Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$18,189.03

Service Code	MSDRG 165
Min. Negotiated Rate	$17,925.42
Max. Negotiated Rate	$18,189.03
Rate for Payer: Amerigroup Medicaid	$18,101.15
Rate for Payer: Iowa Total Care Managed Medicaid	$17,925.42
Rate for Payer: Molina Healthcare Managed Medicaid	$18,189.03

MAJOR CHEST TRAUMA WITH CC

Facility

$8,167.84

Service Code	MSDRG 184
Min. Negotiated Rate	$8,049.46
Max. Negotiated Rate	$8,167.84
Rate for Payer: Amerigroup Medicaid	$8,128.38
Rate for Payer: Iowa Total Care Managed Medicaid	$8,049.46
Rate for Payer: Molina Healthcare Managed Medicaid	$8,167.84

MAJOR CHEST TRAUMA WITH MCC

Facility

$11,101.01

Service Code	MSDRG 183
Min. Negotiated Rate	$10,940.12
Max. Negotiated Rate	$11,101.01
Rate for Payer: Amerigroup Medicaid	$11,047.37
Rate for Payer: Iowa Total Care Managed Medicaid	$10,940.12
Rate for Payer: Molina Healthcare Managed Medicaid	$11,101.01

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$4,806.80

Service Code	MSDRG 185
Min. Negotiated Rate	$4,737.13
Max. Negotiated Rate	$4,806.80
Rate for Payer: Amerigroup Medicaid	$4,783.57
Rate for Payer: Iowa Total Care Managed Medicaid	$4,737.13
Rate for Payer: Molina Healthcare Managed Medicaid	$4,806.80

MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$11,006.43

Service Code	MSDRG 369
Min. Negotiated Rate	$10,846.91
Max. Negotiated Rate	$11,006.43
Rate for Payer: Amerigroup Medicaid	$10,953.25
Rate for Payer: Iowa Total Care Managed Medicaid	$10,846.91
Rate for Payer: Molina Healthcare Managed Medicaid	$11,006.43

MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$19,066.17

Service Code	MSDRG 368
Min. Negotiated Rate	$18,789.84
Max. Negotiated Rate	$19,066.17
Rate for Payer: Amerigroup Medicaid	$18,974.05
Rate for Payer: Iowa Total Care Managed Medicaid	$18,789.84
Rate for Payer: Molina Healthcare Managed Medicaid	$19,066.17

MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$5,919.26

Service Code	MSDRG 370
Min. Negotiated Rate	$5,833.47
Max. Negotiated Rate	$5,919.26
Rate for Payer: Amerigroup Medicaid	$5,890.66
Rate for Payer: Iowa Total Care Managed Medicaid	$5,833.47
Rate for Payer: Molina Healthcare Managed Medicaid	$5,919.26

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$9,574.18

Service Code	MSDRG 372
Min. Negotiated Rate	$9,435.42
Max. Negotiated Rate	$9,574.18
Rate for Payer: Amerigroup Medicaid	$9,527.93
Rate for Payer: Iowa Total Care Managed Medicaid	$9,435.42
Rate for Payer: Molina Healthcare Managed Medicaid	$9,574.18

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$16,076.70

Service Code	MSDRG 371
Min. Negotiated Rate	$15,843.70
Max. Negotiated Rate	$16,076.70
Rate for Payer: Amerigroup Medicaid	$15,999.03
Rate for Payer: Iowa Total Care Managed Medicaid	$15,843.70
Rate for Payer: Molina Healthcare Managed Medicaid	$16,076.70

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$8,931.25

Service Code	MSDRG 373
Min. Negotiated Rate	$8,801.81
Max. Negotiated Rate	$8,931.25
Rate for Payer: Amerigroup Medicaid	$8,888.10
Rate for Payer: Iowa Total Care Managed Medicaid	$8,801.81
Rate for Payer: Molina Healthcare Managed Medicaid	$8,931.25

MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$17,958.21

Service Code	MSDRG 141
Min. Negotiated Rate	$17,697.94
Max. Negotiated Rate	$17,958.21
Rate for Payer: Amerigroup Medicaid	$17,871.44
Rate for Payer: Iowa Total Care Managed Medicaid	$17,697.94
Rate for Payer: Molina Healthcare Managed Medicaid	$17,958.21

MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$35,970.46

Service Code	MSDRG 140
Min. Negotiated Rate	$35,449.13
Max. Negotiated Rate	$35,970.46
Rate for Payer: Amerigroup Medicaid	$35,796.68
Rate for Payer: Iowa Total Care Managed Medicaid	$35,449.13
Rate for Payer: Molina Healthcare Managed Medicaid	$35,970.46

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$12,603.06

Service Code	MSDRG 142
Min. Negotiated Rate	$12,420.40
Max. Negotiated Rate	$12,603.06
Rate for Payer: Amerigroup Medicaid	$12,542.17
Rate for Payer: Iowa Total Care Managed Medicaid	$12,420.40
Rate for Payer: Molina Healthcare Managed Medicaid	$12,603.06

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$10,453.57

Service Code	MSDRG 809
Min. Negotiated Rate	$10,302.06
Max. Negotiated Rate	$10,453.57
Rate for Payer: Amerigroup Medicaid	$10,403.07
Rate for Payer: Iowa Total Care Managed Medicaid	$10,302.06
Rate for Payer: Molina Healthcare Managed Medicaid	$10,453.57

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$17,927.81

Service Code	MSDRG 808
Min. Negotiated Rate	$17,667.97
Max. Negotiated Rate	$17,927.81
Rate for Payer: Amerigroup Medicaid	$17,841.19
Rate for Payer: Iowa Total Care Managed Medicaid	$17,667.97
Rate for Payer: Molina Healthcare Managed Medicaid	$17,927.81

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$8,612.60

Service Code	MSDRG 810
Min. Negotiated Rate	$8,487.77
Max. Negotiated Rate	$8,612.60
Rate for Payer: Amerigroup Medicaid	$8,570.99
Rate for Payer: Iowa Total Care Managed Medicaid	$8,487.77
Rate for Payer: Molina Healthcare Managed Medicaid	$8,612.60

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$29,234.87

Service Code	MSDRG 469
Min. Negotiated Rate	$28,811.16
Max. Negotiated Rate	$29,234.87
Rate for Payer: Amerigroup Medicaid	$29,093.62
Rate for Payer: Iowa Total Care Managed Medicaid	$28,811.16
Rate for Payer: Molina Healthcare Managed Medicaid	$29,234.87

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$22,045.50

Service Code	MSDRG 470
Min. Negotiated Rate	$21,725.99
Max. Negotiated Rate	$22,045.50
Rate for Payer: Amerigroup Medicaid	$21,938.99
Rate for Payer: Iowa Total Care Managed Medicaid	$21,725.99
Rate for Payer: Molina Healthcare Managed Medicaid	$22,045.50

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$26,171.08

Service Code	MSDRG 483
Min. Negotiated Rate	$25,791.78
Max. Negotiated Rate	$26,171.08
Rate for Payer: Amerigroup Medicaid	$26,044.64
Rate for Payer: Iowa Total Care Managed Medicaid	$25,791.78
Rate for Payer: Molina Healthcare Managed Medicaid	$26,171.08

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$17,596.77

Service Code	MSDRG 707
Min. Negotiated Rate	$17,341.74
Max. Negotiated Rate	$17,596.77
Rate for Payer: Amerigroup Medicaid	$17,511.75
Rate for Payer: Iowa Total Care Managed Medicaid	$17,341.74
Rate for Payer: Molina Healthcare Managed Medicaid	$17,596.77

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$14,146.78

Service Code	MSDRG 708
Min. Negotiated Rate	$13,941.74
Max. Negotiated Rate	$14,146.78
Rate for Payer: Amerigroup Medicaid	$14,078.43
Rate for Payer: Iowa Total Care Managed Medicaid	$13,941.74
Rate for Payer: Molina Healthcare Managed Medicaid	$14,146.78

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$22,776.26

Service Code	MSDRG 507
Min. Negotiated Rate	$22,446.16
Max. Negotiated Rate	$22,776.26
Rate for Payer: Amerigroup Medicaid	$22,666.22
Rate for Payer: Iowa Total Care Managed Medicaid	$22,446.16
Rate for Payer: Molina Healthcare Managed Medicaid	$22,776.26

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$15,925.82

Service Code	MSDRG 508
Min. Negotiated Rate	$15,695.00
Max. Negotiated Rate	$15,925.82
Rate for Payer: Amerigroup Medicaid	$15,848.88
Rate for Payer: Iowa Total Care Managed Medicaid	$15,695.00
Rate for Payer: Molina Healthcare Managed Medicaid	$15,925.82

MAJOR SKIN DISORDERS WITH MCC

Facility

$22,661.41

Service Code	MSDRG 595
Min. Negotiated Rate	$22,332.98
Max. Negotiated Rate	$22,661.41
Rate for Payer: Amerigroup Medicaid	$22,551.93
Rate for Payer: Iowa Total Care Managed Medicaid	$22,332.98
Rate for Payer: Molina Healthcare Managed Medicaid	$22,661.41

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$6,357.27

Service Code	MSDRG 596
Min. Negotiated Rate	$6,265.13
Max. Negotiated Rate	$6,357.27
Rate for Payer: Amerigroup Medicaid	$6,326.55
Rate for Payer: Iowa Total Care Managed Medicaid	$6,265.13
Rate for Payer: Molina Healthcare Managed Medicaid	$6,357.27

Know your out-of-pocket cost for care.

All Charges