Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Other Musculoskeletal System and Connective Tissue O.R. Procedures With CC

Facility

$17,967.33

Service Code	MS-DRG 516
Hospital Charge Code	333
Min. Negotiated Rate	$17,706.93
Max. Negotiated Rate	$17,967.33
Rate for Payer: Amerigroup Medicaid	$17,880.53
Rate for Payer: Iowa Total Care Managed Medicaid	$17,706.93
Rate for Payer: Molina Healthcare Managed Medicaid	$17,967.33

Other Musculoskeletal System and Connective Tissue O.R. Procedures With MCC

Facility

$26,002.68

Service Code	MS-DRG 515
Hospital Charge Code	332
Min. Negotiated Rate	$25,625.83
Max. Negotiated Rate	$26,002.68
Rate for Payer: Amerigroup Medicaid	$25,877.06
Rate for Payer: Iowa Total Care Managed Medicaid	$25,625.83
Rate for Payer: Molina Healthcare Managed Medicaid	$26,002.68

Other Musculoskeletal System and Connective Tissue O.R. Procedures Without CC/MCC

Facility

$14,372.88

Service Code	MS-DRG 517
Hospital Charge Code	334
Min. Negotiated Rate	$14,164.58
Max. Negotiated Rate	$14,372.88
Rate for Payer: Amerigroup Medicaid	$14,303.45
Rate for Payer: Iowa Total Care Managed Medicaid	$14,164.58
Rate for Payer: Molina Healthcare Managed Medicaid	$14,372.88

Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses With CC

Facility

$8,712.51

Service Code	MS-DRG 844
Hospital Charge Code	586
Min. Negotiated Rate	$8,586.24
Max. Negotiated Rate	$8,712.51
Rate for Payer: Amerigroup Medicaid	$8,670.42
Rate for Payer: Iowa Total Care Managed Medicaid	$8,586.24
Rate for Payer: Molina Healthcare Managed Medicaid	$8,712.51

Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses With MCC

Facility

$12,995.93

Service Code	MS-DRG 843
Hospital Charge Code	585
Min. Negotiated Rate	$12,807.58
Max. Negotiated Rate	$12,995.93
Rate for Payer: Amerigroup Medicaid	$12,933.14
Rate for Payer: Iowa Total Care Managed Medicaid	$12,807.58
Rate for Payer: Molina Healthcare Managed Medicaid	$12,995.93

Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses Without CC/MCC

Facility

$8,342.43

Service Code	MS-DRG 845
Hospital Charge Code	587
Min. Negotiated Rate	$8,221.53
Max. Negotiated Rate	$8,342.43
Rate for Payer: Amerigroup Medicaid	$8,302.13
Rate for Payer: Iowa Total Care Managed Medicaid	$8,221.53
Rate for Payer: Molina Healthcare Managed Medicaid	$8,342.43

Other O.R. Procedures for Injuries With CC

Facility

$15,323.66

Service Code	MS-DRG 908
Hospital Charge Code	629
Min. Negotiated Rate	$15,101.58
Max. Negotiated Rate	$15,323.66
Rate for Payer: Amerigroup Medicaid	$15,249.63
Rate for Payer: Iowa Total Care Managed Medicaid	$15,101.58
Rate for Payer: Molina Healthcare Managed Medicaid	$15,323.66

Other O.R. Procedures for Injuries With MCC

Facility

$28,519.38

Service Code	MS-DRG 907
Hospital Charge Code	628
Min. Negotiated Rate	$28,106.06
Max. Negotiated Rate	$28,519.38
Rate for Payer: Amerigroup Medicaid	$28,381.61
Rate for Payer: Iowa Total Care Managed Medicaid	$28,106.06
Rate for Payer: Molina Healthcare Managed Medicaid	$28,519.38

Other O.R. Procedures for Injuries Without CC/MCC

Facility

$9,137.69

Service Code	MS-DRG 909
Hospital Charge Code	630
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

Other O.R. Procedures for Multiple Significant Trauma With CC

Facility

$32,094.15

Service Code	MS-DRG 958
Hospital Charge Code	661
Min. Negotiated Rate	$31,629.02
Max. Negotiated Rate	$32,094.15
Rate for Payer: Amerigroup Medicaid	$31,939.11
Rate for Payer: Iowa Total Care Managed Medicaid	$31,629.02
Rate for Payer: Molina Healthcare Managed Medicaid	$32,094.15

Other O.R. Procedures for Multiple Significant Trauma With MCC

Facility

$58,260.21

Service Code	MS-DRG 957
Hospital Charge Code	660
Min. Negotiated Rate	$57,415.86
Max. Negotiated Rate	$58,260.21
Rate for Payer: Amerigroup Medicaid	$57,978.76
Rate for Payer: Iowa Total Care Managed Medicaid	$57,415.86
Rate for Payer: Molina Healthcare Managed Medicaid	$58,260.21

Other O.R. Procedures for Multiple Significant Trauma Without CC/MCC

Facility

$21,810.79

Service Code	MS-DRG 959
Hospital Charge Code	662
Min. Negotiated Rate	$21,494.69
Max. Negotiated Rate	$21,810.79
Rate for Payer: Iowa Total Care Managed Medicaid	$21,494.69
Rate for Payer: Amerigroup Medicaid	$21,705.43
Rate for Payer: Molina Healthcare Managed Medicaid	$21,810.79

Other O.R. Procedures of the Blood and Blood Forming Organs With CC

Facility

$16,475.22

Service Code	MS-DRG 803
Hospital Charge Code	545
Min. Negotiated Rate	$16,236.45
Max. Negotiated Rate	$16,475.22
Rate for Payer: Amerigroup Medicaid	$16,395.63
Rate for Payer: Iowa Total Care Managed Medicaid	$16,236.45
Rate for Payer: Molina Healthcare Managed Medicaid	$16,475.22

Other O.R. Procedures of the Blood and Blood Forming Organs With MCC

Facility

$36,512.41

Service Code	MS-DRG 802
Hospital Charge Code	544
Min. Negotiated Rate	$35,983.24
Max. Negotiated Rate	$36,512.41
Rate for Payer: Amerigroup Medicaid	$36,336.02
Rate for Payer: Iowa Total Care Managed Medicaid	$35,983.24
Rate for Payer: Molina Healthcare Managed Medicaid	$36,512.41

Other O.R. Procedures of the Blood and Blood Forming Organs Without CC/MCC

Facility

$11,632.75

Service Code	MS-DRG 804
Hospital Charge Code	546
Min. Negotiated Rate	$11,464.16
Max. Negotiated Rate	$11,632.75
Rate for Payer: Amerigroup Medicaid	$11,576.55
Rate for Payer: Iowa Total Care Managed Medicaid	$11,464.16
Rate for Payer: Molina Healthcare Managed Medicaid	$11,632.75

Other Respiratory System Diagnoses With MCC

Facility

$11,446.73

Service Code	MS-DRG 205
Hospital Charge Code	76
Min. Negotiated Rate	$11,280.83
Max. Negotiated Rate	$11,446.73
Rate for Payer: Amerigroup Medicaid	$11,391.43
Rate for Payer: Iowa Total Care Managed Medicaid	$11,280.83
Rate for Payer: Molina Healthcare Managed Medicaid	$11,446.73

Other Respiratory System Diagnoses Without MCC

Facility

$6,744.02

Service Code	MS-DRG 206
Hospital Charge Code	77
Min. Negotiated Rate	$6,646.28
Max. Negotiated Rate	$6,744.02
Rate for Payer: Amerigroup Medicaid	$6,711.44
Rate for Payer: Iowa Total Care Managed Medicaid	$6,646.28
Rate for Payer: Molina Healthcare Managed Medicaid	$6,744.02

Other Respiratory System O.R. Procedures With CC

Facility

$16,549.04

Service Code	MS-DRG 167
Hospital Charge Code	44
Min. Negotiated Rate	$16,309.20
Max. Negotiated Rate	$16,549.04
Rate for Payer: Amerigroup Medicaid	$16,469.09
Rate for Payer: Iowa Total Care Managed Medicaid	$16,309.20
Rate for Payer: Molina Healthcare Managed Medicaid	$16,549.04

Other Respiratory System O.R. Procedures With MCC

Facility

$30,598.10

Service Code	MS-DRG 166
Hospital Charge Code	43
Min. Negotiated Rate	$30,154.65
Max. Negotiated Rate	$30,598.10
Rate for Payer: Amerigroup Medicaid	$30,450.28
Rate for Payer: Iowa Total Care Managed Medicaid	$30,154.65
Rate for Payer: Molina Healthcare Managed Medicaid	$30,598.10

Other Respiratory System O.R. Procedures Without CC/MCC

Facility

$12,104.20

Service Code	MS-DRG 168
Hospital Charge Code	45
Min. Negotiated Rate	$11,928.78
Max. Negotiated Rate	$12,104.20
Rate for Payer: Amerigroup Medicaid	$12,045.73
Rate for Payer: Iowa Total Care Managed Medicaid	$11,928.78
Rate for Payer: Molina Healthcare Managed Medicaid	$12,104.20

Other Skin, Subcutaneous Tissue and Breast Procedures With CC

Facility

$11,584.53

Service Code	MS-DRG 580
Hospital Charge Code	384
Min. Negotiated Rate	$11,416.64
Max. Negotiated Rate	$11,584.53
Rate for Payer: Amerigroup Medicaid	$11,528.56
Rate for Payer: Iowa Total Care Managed Medicaid	$11,416.64
Rate for Payer: Molina Healthcare Managed Medicaid	$11,584.53

Other Skin, Subcutaneous Tissue and Breast Procedures With MCC

Facility

$17,367.92

Service Code	MS-DRG 579
Hospital Charge Code	383
Min. Negotiated Rate	$17,116.21
Max. Negotiated Rate	$17,367.92
Rate for Payer: Amerigroup Medicaid	$17,284.02
Rate for Payer: Iowa Total Care Managed Medicaid	$17,116.21
Rate for Payer: Molina Healthcare Managed Medicaid	$17,367.92

Other Skin, Subcutaneous Tissue and Breast Procedures Without CC/MCC

Facility

$8,640.66

Service Code	MS-DRG 581
Hospital Charge Code	385
Min. Negotiated Rate	$8,515.43
Max. Negotiated Rate	$8,640.66
Rate for Payer: Amerigroup Medicaid	$8,598.91
Rate for Payer: Iowa Total Care Managed Medicaid	$8,515.43
Rate for Payer: Molina Healthcare Managed Medicaid	$8,640.66

Other Vascular Procedures With CC

Facility

$24,177.89

Service Code	MS-DRG 253
Hospital Charge Code	115
Min. Negotiated Rate	$23,827.49
Max. Negotiated Rate	$24,177.89
Rate for Payer: Amerigroup Medicaid	$24,061.09
Rate for Payer: Iowa Total Care Managed Medicaid	$23,827.49
Rate for Payer: Molina Healthcare Managed Medicaid	$24,177.89

Other Vascular Procedures With MCC

Facility

$32,664.02

Service Code	MS-DRG 252
Hospital Charge Code	114
Min. Negotiated Rate	$32,190.63
Max. Negotiated Rate	$32,664.02
Rate for Payer: Amerigroup Medicaid	$32,506.22
Rate for Payer: Iowa Total Care Managed Medicaid	$32,190.63
Rate for Payer: Molina Healthcare Managed Medicaid	$32,664.02

Know your out-of-pocket cost for care.

All Charges