Van Diest Medical Center

All Charges

Charge

Type

Price

Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity Without MCC

Facility IP

$19,270.47

Service Code	MS-DRG 470
Hospital Charge Code	290
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$19,270.47
Rate for Payer: Amerigroup Medicaid	$19,177.37
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$18,991.19
Rate for Payer: Molina Healthcare Managed Medicaid	$19,270.47

Major Joint or Limb Reattachment Procedures of Upper Extremities

Facility IP

$22,876.73

Service Code	MS-DRG 483
Hospital Charge Code	303
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$22,876.73
Rate for Payer: Amerigroup Medicaid	$22,766.21
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22,545.18
Rate for Payer: Molina Healthcare Managed Medicaid	$22,876.73

Major Male Pelvic Procedures With CC/MCC

Facility IP

$15,381.72

Service Code	MS-DRG 707
Hospital Charge Code	474
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$15,381.72
Rate for Payer: Amerigroup Medicaid	$15,307.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15,158.80
Rate for Payer: Molina Healthcare Managed Medicaid	$15,381.72

Major Male Pelvic Procedures Without CC/MCC

Facility IP

$12,366.01

Service Code	MS-DRG 708
Hospital Charge Code	475
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$12,366.01
Rate for Payer: Amerigroup Medicaid	$12,306.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12,186.80
Rate for Payer: Molina Healthcare Managed Medicaid	$12,366.01

Major Shoulder or Elbow Joint Procedures With CC/MCC

Facility IP

$19,909.24

Service Code	MS-DRG 507
Hospital Charge Code	324
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$19,909.24
Rate for Payer: Amerigroup Medicaid	$19,813.06
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$19,620.70
Rate for Payer: Molina Healthcare Managed Medicaid	$19,909.24

Major Shoulder or Elbow Joint Procedures Without CC/MCC

Facility IP

$13,921.11

Service Code	MS-DRG 508
Hospital Charge Code	325
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$13,921.11
Rate for Payer: Amerigroup Medicaid	$13,853.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$13,719.36
Rate for Payer: Molina Healthcare Managed Medicaid	$13,921.11

Major Skin Disorders With MCC

Facility IP

$19,808.84

Service Code	MS-DRG 595
Hospital Charge Code	393
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$19,808.84
Rate for Payer: Amerigroup Medicaid	$19,713.15
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$19,521.76
Rate for Payer: Molina Healthcare Managed Medicaid	$19,808.84

Major Skin Disorders Without MCC

Facility IP

$5,557.03

Service Code	MS-DRG 596
Hospital Charge Code	394
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$5,557.03
Rate for Payer: Amerigroup Medicaid	$5,530.18
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$5,476.49
Rate for Payer: Molina Healthcare Managed Medicaid	$5,557.03

Major Small and Large Bowel Procedures With CC

Facility IP

$20,253.72

Service Code	MS-DRG 330
Hospital Charge Code	180
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$20,253.72
Rate for Payer: Amerigroup Medicaid	$20,155.87
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$19,960.19
Rate for Payer: Molina Healthcare Managed Medicaid	$20,253.72

Major Small and Large Bowel Procedures With MCC

Facility IP

$33,213.23

Service Code	MS-DRG 329
Hospital Charge Code	179
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$33,213.23
Rate for Payer: Amerigroup Medicaid	$33,052.78
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$32,731.88
Rate for Payer: Molina Healthcare Managed Medicaid	$33,213.23

Major Small and Large Bowel Procedures Without CC/MCC

Facility IP

$14,926.02

Service Code	MS-DRG 331
Hospital Charge Code	181
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$14,926.02
Rate for Payer: Amerigroup Medicaid	$14,853.92
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$14,709.71
Rate for Payer: Molina Healthcare Managed Medicaid	$14,926.02

Major Thumb or Joint Procedures

Facility IP

$10,886.70

Service Code	MS-DRG 506
Hospital Charge Code	323
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$10,886.70
Rate for Payer: Amerigroup Medicaid	$10,834.11
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$10,728.92
Rate for Payer: Molina Healthcare Managed Medicaid	$10,886.70

Malignancy, Female Reproductive System With CC

Facility IP

$8,622.94

Service Code	MS-DRG 755
Hospital Charge Code	513
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$8,622.94
Rate for Payer: Amerigroup Medicaid	$8,581.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8,497.97
Rate for Payer: Molina Healthcare Managed Medicaid	$8,622.94

Malignancy, Female Reproductive System With MCC

Facility IP

$12,882.74

Service Code	MS-DRG 754
Hospital Charge Code	512
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$12,882.74
Rate for Payer: Amerigroup Medicaid	$12,820.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12,696.03
Rate for Payer: Molina Healthcare Managed Medicaid	$12,882.74

Malignancy, Female Reproductive System Without CC/MCC

Facility IP

$8,622.94

Service Code	MS-DRG 756
Hospital Charge Code	514
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$8,622.94
Rate for Payer: Amerigroup Medicaid	$8,581.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8,497.97
Rate for Payer: Molina Healthcare Managed Medicaid	$8,622.94

Malignancy, Male Reproductive System With CC

Facility IP

$10,722.33

Service Code	MS-DRG 723
Hospital Charge Code	487
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$10,722.33
Rate for Payer: Amerigroup Medicaid	$10,670.53
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$10,566.93
Rate for Payer: Molina Healthcare Managed Medicaid	$10,722.33

Malignancy, Male Reproductive System With MCC

Facility IP

$16,824.63

Service Code	MS-DRG 722
Hospital Charge Code	486
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$16,824.63
Rate for Payer: Amerigroup Medicaid	$16,743.35
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$16,580.79
Rate for Payer: Molina Healthcare Managed Medicaid	$16,824.63

Malignancy, Male Reproductive System Without CC/MCC

Facility IP

$6,393.63

Service Code	MS-DRG 724
Hospital Charge Code	488
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$6,393.63
Rate for Payer: Amerigroup Medicaid	$6,362.74
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,300.97
Rate for Payer: Molina Healthcare Managed Medicaid	$6,393.63

Malignancy of Hepatobiliary System or Pancreas With CC

Facility IP

$13,896.51

Service Code	MS-DRG 436
Hospital Charge Code	262
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$13,896.51
Rate for Payer: Amerigroup Medicaid	$13,829.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$13,695.11
Rate for Payer: Molina Healthcare Managed Medicaid	$13,896.51

Malignancy of Hepatobiliary System or Pancreas With MCC

Facility IP

$13,896.51

Service Code	MS-DRG 435
Hospital Charge Code	261
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$13,896.51
Rate for Payer: Amerigroup Medicaid	$13,829.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$13,695.11
Rate for Payer: Molina Healthcare Managed Medicaid	$13,896.51

Malignancy of Hepatobiliary System or Pancreas Without CC/MCC

Facility IP

$8,806.01

Service Code	MS-DRG 437
Hospital Charge Code	263
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$8,806.01
Rate for Payer: Amerigroup Medicaid	$8,763.47
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$8,678.38
Rate for Payer: Molina Healthcare Managed Medicaid	$8,806.01

Malignant Breast Disorders With CC

Facility IP

$6,127.88

Service Code	MS-DRG 598
Hospital Charge Code	396
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$6,127.88
Rate for Payer: Amerigroup Medicaid	$6,098.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,039.07
Rate for Payer: Molina Healthcare Managed Medicaid	$6,127.88

Malignant Breast Disorders With MCC

Facility IP

$16,113.01

Service Code	MS-DRG 597
Hospital Charge Code	395
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$16,113.01
Rate for Payer: Amerigroup Medicaid	$16,035.17
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15,879.49
Rate for Payer: Molina Healthcare Managed Medicaid	$16,113.01

Malignant Breast Disorders Without CC/MCC

Facility IP

$6,127.88

Service Code	MS-DRG 599
Hospital Charge Code	397
Min. Negotiated Rate	$2,034.00
Max. Negotiated Rate	$6,127.88
Rate for Payer: Amerigroup Medicaid	$6,098.28
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,034.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,039.07
Rate for Payer: Molina Healthcare Managed Medicaid	$6,127.88

MALLEOLUS IMPLANT 4.5MM X 65MM

Facility OP

$4,095.00

Service Code	CPT C1713
Hospital Charge Code	8924289
Hospital Revenue Code	278
Min. Negotiated Rate	$2,046.68
Max. Negotiated Rate	$3,685.50
Rate for Payer: Aetna of IA Commercial	$3,685.50
Rate for Payer: Aetna of IA Medical Rental Products	$3,685.50
Rate for Payer: Aetna of IA Medicare	$2,334.15
Rate for Payer: Amerigroup Medicaid	$2,066.75
Rate for Payer: Amerigroup Medicare	$2,067.98
Rate for Payer: Cash Price	$3,276.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$3,071.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$2,047.50
Rate for Payer: Iowa Total Care Managed Medicaid	$2,046.68
Rate for Payer: Medical Associates Commercial	$3,071.25
Rate for Payer: Medical Associates Managed Medicare	$2,047.50
Rate for Payer: Midlands Choice Commercial	$2,866.50
Rate for Payer: Molina Healthcare Managed Medicaid	$2,078.21
Rate for Payer: Partners Health Alliance Commercial	$3,071.25
Rate for Payer: United Healthcare Commercial	$3,685.50
Rate for Payer: United Healthcare Managed Medicare	$2,416.05

Price Transparency.

All Charges