Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Magic Mouthwash [VDMC]

Facility

$167.52

Service Code	HCPCS A9270GY
Hospital Charge Code	20213408
Hospital Revenue Code	259
Min. Negotiated Rate	$83.73
Max. Negotiated Rate	$150.77
Rate for Payer: Aetna of IA Commercial	$150.77
Rate for Payer: Aetna of IA Medical Rental Products	$150.77
Rate for Payer: Aetna of IA Medicare	$95.49
Rate for Payer: Amerigroup Medicaid	$84.55
Rate for Payer: Amerigroup Medicare	$84.60
Rate for Payer: Cash Price	$134.02
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$125.64
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$83.76
Rate for Payer: Iowa Total Care Managed Medicaid	$83.73
Rate for Payer: Medical Associates Commercial	$125.64
Rate for Payer: Medical Associates Managed Medicare	$83.76
Rate for Payer: Midlands Choice Commercial	$117.26
Rate for Payer: Molina Healthcare Managed Medicaid	$85.02
Rate for Payer: Molina Healthcare Managed Medicare	$84.97
Rate for Payer: Oscar Health of IA Commercial	$125.64
Rate for Payer: Partners Health Alliance Commercial	$125.64
Rate for Payer: United Healthcare Commercial	$150.77
Rate for Payer: United Healthcare Managed Medicare	$98.84

MAGNESIUM

Facility

$64.00

Service Code	CPT 83735
Hospital Charge Code	633781
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: United Healthcare Commercial	$57.60

MAGNESIUM

Facility

$64.00

Service Code	CPT 83735
Hospital Charge Code	633781
Hospital Revenue Code	301
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of IA Commercial	$57.60
Rate for Payer: Aetna of IA Medical Rental Products	$57.60
Rate for Payer: Aetna of IA Medicare	$36.48
Rate for Payer: Amerigroup Medicaid	$32.30
Rate for Payer: Amerigroup Medicare	$32.32
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$48.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$32.00
Rate for Payer: Iowa Total Care Managed Medicaid	$31.99
Rate for Payer: Medical Associates Commercial	$48.00
Rate for Payer: Medical Associates Managed Medicare	$32.00
Rate for Payer: Midlands Choice Commercial	$44.80
Rate for Payer: Molina Healthcare Managed Medicaid	$32.48
Rate for Payer: Molina Healthcare Managed Medicare	$32.46
Rate for Payer: Oscar Health of IA Commercial	$48.00
Rate for Payer: Partners Health Alliance Commercial	$48.00
Rate for Payer: United Healthcare Commercial	$57.60
Rate for Payer: United Healthcare Managed Medicare	$37.76
Rate for Payer: Wellmark IA HMO	$20.46
Rate for Payer: Wellmark IA PPO	$22.51

magnesium chloride DR 64 mg Tab [VDMC]

Facility

$1.28

Service Code	HCPCS A9270
Hospital Charge Code	10373307
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of IA Commercial	$1.15
Rate for Payer: Aetna of IA Medical Rental Products	$1.15
Rate for Payer: Cash Price	$1.02
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.96
Rate for Payer: Medical Associates Commercial	$0.96
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: United Healthcare Commercial	$1.15

magnesium chloride DR 64 mg Tab [VDMC]

Facility

$1.28

Service Code	HCPCS A9270
Hospital Charge Code	10373307
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of IA Commercial	$1.15
Rate for Payer: Aetna of IA Medical Rental Products	$1.15
Rate for Payer: Aetna of IA Medicare	$0.73
Rate for Payer: Amerigroup Medicaid	$0.65
Rate for Payer: Amerigroup Medicare	$0.65
Rate for Payer: Cash Price	$1.02
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.96
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.64
Rate for Payer: Iowa Total Care Managed Medicaid	$0.64
Rate for Payer: Medical Associates Commercial	$0.96
Rate for Payer: Medical Associates Managed Medicare	$0.64
Rate for Payer: Midlands Choice Commercial	$0.90
Rate for Payer: Molina Healthcare Managed Medicaid	$0.65
Rate for Payer: Molina Healthcare Managed Medicare	$0.65
Rate for Payer: Oscar Health of IA Commercial	$0.96
Rate for Payer: Partners Health Alliance Commercial	$0.96
Rate for Payer: United Healthcare Commercial	$1.15
Rate for Payer: United Healthcare Managed Medicare	$0.76

magnesium citrate 8.85% Oral Liq 296 mL [VDMC]

Facility

$13.16

Service Code	HCPCS A9270
Hospital Charge Code	10435641
Hospital Revenue Code	259
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$11.84
Rate for Payer: Aetna of IA Commercial	$11.84
Rate for Payer: Aetna of IA Medical Rental Products	$11.84
Rate for Payer: Aetna of IA Medicare	$7.50
Rate for Payer: Amerigroup Medicaid	$6.64
Rate for Payer: Amerigroup Medicare	$6.65
Rate for Payer: Cash Price	$10.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.87
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.58
Rate for Payer: Iowa Total Care Managed Medicaid	$6.58
Rate for Payer: Medical Associates Commercial	$9.87
Rate for Payer: Medical Associates Managed Medicare	$6.58
Rate for Payer: Midlands Choice Commercial	$9.21
Rate for Payer: Molina Healthcare Managed Medicaid	$6.68
Rate for Payer: Molina Healthcare Managed Medicare	$6.67
Rate for Payer: Oscar Health of IA Commercial	$9.87
Rate for Payer: Partners Health Alliance Commercial	$9.87
Rate for Payer: United Healthcare Commercial	$11.84
Rate for Payer: United Healthcare Managed Medicare	$7.76

magnesium citrate 8.85% Oral Liq 296 mL [VDMC]

Facility

$13.16

Service Code	HCPCS A9270
Hospital Charge Code	10435641
Hospital Revenue Code	259
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$11.84
Rate for Payer: Aetna of IA Commercial	$11.84
Rate for Payer: Aetna of IA Medical Rental Products	$11.84
Rate for Payer: Cash Price	$10.53
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.87
Rate for Payer: Medical Associates Commercial	$9.87
Rate for Payer: Midlands Choice Commercial	$9.21
Rate for Payer: United Healthcare Commercial	$11.84

magnesium hydroxide 24% Oral Conc 10 mL [VDMC]

Facility

$8.98

Service Code	HCPCS A9270
Hospital Charge Code	10435706
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$8.08
Rate for Payer: Aetna of IA Commercial	$8.08
Rate for Payer: Aetna of IA Medical Rental Products	$8.08
Rate for Payer: Aetna of IA Medicare	$5.12
Rate for Payer: Amerigroup Medicaid	$4.53
Rate for Payer: Amerigroup Medicare	$4.53
Rate for Payer: Cash Price	$7.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.74
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$4.49
Rate for Payer: Iowa Total Care Managed Medicaid	$4.49
Rate for Payer: Medical Associates Commercial	$6.74
Rate for Payer: Medical Associates Managed Medicare	$4.49
Rate for Payer: Midlands Choice Commercial	$6.29
Rate for Payer: Molina Healthcare Managed Medicaid	$4.56
Rate for Payer: Molina Healthcare Managed Medicare	$4.55
Rate for Payer: Oscar Health of IA Commercial	$6.74
Rate for Payer: Partners Health Alliance Commercial	$6.74
Rate for Payer: United Healthcare Commercial	$8.08
Rate for Payer: United Healthcare Managed Medicare	$5.30

magnesium hydroxide 24% Oral Conc 10 mL [VDMC]

Facility

$8.98

Service Code	HCPCS A9270
Hospital Charge Code	10435706
Hospital Revenue Code	259
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$8.08
Rate for Payer: Aetna of IA Commercial	$8.08
Rate for Payer: Aetna of IA Medical Rental Products	$8.08
Rate for Payer: Cash Price	$7.19
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$6.74
Rate for Payer: Medical Associates Commercial	$6.74
Rate for Payer: Midlands Choice Commercial	$6.29
Rate for Payer: United Healthcare Commercial	$8.08

magnesium oxide 400 mg Tab [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10402061
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Aetna of IA Medicare	$0.63
Rate for Payer: Amerigroup Medicaid	$0.56
Rate for Payer: Amerigroup Medicare	$0.56
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.56
Rate for Payer: Iowa Total Care Managed Medicaid	$0.55
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Medical Associates Managed Medicare	$0.56
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: Molina Healthcare Managed Medicaid	$0.56
Rate for Payer: Molina Healthcare Managed Medicare	$0.56
Rate for Payer: Oscar Health of IA Commercial	$0.83
Rate for Payer: Partners Health Alliance Commercial	$0.83
Rate for Payer: United Healthcare Commercial	$1.00
Rate for Payer: United Healthcare Managed Medicare	$0.65

magnesium oxide 400 mg Tab [VDMC]

Facility

$1.11

Service Code	HCPCS A9270
Hospital Charge Code	10402061
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of IA Commercial	$1.00
Rate for Payer: Aetna of IA Medical Rental Products	$1.00
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.83
Rate for Payer: Medical Associates Commercial	$0.83
Rate for Payer: Midlands Choice Commercial	$0.78
Rate for Payer: United Healthcare Commercial	$1.00

magnesium sulfate 10 mg/mL-D5% 100ml]VDMC]

Facility

$79.95

Service Code	HCPCS J3475
Hospital Charge Code	14145942
Hospital Revenue Code	259
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$71.96
Rate for Payer: Aetna of IA Commercial	$71.96
Rate for Payer: Aetna of IA Medical Rental Products	$71.96
Rate for Payer: Aetna of IA Medicare	$45.57
Rate for Payer: Amerigroup Medicaid	$40.35
Rate for Payer: Amerigroup Medicare	$40.37
Rate for Payer: Cash Price	$63.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$59.96
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$39.98
Rate for Payer: Iowa Total Care Managed Medicaid	$39.96
Rate for Payer: Medical Associates Commercial	$59.96
Rate for Payer: Medical Associates Managed Medicare	$39.98
Rate for Payer: Midlands Choice Commercial	$55.96
Rate for Payer: Molina Healthcare Managed Medicaid	$40.57
Rate for Payer: Molina Healthcare Managed Medicare	$40.55
Rate for Payer: Oscar Health of IA Commercial	$59.96
Rate for Payer: Partners Health Alliance Commercial	$59.96
Rate for Payer: United Healthcare Commercial	$71.96
Rate for Payer: United Healthcare Managed Medicare	$47.17

magnesium sulfate 10 mg/mL-D5% 100ml]VDMC]

Facility

$79.95

Service Code	HCPCS J3475
Hospital Charge Code	14145942
Hospital Revenue Code	259
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$71.96
Rate for Payer: Aetna of IA Commercial	$71.96
Rate for Payer: Aetna of IA Medical Rental Products	$71.96
Rate for Payer: Cash Price	$63.96
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$59.96
Rate for Payer: Medical Associates Commercial	$59.96
Rate for Payer: Midlands Choice Commercial	$55.96
Rate for Payer: United Healthcare Commercial	$71.96

magnesium sulfate 2 g/50 mL-sterile water 50ml [VDMC]

Facility

$111.63

Service Code	HCPCS J3475
Hospital Charge Code	27167226
Hospital Revenue Code	259
Min. Negotiated Rate	$55.79
Max. Negotiated Rate	$100.47
Rate for Payer: Aetna of IA Commercial	$100.47
Rate for Payer: Aetna of IA Medical Rental Products	$100.47
Rate for Payer: Aetna of IA Medicare	$63.63
Rate for Payer: Amerigroup Medicaid	$56.34
Rate for Payer: Amerigroup Medicare	$56.37
Rate for Payer: Cash Price	$89.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.72
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$55.82
Rate for Payer: Iowa Total Care Managed Medicaid	$55.79
Rate for Payer: Medical Associates Commercial	$83.72
Rate for Payer: Medical Associates Managed Medicare	$55.82
Rate for Payer: Midlands Choice Commercial	$78.14
Rate for Payer: Molina Healthcare Managed Medicaid	$56.65
Rate for Payer: Molina Healthcare Managed Medicare	$56.62
Rate for Payer: Oscar Health of IA Commercial	$83.72
Rate for Payer: Partners Health Alliance Commercial	$83.72
Rate for Payer: United Healthcare Commercial	$100.47
Rate for Payer: United Healthcare Managed Medicare	$65.86

magnesium sulfate 2 g/50 mL-sterile water 50ml [VDMC]

Facility

$111.63

Service Code	HCPCS J3475
Hospital Charge Code	27167226
Hospital Revenue Code	259
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$100.47
Rate for Payer: Aetna of IA Commercial	$100.47
Rate for Payer: Aetna of IA Medical Rental Products	$100.47
Rate for Payer: Cash Price	$89.30
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$83.72
Rate for Payer: Medical Associates Commercial	$83.72
Rate for Payer: Midlands Choice Commercial	$78.14
Rate for Payer: United Healthcare Commercial	$100.47

magnesium sulfate 40 mg/mL 1000ml bag [VDMC]

Facility

$83.80

Service Code	HCPCS J3475
Hospital Charge Code	10402201
Hospital Revenue Code	259
Min. Negotiated Rate	$58.66
Max. Negotiated Rate	$75.42
Rate for Payer: Aetna of IA Commercial	$75.42
Rate for Payer: Aetna of IA Medical Rental Products	$75.42
Rate for Payer: Cash Price	$67.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.85
Rate for Payer: Medical Associates Commercial	$62.85
Rate for Payer: Midlands Choice Commercial	$58.66
Rate for Payer: United Healthcare Commercial	$75.42

magnesium sulfate 40 mg/mL 1000ml bag [VDMC]

Facility

$83.80

Service Code	HCPCS J3475
Hospital Charge Code	10402201
Hospital Revenue Code	259
Min. Negotiated Rate	$41.88
Max. Negotiated Rate	$75.42
Rate for Payer: Aetna of IA Commercial	$75.42
Rate for Payer: Aetna of IA Medical Rental Products	$75.42
Rate for Payer: Aetna of IA Medicare	$47.77
Rate for Payer: Amerigroup Medicaid	$42.29
Rate for Payer: Amerigroup Medicare	$42.32
Rate for Payer: Cash Price	$67.04
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$62.85
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$41.90
Rate for Payer: Iowa Total Care Managed Medicaid	$41.88
Rate for Payer: Medical Associates Commercial	$62.85
Rate for Payer: Medical Associates Managed Medicare	$41.90
Rate for Payer: Midlands Choice Commercial	$58.66
Rate for Payer: Molina Healthcare Managed Medicaid	$42.53
Rate for Payer: Molina Healthcare Managed Medicare	$42.50
Rate for Payer: Oscar Health of IA Commercial	$62.85
Rate for Payer: Partners Health Alliance Commercial	$62.85
Rate for Payer: United Healthcare Commercial	$75.42
Rate for Payer: United Healthcare Managed Medicare	$49.44

magnesium sulfate 50% 5gm/10ml SDV [VDMC]

Facility

$24.21

Service Code	HCPCS J3475
Hospital Charge Code	22490376
Hospital Revenue Code	259
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$21.79
Rate for Payer: Aetna of IA Commercial	$21.79
Rate for Payer: Aetna of IA Medical Rental Products	$21.79
Rate for Payer: Cash Price	$19.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.16
Rate for Payer: Medical Associates Commercial	$18.16
Rate for Payer: Midlands Choice Commercial	$16.95
Rate for Payer: United Healthcare Commercial	$21.79

magnesium sulfate 50% 5gm/10ml SDV [VDMC]

Facility

$24.21

Service Code	HCPCS J3475
Hospital Charge Code	22490376
Hospital Revenue Code	259
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$21.79
Rate for Payer: Aetna of IA Commercial	$21.79
Rate for Payer: Aetna of IA Medical Rental Products	$21.79
Rate for Payer: Aetna of IA Medicare	$13.80
Rate for Payer: Amerigroup Medicaid	$12.22
Rate for Payer: Amerigroup Medicare	$12.23
Rate for Payer: Cash Price	$19.37
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.10
Rate for Payer: Iowa Total Care Managed Medicaid	$12.10
Rate for Payer: Medical Associates Commercial	$18.16
Rate for Payer: Medical Associates Managed Medicare	$12.10
Rate for Payer: Midlands Choice Commercial	$16.95
Rate for Payer: Molina Healthcare Managed Medicaid	$12.29
Rate for Payer: Molina Healthcare Managed Medicare	$12.28
Rate for Payer: Oscar Health of IA Commercial	$18.16
Rate for Payer: Partners Health Alliance Commercial	$18.16
Rate for Payer: United Healthcare Commercial	$21.79
Rate for Payer: United Healthcare Managed Medicare	$14.28

magnesium sulfate 50% Inj Sol 2 mL SDV [VDMC]

Facility

$24.23

Service Code	HCPCS J3475
Hospital Charge Code	10435773
Hospital Revenue Code	259
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$21.81
Rate for Payer: Aetna of IA Commercial	$21.81
Rate for Payer: Aetna of IA Medical Rental Products	$21.81
Rate for Payer: Aetna of IA Medicare	$13.81
Rate for Payer: Amerigroup Medicaid	$12.23
Rate for Payer: Amerigroup Medicare	$12.24
Rate for Payer: Cash Price	$19.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.17
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.12
Rate for Payer: Iowa Total Care Managed Medicaid	$12.11
Rate for Payer: Medical Associates Commercial	$18.17
Rate for Payer: Medical Associates Managed Medicare	$12.12
Rate for Payer: Midlands Choice Commercial	$16.96
Rate for Payer: Molina Healthcare Managed Medicaid	$12.30
Rate for Payer: Molina Healthcare Managed Medicare	$12.29
Rate for Payer: Oscar Health of IA Commercial	$18.17
Rate for Payer: Partners Health Alliance Commercial	$18.17
Rate for Payer: United Healthcare Commercial	$21.81
Rate for Payer: United Healthcare Managed Medicare	$14.30

magnesium sulfate 50% Inj Sol 2 mL SDV [VDMC]

Facility

$24.23

Service Code	HCPCS J3475
Hospital Charge Code	10435773
Hospital Revenue Code	259
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$21.81
Rate for Payer: Aetna of IA Commercial	$21.81
Rate for Payer: Aetna of IA Medical Rental Products	$21.81
Rate for Payer: Cash Price	$19.39
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.17
Rate for Payer: Medical Associates Commercial	$18.17
Rate for Payer: Midlands Choice Commercial	$16.96
Rate for Payer: United Healthcare Commercial	$21.81

Major Bladder Procedures With CC

Facility

$20,862.97

Service Code	MS-DRG 654
Hospital Charge Code	436
Min. Negotiated Rate	$20,560.61
Max. Negotiated Rate	$20,862.97
Rate for Payer: Amerigroup Medicaid	$20,762.18
Rate for Payer: Iowa Total Care Managed Medicaid	$20,560.61
Rate for Payer: Molina Healthcare Managed Medicaid	$20,862.97

Major Bladder Procedures With MCC

Facility

$33,097.09

Service Code	MS-DRG 653
Hospital Charge Code	435
Min. Negotiated Rate	$32,617.42
Max. Negotiated Rate	$33,097.09
Rate for Payer: Amerigroup Medicaid	$32,937.20
Rate for Payer: Iowa Total Care Managed Medicaid	$32,617.42
Rate for Payer: Molina Healthcare Managed Medicaid	$33,097.09

Major Bladder Procedures Without CC/MCC

Facility

$20,862.97

Service Code	MS-DRG 655
Hospital Charge Code	437
Min. Negotiated Rate	$20,560.61
Max. Negotiated Rate	$20,862.97
Rate for Payer: Amerigroup Medicaid	$20,762.18
Rate for Payer: Iowa Total Care Managed Medicaid	$20,560.61
Rate for Payer: Molina Healthcare Managed Medicaid	$20,862.97

Major Chest Procedures With CC

Facility

$22,081.46

Service Code	MS-DRG 164
Hospital Charge Code	41
Min. Negotiated Rate	$21,761.43
Max. Negotiated Rate	$22,081.46
Rate for Payer: Amerigroup Medicaid	$21,974.78
Rate for Payer: Iowa Total Care Managed Medicaid	$21,761.43
Rate for Payer: Molina Healthcare Managed Medicaid	$22,081.46

Know your out-of-pocket cost for care.

All Charges