Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Other Infectious and Parasitic Diseases Diagnoses Without CC/MCC

Facility

$5,428.09

Service Code	MS-DRG 869
Hospital Charge Code	605
Min. Negotiated Rate	$5,349.42
Max. Negotiated Rate	$5,428.09
Rate for Payer: Amerigroup Medicaid	$5,401.87
Rate for Payer: Iowa Total Care Managed Medicaid	$5,349.42
Rate for Payer: Molina Healthcare Managed Medicaid	$5,428.09

Other Injury, Poisoning and Toxic Effect Diagnoses With MCC

Facility

$12,502.82

Service Code	MS-DRG 922
Hospital Charge Code	640
Min. Negotiated Rate	$12,321.62
Max. Negotiated Rate	$12,502.82
Rate for Payer: Amerigroup Medicaid	$12,442.42
Rate for Payer: Iowa Total Care Managed Medicaid	$12,321.62
Rate for Payer: Molina Healthcare Managed Medicaid	$12,502.82

Other Injury, Poisoning and Toxic Effect Diagnoses Without MCC

Facility

$6,848.36

Service Code	MS-DRG 923
Hospital Charge Code	641
Min. Negotiated Rate	$6,749.11
Max. Negotiated Rate	$6,848.36
Rate for Payer: Amerigroup Medicaid	$6,815.27
Rate for Payer: Iowa Total Care Managed Medicaid	$6,749.11
Rate for Payer: Molina Healthcare Managed Medicaid	$6,848.36

Other Kidney and Urinary Tract Diagnoses With CC

Facility

$9,132.78

Service Code	MS-DRG 699
Hospital Charge Code	472
Min. Negotiated Rate	$9,000.42
Max. Negotiated Rate	$9,132.78
Rate for Payer: Amerigroup Medicaid	$9,088.66
Rate for Payer: Iowa Total Care Managed Medicaid	$9,000.42
Rate for Payer: Molina Healthcare Managed Medicaid	$9,132.78

Other Kidney and Urinary Tract Diagnoses With MCC

Facility

$12,003.81

Service Code	MS-DRG 698
Hospital Charge Code	471
Min. Negotiated Rate	$11,829.84
Max. Negotiated Rate	$12,003.81
Rate for Payer: Amerigroup Medicaid	$11,945.82
Rate for Payer: Iowa Total Care Managed Medicaid	$11,829.84
Rate for Payer: Molina Healthcare Managed Medicaid	$12,003.81

Other Kidney and Urinary Tract Diagnoses Without CC/MCC

Facility

$4,505.86

Service Code	MS-DRG 700
Hospital Charge Code	473
Min. Negotiated Rate	$4,440.56
Max. Negotiated Rate	$4,505.86
Rate for Payer: Amerigroup Medicaid	$4,484.09
Rate for Payer: Iowa Total Care Managed Medicaid	$4,440.56
Rate for Payer: Molina Healthcare Managed Medicaid	$4,505.86

Other Kidney and Urinary Tract Procedures With CC

Facility

$21,711.38

Service Code	MS-DRG 674
Hospital Charge Code	456
Min. Negotiated Rate	$21,396.72
Max. Negotiated Rate	$21,711.38
Rate for Payer: Amerigroup Medicaid	$21,606.50
Rate for Payer: Iowa Total Care Managed Medicaid	$21,396.72
Rate for Payer: Molina Healthcare Managed Medicaid	$21,711.38

Other Kidney and Urinary Tract Procedures With MCC

Facility

$25,090.28

Service Code	MS-DRG 673
Hospital Charge Code	455
Min. Negotiated Rate	$24,726.66
Max. Negotiated Rate	$25,090.28
Rate for Payer: Amerigroup Medicaid	$24,969.07
Rate for Payer: Iowa Total Care Managed Medicaid	$24,726.66
Rate for Payer: Molina Healthcare Managed Medicaid	$25,090.28

Other Kidney and Urinary Tract Procedures Without CC/MCC

Facility

$17,248.83

Service Code	MS-DRG 675
Hospital Charge Code	457
Min. Negotiated Rate	$16,998.85
Max. Negotiated Rate	$17,248.83
Rate for Payer: Amerigroup Medicaid	$17,165.51
Rate for Payer: Iowa Total Care Managed Medicaid	$16,998.85
Rate for Payer: Molina Healthcare Managed Medicaid	$17,248.83

Other Major Cardiovascular Procedures With CC

Facility

$33,505.55

Service Code	MS-DRG 271
Hospital Charge Code	133
Min. Negotiated Rate	$33,019.96
Max. Negotiated Rate	$33,505.55
Rate for Payer: Amerigroup Medicaid	$33,343.69
Rate for Payer: Iowa Total Care Managed Medicaid	$33,019.96
Rate for Payer: Molina Healthcare Managed Medicaid	$33,505.55

Other Major Cardiovascular Procedures With MCC

Facility

$46,726.87

Service Code	MS-DRG 270
Hospital Charge Code	132
Min. Negotiated Rate	$46,049.66
Max. Negotiated Rate	$46,726.87
Rate for Payer: Amerigroup Medicaid	$46,501.13
Rate for Payer: Iowa Total Care Managed Medicaid	$46,049.66
Rate for Payer: Molina Healthcare Managed Medicaid	$46,726.87

Other Major Cardiovascular Procedures Without CC/MCC

Facility

$22,004.69

Service Code	MS-DRG 272
Hospital Charge Code	134
Min. Negotiated Rate	$21,685.78
Max. Negotiated Rate	$22,004.69
Rate for Payer: Amerigroup Medicaid	$21,898.39
Rate for Payer: Iowa Total Care Managed Medicaid	$21,685.78
Rate for Payer: Molina Healthcare Managed Medicaid	$22,004.69

Other Male Reproductive System Diagnoses With CC/MCC

Facility

$9,892.61

Service Code	MS-DRG 729
Hospital Charge Code	493
Min. Negotiated Rate	$9,749.24
Max. Negotiated Rate	$9,892.61
Rate for Payer: Amerigroup Medicaid	$9,844.82
Rate for Payer: Iowa Total Care Managed Medicaid	$9,749.24
Rate for Payer: Molina Healthcare Managed Medicaid	$9,892.61

Other Male Reproductive System Diagnoses Without CC/MCC

Facility

$5,568.84

Service Code	MS-DRG 730
Hospital Charge Code	494
Min. Negotiated Rate	$5,488.13
Max. Negotiated Rate	$5,568.84
Rate for Payer: Amerigroup Medicaid	$5,541.94
Rate for Payer: Iowa Total Care Managed Medicaid	$5,488.13
Rate for Payer: Molina Healthcare Managed Medicaid	$5,568.84

Other Male Reproductive System O.R. Procedures Except Malignancy With CC/MCC

Facility

$13,474.27

Service Code	MS-DRG 717
Hospital Charge Code	484
Min. Negotiated Rate	$13,278.99
Max. Negotiated Rate	$13,474.27
Rate for Payer: Amerigroup Medicaid	$13,409.18
Rate for Payer: Iowa Total Care Managed Medicaid	$13,278.99
Rate for Payer: Molina Healthcare Managed Medicaid	$13,474.27

Other Male Reproductive System O.R. Procedures Except Malignancy Without CC/MCC

Facility

$6,631.82

Service Code	MS-DRG 718
Hospital Charge Code	485
Min. Negotiated Rate	$6,535.71
Max. Negotiated Rate	$6,631.82
Rate for Payer: Amerigroup Medicaid	$6,599.79
Rate for Payer: Iowa Total Care Managed Medicaid	$6,535.71
Rate for Payer: Molina Healthcare Managed Medicaid	$6,631.82

Other Male Reproductive System O.R. Procedures for Malignancy With CC/MCC

Facility

$19,875.78

Service Code	MS-DRG 715
Hospital Charge Code	482
Min. Negotiated Rate	$19,587.72
Max. Negotiated Rate	$19,875.78
Rate for Payer: Amerigroup Medicaid	$19,779.76
Rate for Payer: Iowa Total Care Managed Medicaid	$19,587.72
Rate for Payer: Molina Healthcare Managed Medicaid	$19,875.78

Other Male Reproductive System O.R. Procedures for Malignancy Without CC/MCC

Facility

$11,742.99

Service Code	MS-DRG 716
Hospital Charge Code	483
Min. Negotiated Rate	$11,572.80
Max. Negotiated Rate	$11,742.99
Rate for Payer: Amerigroup Medicaid	$11,686.26
Rate for Payer: Iowa Total Care Managed Medicaid	$11,572.80
Rate for Payer: Molina Healthcare Managed Medicaid	$11,742.99

Other Mental Disorder Diagnoses

Facility

$12,804.00

Service Code	MS-DRG 887
Hospital Charge Code	617
Min. Negotiated Rate	$12,618.43
Max. Negotiated Rate	$12,804.00
Rate for Payer: Amerigroup Medicaid	$12,742.14
Rate for Payer: Iowa Total Care Managed Medicaid	$12,618.43
Rate for Payer: Molina Healthcare Managed Medicaid	$12,804.00

Other Multiple Significant Trauma With CC

Facility

$13,236.08

Service Code	MS-DRG 964
Hospital Charge Code	664
Min. Negotiated Rate	$13,044.25
Max. Negotiated Rate	$13,236.08
Rate for Payer: Amerigroup Medicaid	$13,172.13
Rate for Payer: Iowa Total Care Managed Medicaid	$13,044.25
Rate for Payer: Molina Healthcare Managed Medicaid	$13,236.08

Other Multiple Significant Trauma With MCC

Facility

$19,123.81

Service Code	MS-DRG 963
Hospital Charge Code	663
Min. Negotiated Rate	$18,846.65
Max. Negotiated Rate	$19,123.81
Rate for Payer: Amerigroup Medicaid	$19,031.42
Rate for Payer: Iowa Total Care Managed Medicaid	$18,846.65
Rate for Payer: Molina Healthcare Managed Medicaid	$19,123.81

Other Multiple Significant Trauma Without CC/MCC

Facility

$9,399.51

Service Code	MS-DRG 965
Hospital Charge Code	665
Min. Negotiated Rate	$9,263.28
Max. Negotiated Rate	$9,399.51
Rate for Payer: Amerigroup Medicaid	$9,354.10
Rate for Payer: Iowa Total Care Managed Medicaid	$9,263.28
Rate for Payer: Molina Healthcare Managed Medicaid	$9,399.51

Other Musculoskeletal System and Connective Tissue Diagnoses With CC

Facility

$8,878.84

Service Code	MS-DRG 565
Hospital Charge Code	372
Min. Negotiated Rate	$8,750.16
Max. Negotiated Rate	$8,878.84
Rate for Payer: Amerigroup Medicaid	$8,835.95
Rate for Payer: Iowa Total Care Managed Medicaid	$8,750.16
Rate for Payer: Molina Healthcare Managed Medicaid	$8,878.84

Other Musculoskeletal System and Connective Tissue Diagnoses With MCC

Facility

$9,876.86

Service Code	MS-DRG 564
Hospital Charge Code	371
Min. Negotiated Rate	$9,733.72
Max. Negotiated Rate	$9,876.86
Rate for Payer: Amerigroup Medicaid	$9,829.15
Rate for Payer: Iowa Total Care Managed Medicaid	$9,733.72
Rate for Payer: Molina Healthcare Managed Medicaid	$9,876.86

Other Musculoskeletal System and Connective Tissue Diagnoses Without CC/MCC

Facility

$5,166.29

Service Code	MS-DRG 566
Hospital Charge Code	373
Min. Negotiated Rate	$5,091.41
Max. Negotiated Rate	$5,166.29
Rate for Payer: Amerigroup Medicaid	$5,141.33
Rate for Payer: Iowa Total Care Managed Medicaid	$5,091.41
Rate for Payer: Molina Healthcare Managed Medicaid	$5,166.29

Know your out-of-pocket cost for care.

All Charges