Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Major Chest Procedures With MCC

Facility

$40,115.72

Service Code	MS-DRG 163
Hospital Charge Code	40
Min. Negotiated Rate	$39,534.33
Max. Negotiated Rate	$40,115.72
Rate for Payer: Amerigroup Medicaid	$39,921.92
Rate for Payer: Iowa Total Care Managed Medicaid	$39,534.33
Rate for Payer: Molina Healthcare Managed Medicaid	$40,115.72

Major Chest Procedures Without CC/MCC

Facility

$15,899.44

Service Code	MS-DRG 165
Hospital Charge Code	42
Min. Negotiated Rate	$15,669.02
Max. Negotiated Rate	$15,899.44
Rate for Payer: Amerigroup Medicaid	$15,822.63
Rate for Payer: Iowa Total Care Managed Medicaid	$15,669.02
Rate for Payer: Molina Healthcare Managed Medicaid	$15,899.44

Major Chest Trauma With CC

Facility

$7,139.69

Service Code	MS-DRG 184
Hospital Charge Code	55
Min. Negotiated Rate	$7,036.22
Max. Negotiated Rate	$7,139.69
Rate for Payer: Amerigroup Medicaid	$7,105.20
Rate for Payer: Iowa Total Care Managed Medicaid	$7,036.22
Rate for Payer: Molina Healthcare Managed Medicaid	$7,139.69

Major Chest Trauma With MCC

Facility

$9,703.63

Service Code	MS-DRG 183
Hospital Charge Code	54
Min. Negotiated Rate	$9,563.00
Max. Negotiated Rate	$9,703.63
Rate for Payer: Amerigroup Medicaid	$9,656.75
Rate for Payer: Iowa Total Care Managed Medicaid	$9,563.00
Rate for Payer: Molina Healthcare Managed Medicaid	$9,703.63

Major Chest Trauma Without CC/MCC

Facility

$4,201.73

Service Code	MS-DRG 185
Hospital Charge Code	56
Min. Negotiated Rate	$4,140.83
Max. Negotiated Rate	$4,201.73
Rate for Payer: Amerigroup Medicaid	$4,181.43
Rate for Payer: Iowa Total Care Managed Medicaid	$4,140.83
Rate for Payer: Molina Healthcare Managed Medicaid	$4,201.73

Major Esophageal Disorders With CC

Facility

$9,620.96

Service Code	MS-DRG 369
Hospital Charge Code	210
Min. Negotiated Rate	$9,481.52
Max. Negotiated Rate	$9,620.96
Rate for Payer: Amerigroup Medicaid	$9,574.48
Rate for Payer: Iowa Total Care Managed Medicaid	$9,481.52
Rate for Payer: Molina Healthcare Managed Medicaid	$9,620.96

Major Esophageal Disorders With MCC

Facility

$16,666.16

Service Code	MS-DRG 368
Hospital Charge Code	209
Min. Negotiated Rate	$16,424.62
Max. Negotiated Rate	$16,666.16
Rate for Payer: Amerigroup Medicaid	$16,585.65
Rate for Payer: Iowa Total Care Managed Medicaid	$16,424.62
Rate for Payer: Molina Healthcare Managed Medicaid	$16,666.16

Major Esophageal Disorders Without CC/MCC

Facility

$5,174.16

Service Code	MS-DRG 370
Hospital Charge Code	211
Min. Negotiated Rate	$5,099.17
Max. Negotiated Rate	$5,174.16
Rate for Payer: Amerigroup Medicaid	$5,149.17
Rate for Payer: Iowa Total Care Managed Medicaid	$5,099.17
Rate for Payer: Molina Healthcare Managed Medicaid	$5,174.16

Major Gastrointestinal Disorders and Peritoneal Infections With CC

Facility

$8,369.01

Service Code	MS-DRG 372
Hospital Charge Code	213
Min. Negotiated Rate	$8,247.72
Max. Negotiated Rate	$8,369.01
Rate for Payer: Amerigroup Medicaid	$8,328.58
Rate for Payer: Iowa Total Care Managed Medicaid	$8,247.72
Rate for Payer: Molina Healthcare Managed Medicaid	$8,369.01

Major Gastrointestinal Disorders and Peritoneal Infections With MCC

Facility

$14,053.00

Service Code	MS-DRG 371
Hospital Charge Code	212
Min. Negotiated Rate	$13,849.34
Max. Negotiated Rate	$14,053.00
Rate for Payer: Amerigroup Medicaid	$13,985.11
Rate for Payer: Iowa Total Care Managed Medicaid	$13,849.34
Rate for Payer: Molina Healthcare Managed Medicaid	$14,053.00

Major Gastrointestinal Disorders and Peritoneal Infections Without CC/MCC

Facility

$7,807.00

Service Code	MS-DRG 373
Hospital Charge Code	214
Min. Negotiated Rate	$7,693.86
Max. Negotiated Rate	$7,807.00
Rate for Payer: Amerigroup Medicaid	$7,769.29
Rate for Payer: Iowa Total Care Managed Medicaid	$7,693.86
Rate for Payer: Molina Healthcare Managed Medicaid	$7,807.00

Major Head and Neck Procedures With CC

Facility

$15,697.67

Service Code	MS-DRG 141
Hospital Charge Code	21
Min. Negotiated Rate	$15,470.17
Max. Negotiated Rate	$15,697.67
Rate for Payer: Amerigroup Medicaid	$15,621.83
Rate for Payer: Iowa Total Care Managed Medicaid	$15,470.17
Rate for Payer: Molina Healthcare Managed Medicaid	$15,697.67

Major Head and Neck Procedures With MCC

Facility

$31,442.58

Service Code	MS-DRG 140
Hospital Charge Code	20
Min. Negotiated Rate	$30,986.89
Max. Negotiated Rate	$31,442.58
Rate for Payer: Amerigroup Medicaid	$31,290.68
Rate for Payer: Iowa Total Care Managed Medicaid	$30,986.89
Rate for Payer: Molina Healthcare Managed Medicaid	$31,442.58

Major Head and Neck Procedures Without CC/MCC

Facility

$11,016.61

Service Code	MS-DRG 142
Hospital Charge Code	22
Min. Negotiated Rate	$10,856.95
Max. Negotiated Rate	$11,016.61
Rate for Payer: Amerigroup Medicaid	$10,963.39
Rate for Payer: Iowa Total Care Managed Medicaid	$10,856.95
Rate for Payer: Molina Healthcare Managed Medicaid	$11,016.61

Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders With CC

Facility

$9,137.69

Service Code	MS-DRG 809
Hospital Charge Code	551
Min. Negotiated Rate	$9,005.26
Max. Negotiated Rate	$9,137.69
Rate for Payer: Amerigroup Medicaid	$9,093.55
Rate for Payer: Iowa Total Care Managed Medicaid	$9,005.26
Rate for Payer: Molina Healthcare Managed Medicaid	$9,137.69

Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders With MCC

Facility

$15,671.09

Service Code	MS-DRG 808
Hospital Charge Code	550
Min. Negotiated Rate	$15,443.97
Max. Negotiated Rate	$15,671.09
Rate for Payer: Amerigroup Medicaid	$15,595.38
Rate for Payer: Iowa Total Care Managed Medicaid	$15,443.97
Rate for Payer: Molina Healthcare Managed Medicaid	$15,671.09

Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders Without CC/MCC

Facility

$7,528.47

Service Code	MS-DRG 810
Hospital Charge Code	552
Min. Negotiated Rate	$7,419.36
Max. Negotiated Rate	$7,528.47
Rate for Payer: Amerigroup Medicaid	$7,492.10
Rate for Payer: Iowa Total Care Managed Medicaid	$7,419.36
Rate for Payer: Molina Healthcare Managed Medicaid	$7,528.47

Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity With MCC or Total Ankle Replacement

Facility

$25,554.84

Service Code	MS-DRG 469
Hospital Charge Code	289
Min. Negotiated Rate	$25,184.48
Max. Negotiated Rate	$25,554.84
Rate for Payer: Amerigroup Medicaid	$25,431.39
Rate for Payer: Iowa Total Care Managed Medicaid	$25,184.48
Rate for Payer: Molina Healthcare Managed Medicaid	$25,554.84

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

Facility

$19,270.47

Service Code	MS-DRG 470
Hospital Charge Code	290
Min. Negotiated Rate	$18,991.19
Max. Negotiated Rate	$19,270.47
Rate for Payer: Amerigroup Medicaid	$19,177.37
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

$22,876.73

Service Code	MS-DRG 483
Hospital Charge Code	303
Min. Negotiated Rate	$22,545.18
Max. Negotiated Rate	$22,876.73
Rate for Payer: Amerigroup Medicaid	$22,766.21
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

$15,381.72

Service Code	MS-DRG 707
Hospital Charge Code	474
Min. Negotiated Rate	$15,158.80
Max. Negotiated Rate	$15,381.72
Rate for Payer: Amerigroup Medicaid	$15,307.42
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

$12,366.01

Service Code	MS-DRG 708
Hospital Charge Code	475
Min. Negotiated Rate	$12,186.80
Max. Negotiated Rate	$12,366.01
Rate for Payer: Amerigroup Medicaid	$12,306.28
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

$19,909.24

Service Code	MS-DRG 507
Hospital Charge Code	324
Min. Negotiated Rate	$19,620.70
Max. Negotiated Rate	$19,909.24
Rate for Payer: Amerigroup Medicaid	$19,813.06
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

$13,921.11

Service Code	MS-DRG 508
Hospital Charge Code	325
Min. Negotiated Rate	$13,719.36
Max. Negotiated Rate	$13,921.11
Rate for Payer: Amerigroup Medicaid	$13,853.86
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

$19,808.84

Service Code	MS-DRG 595
Hospital Charge Code	393
Min. Negotiated Rate	$19,521.76
Max. Negotiated Rate	$19,808.84
Rate for Payer: Amerigroup Medicaid	$19,713.15
Rate for Payer: Iowa Total Care Managed Medicaid	$19,521.76
Rate for Payer: Molina Healthcare Managed Medicaid	$19,808.84

Know your out-of-pocket cost for care.

All Charges