medicaid	$541.54
Rate for Payer: Amerigroup Medicare	$541.86
Rate for Payer: Cash Price	$858.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$804.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$536.50
Rate for Payer: Iowa Total Care Managed Medicaid	$536.29
Rate for Payer: Medical Associates Commercial	$804.75
Rate for Payer: Medical Associates Managed Medicare	$536.50
Rate for Payer: Midlands Choice Commercial	$751.10
Rate for Payer: Molina Healthcare Managed Medicaid	$544.55
Rate for Payer: Molina Healthcare Managed Medicare	$544.23
Rate for Payer: Oscar Health of IA Commercial	$804.75
Rate for Payer: Partners Health Alliance Commercial	$804.75
Rate for Payer: United Healthcare Commercial	$965.70
Rate for Payer: United Healthcare Managed Medicare	$633.07

D&C, Conization, Laparoscopy and Tubal Interruption With CC/MCC

Facility

$9,226.28

Service Code	MS-DRG 744
Hospital Charge Code	505
Min. Negotiated Rate	$9,092.57
Max. Negotiated Rate	$9,226.28
Rate for Payer: Amerigroup Medicaid	$9,181.71
Rate for Payer: Iowa Total Care Managed Medicaid	$9,092.57
Rate for Payer: Molina Healthcare Managed Medicaid	$9,226.28

D&C, Conization, Laparoscopy and Tubal Interruption Without CC/MCC

Facility

$9,226.28

Service Code	MS-DRG 745
Hospital Charge Code	506
Min. Negotiated Rate	$9,092.57
Max. Negotiated Rate	$9,226.28
Rate for Payer: Amerigroup Medicaid	$9,181.71
Rate for Payer: Iowa Total Care Managed Medicaid	$9,092.57
Rate for Payer: Molina Healthcare Managed Medicaid	$9,226.28

DDIMER

Facility

$77.00

Service Code	CPT 85379
Hospital Charge Code	8057341
Hospital Revenue Code	305
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Aetna of IA Medicare	$43.89
Rate for Payer: Amerigroup Medicaid	$38.86
Rate for Payer: Amerigroup Medicare	$38.88
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.50
Rate for Payer: Iowa Total Care Managed Medicaid	$38.48
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Medical Associates Managed Medicare	$38.50
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: Molina Healthcare Managed Medicaid	$39.08
Rate for Payer: Molina Healthcare Managed Medicare	$39.05
Rate for Payer: Oscar Health of IA Commercial	$57.75
Rate for Payer: Partners Health Alliance Commercial	$57.75
Rate for Payer: United Healthcare Commercial	$69.30
Rate for Payer: United Healthcare Managed Medicare	$45.43
Rate for Payer: Wellmark IA HMO	$24.18
Rate for Payer: Wellmark IA PPO	$26.60

DDIMER

Facility

$77.00

Service Code	CPT 85379
Hospital Charge Code	633718
Hospital Revenue Code	305
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: United Healthcare Commercial	$69.30

DDIMER

Facility

$77.00

Service Code	CPT 85379
Hospital Charge Code	8057341
Hospital Revenue Code	305
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: United Healthcare Commercial	$69.30

DDIMER

Facility

$77.00

Service Code	CPT 85379
Hospital Charge Code	633718
Hospital Revenue Code	305
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of IA Commercial	$69.30
Rate for Payer: Aetna of IA Medical Rental Products	$69.30
Rate for Payer: Aetna of IA Medicare	$43.89
Rate for Payer: Amerigroup Medicaid	$38.86
Rate for Payer: Amerigroup Medicare	$38.88
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$57.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$38.50
Rate for Payer: Iowa Total Care Managed Medicaid	$38.48
Rate for Payer: Medical Associates Commercial	$57.75
Rate for Payer: Medical Associates Managed Medicare	$38.50
Rate for Payer: Midlands Choice Commercial	$53.90
Rate for Payer: Molina Healthcare Managed Medicaid	$39.08
Rate for Payer: Molina Healthcare Managed Medicare	$39.05
Rate for Payer: Oscar Health of IA Commercial	$57.75
Rate for Payer: Partners Health Alliance Commercial	$57.75
Rate for Payer: United Healthcare Commercial	$69.30
Rate for Payer: United Healthcare Managed Medicare	$45.43
Rate for Payer: Wellmark IA HMO	$24.18
Rate for Payer: Wellmark IA PPO	$26.60

Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less

Facility

$3,510.94

Service Code	CPT 11044
Hospital Revenue Code	360
Min. Negotiated Rate	$3,191.76
Max. Negotiated Rate	$3,510.94
Rate for Payer: Wellmark IA HMO	$3,191.76
Rate for Payer: Wellmark IA PPO	$3,510.94

Know your out-of-pocket cost for care.

All Charges