Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Other Disorders of Nervous System With CC

Facility

$7,589.49

Service Code	MS-DRG 092
Hospital Charge Code	772
Min. Negotiated Rate	$7,479.50
Max. Negotiated Rate	$7,589.49
Rate for Payer: Amerigroup Medicaid	$7,552.83
Rate for Payer: Iowa Total Care Managed Medicaid	$7,479.50
Rate for Payer: Molina Healthcare Managed Medicaid	$7,589.49

Other Disorders of Nervous System With MCC

Facility

$14,572.68

Service Code	MS-DRG 091
Hospital Charge Code	771
Min. Negotiated Rate	$14,361.48
Max. Negotiated Rate	$14,572.68
Rate for Payer: Amerigroup Medicaid	$14,502.28
Rate for Payer: Iowa Total Care Managed Medicaid	$14,361.48
Rate for Payer: Molina Healthcare Managed Medicaid	$14,572.68

Other Disorders of Nervous System Without CC/MCC

Facility

$5,647.58

Service Code	MS-DRG 093
Hospital Charge Code	773
Min. Negotiated Rate	$5,565.73
Max. Negotiated Rate	$5,647.58
Rate for Payer: Amerigroup Medicaid	$5,620.30
Rate for Payer: Iowa Total Care Managed Medicaid	$5,565.73
Rate for Payer: Molina Healthcare Managed Medicaid	$5,647.58

Other Disorders of the Eye With MCC

Facility

$9,032.38

Service Code	MS-DRG 124
Hospital Charge Code	13
Min. Negotiated Rate	$8,901.48
Max. Negotiated Rate	$9,032.38
Rate for Payer: Amerigroup Medicaid	$8,988.75
Rate for Payer: Iowa Total Care Managed Medicaid	$8,901.48
Rate for Payer: Molina Healthcare Managed Medicaid	$9,032.38

Other Disorders of the Eye Without MCC

Facility

$4,133.81

Service Code	MS-DRG 125
Hospital Charge Code	14
Min. Negotiated Rate	$4,073.90
Max. Negotiated Rate	$4,133.81
Rate for Payer: Amerigroup Medicaid	$4,113.84
Rate for Payer: Iowa Total Care Managed Medicaid	$4,073.90
Rate for Payer: Molina Healthcare Managed Medicaid	$4,133.81

Other Ear, Nose, Mouth and Throat Diagnoses With CC

Facility

$7,350.31

Service Code	MS-DRG 155
Hospital Charge Code	35
Min. Negotiated Rate	$7,243.78
Max. Negotiated Rate	$7,350.31
Rate for Payer: Amerigroup Medicaid	$7,314.80
Rate for Payer: Iowa Total Care Managed Medicaid	$7,243.78
Rate for Payer: Molina Healthcare Managed Medicaid	$7,350.31

Other Ear, Nose, Mouth and Throat Diagnoses With MCC

Facility

$10,118.00

Service Code	MS-DRG 154
Hospital Charge Code	34
Min. Negotiated Rate	$9,971.37
Max. Negotiated Rate	$10,118.00
Rate for Payer: Amerigroup Medicaid	$10,069.13
Rate for Payer: Iowa Total Care Managed Medicaid	$9,971.37
Rate for Payer: Molina Healthcare Managed Medicaid	$10,118.00

Other Ear, Nose, Mouth and Throat Diagnoses Without CC/MCC

Facility

$6,140.69

Service Code	MS-DRG 156
Hospital Charge Code	36
Min. Negotiated Rate	$6,051.69
Max. Negotiated Rate	$6,140.69
Rate for Payer: Amerigroup Medicaid	$6,111.02
Rate for Payer: Iowa Total Care Managed Medicaid	$6,051.69
Rate for Payer: Molina Healthcare Managed Medicaid	$6,140.69

Other Ear, Nose, Mouth and Throat O.R. Procedures With CC

Facility

$9,970.36

Service Code	MS-DRG 144
Hospital Charge Code	24
Min. Negotiated Rate	$9,825.86
Max. Negotiated Rate	$9,970.36
Rate for Payer: Amerigroup Medicaid	$9,922.20
Rate for Payer: Iowa Total Care Managed Medicaid	$9,825.86
Rate for Payer: Molina Healthcare Managed Medicaid	$9,970.36

Other Ear, Nose, Mouth and Throat O.R. Procedures With MCC

Facility

$24,392.46

Service Code	MS-DRG 143
Hospital Charge Code	23
Min. Negotiated Rate	$24,038.94
Max. Negotiated Rate	$24,392.46
Rate for Payer: Amerigroup Medicaid	$24,274.62
Rate for Payer: Iowa Total Care Managed Medicaid	$24,038.94
Rate for Payer: Molina Healthcare Managed Medicaid	$24,392.46

Other Ear, Nose, Mouth and Throat O.R. Procedures Without CC/MCC

Facility

$8,322.75

Service Code	MS-DRG 145
Hospital Charge Code	25
Min. Negotiated Rate	$8,202.13
Max. Negotiated Rate	$8,322.75
Rate for Payer: Amerigroup Medicaid	$8,282.54
Rate for Payer: Iowa Total Care Managed Medicaid	$8,202.13
Rate for Payer: Molina Healthcare Managed Medicaid	$8,322.75

Other Endocrine, Nutritional and Metabolic O.R. Procedures With CC

Facility

$16,346.28

Service Code	MS-DRG 629
Hospital Charge Code	421
Min. Negotiated Rate	$16,109.38
Max. Negotiated Rate	$16,346.28
Rate for Payer: Amerigroup Medicaid	$16,267.32
Rate for Payer: Iowa Total Care Managed Medicaid	$16,109.38
Rate for Payer: Molina Healthcare Managed Medicaid	$16,346.28

Other Endocrine, Nutritional and Metabolic O.R. Procedures With MCC

Facility

$20,623.79

Service Code	MS-DRG 628
Hospital Charge Code	420
Min. Negotiated Rate	$20,324.90
Max. Negotiated Rate	$20,623.79
Rate for Payer: Amerigroup Medicaid	$20,524.16
Rate for Payer: Iowa Total Care Managed Medicaid	$20,324.90
Rate for Payer: Molina Healthcare Managed Medicaid	$20,623.79

Other Endocrine, Nutritional and Metabolic O.R. Procedures Without CC/MCC

Facility

$13,851.23

Service Code	MS-DRG 630
Hospital Charge Code	422
Min. Negotiated Rate	$13,650.49
Max. Negotiated Rate	$13,851.23
Rate for Payer: Amerigroup Medicaid	$13,784.31
Rate for Payer: Iowa Total Care Managed Medicaid	$13,650.49
Rate for Payer: Molina Healthcare Managed Medicaid	$13,851.23

Other Endovascular Cardiac Valve Procedures With MCC

Facility

$42,488.73

Service Code	MS-DRG 319
Hospital Charge Code	174
Min. Negotiated Rate	$41,872.95
Max. Negotiated Rate	$42,488.73
Rate for Payer: Amerigroup Medicaid	$42,283.47
Rate for Payer: Iowa Total Care Managed Medicaid	$41,872.95
Rate for Payer: Molina Healthcare Managed Medicaid	$42,488.73

Other Endovascular Cardiac Valve Procedures Without MCC

Facility

$24,057.82

Service Code	MS-DRG 320
Hospital Charge Code	175
Min. Negotiated Rate	$23,709.16
Max. Negotiated Rate	$24,057.82
Rate for Payer: Amerigroup Medicaid	$23,941.60
Rate for Payer: Iowa Total Care Managed Medicaid	$23,709.16
Rate for Payer: Molina Healthcare Managed Medicaid	$24,057.82

Other Factors Influencing Health Status

Facility

$4,330.67

Service Code	MS-DRG 951
Hospital Charge Code	657
Min. Negotiated Rate	$4,267.90
Max. Negotiated Rate	$4,330.67
Rate for Payer: Amerigroup Medicaid	$4,309.75
Rate for Payer: Iowa Total Care Managed Medicaid	$4,267.90
Rate for Payer: Molina Healthcare Managed Medicaid	$4,330.67

Other Female Reproductive System O.R. Procedures With CC/MCC

Facility

$21,485.99

Service Code	MS-DRG 749
Hospital Charge Code	510
Min. Negotiated Rate	$21,174.60
Max. Negotiated Rate	$21,485.99
Rate for Payer: Amerigroup Medicaid	$21,382.19
Rate for Payer: Iowa Total Care Managed Medicaid	$21,174.60
Rate for Payer: Molina Healthcare Managed Medicaid	$21,485.99

Other Female Reproductive System O.R. Procedures Without CC/MCC

Facility

$14,431.94

Service Code	MS-DRG 750
Hospital Charge Code	511
Min. Negotiated Rate	$14,222.78
Max. Negotiated Rate	$14,431.94
Rate for Payer: Amerigroup Medicaid	$14,362.22
Rate for Payer: Iowa Total Care Managed Medicaid	$14,222.78
Rate for Payer: Molina Healthcare Managed Medicaid	$14,431.94

Other Heart Assist System Implant

Facility

$81,004.06

Service Code	MS-DRG 215
Hospital Charge Code	80
Min. Negotiated Rate	$79,830.09
Max. Negotiated Rate	$81,004.06
Rate for Payer: Amerigroup Medicaid	$80,612.73
Rate for Payer: Iowa Total Care Managed Medicaid	$79,830.09
Rate for Payer: Molina Healthcare Managed Medicaid	$81,004.06

Other Hepatobiliary or Pancreas O.R. Procedures With CC

Facility

$22,462.36

Service Code	MS-DRG 424
Hospital Charge Code	256
Min. Negotiated Rate	$22,136.82
Max. Negotiated Rate	$22,462.36
Rate for Payer: Amerigroup Medicaid	$22,353.84
Rate for Payer: Iowa Total Care Managed Medicaid	$22,136.82
Rate for Payer: Molina Healthcare Managed Medicaid	$22,462.36

Other Hepatobiliary or Pancreas O.R. Procedures With MCC

Facility

$34,716.17

Service Code	MS-DRG 423
Hospital Charge Code	255
Min. Negotiated Rate	$34,213.03
Max. Negotiated Rate	$34,716.17
Rate for Payer: Amerigroup Medicaid	$34,548.46
Rate for Payer: Iowa Total Care Managed Medicaid	$34,213.03
Rate for Payer: Molina Healthcare Managed Medicaid	$34,716.17

Other Hepatobiliary or Pancreas O.R. Procedures Without CC/MCC

Facility

$13,767.57

Service Code	MS-DRG 425
Hospital Charge Code	257
Min. Negotiated Rate	$13,568.04
Max. Negotiated Rate	$13,767.57
Rate for Payer: Amerigroup Medicaid	$13,701.06
Rate for Payer: Iowa Total Care Managed Medicaid	$13,568.04
Rate for Payer: Molina Healthcare Managed Medicaid	$13,767.57

Other Infectious and Parasitic Diseases Diagnoses With CC

Facility

$8,977.27

Service Code	MS-DRG 868
Hospital Charge Code	604
Min. Negotiated Rate	$8,847.16
Max. Negotiated Rate	$8,977.27
Rate for Payer: Amerigroup Medicaid	$8,933.90
Rate for Payer: Iowa Total Care Managed Medicaid	$8,847.16
Rate for Payer: Molina Healthcare Managed Medicaid	$8,977.27

Other Infectious and Parasitic Diseases Diagnoses With MCC

Facility

$15,364.01

Service Code	MS-DRG 867
Hospital Charge Code	603
Min. Negotiated Rate	$15,141.34
Max. Negotiated Rate	$15,364.01
Rate for Payer: Amerigroup Medicaid	$15,289.78
Rate for Payer: Iowa Total Care Managed Medicaid	$15,141.34
Rate for Payer: Molina Healthcare Managed Medicaid	$15,364.01

Know your out-of-pocket cost for care.

All Charges