Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$8,551.80

Service Code	MSDRG 394
Min. Negotiated Rate	$8,427.85
Max. Negotiated Rate	$8,551.80
Rate for Payer: Amerigroup Medicaid	$8,510.48
Rate for Payer: Iowa Total Care Managed Medicaid	$8,427.85
Rate for Payer: Molina Healthcare Managed Medicaid	$8,551.80

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$16,412.24

Service Code	MSDRG 393
Min. Negotiated Rate	$16,174.38
Max. Negotiated Rate	$16,412.24
Rate for Payer: Amerigroup Medicaid	$16,332.95
Rate for Payer: Iowa Total Care Managed Medicaid	$16,174.38
Rate for Payer: Molina Healthcare Managed Medicaid	$16,412.24

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$7,920.12

Service Code	MSDRG 395
Min. Negotiated Rate	$7,805.33
Max. Negotiated Rate	$7,920.12
Rate for Payer: Amerigroup Medicaid	$7,881.86
Rate for Payer: Iowa Total Care Managed Medicaid	$7,805.33
Rate for Payer: Molina Healthcare Managed Medicaid	$7,920.12

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$23,461.98

Service Code	MSDRG 357
Min. Negotiated Rate	$23,121.94
Max. Negotiated Rate	$23,461.98
Rate for Payer: Amerigroup Medicaid	$23,348.63
Rate for Payer: Iowa Total Care Managed Medicaid	$23,121.94
Rate for Payer: Molina Healthcare Managed Medicaid	$23,461.98

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$35,979.47

Service Code	MSDRG 356
Min. Negotiated Rate	$35,458.01
Max. Negotiated Rate	$35,979.47
Rate for Payer: Amerigroup Medicaid	$35,805.64
Rate for Payer: Iowa Total Care Managed Medicaid	$35,458.01
Rate for Payer: Molina Healthcare Managed Medicaid	$35,979.47

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$12,809.11

Service Code	MSDRG 358
Min. Negotiated Rate	$12,623.47
Max. Negotiated Rate	$12,809.11
Rate for Payer: Amerigroup Medicaid	$12,747.23
Rate for Payer: Iowa Total Care Managed Medicaid	$12,623.47
Rate for Payer: Molina Healthcare Managed Medicaid	$12,809.11

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$8,682.41

Service Code	MSDRG 092
Min. Negotiated Rate	$8,556.57
Max. Negotiated Rate	$8,682.41
Rate for Payer: Amerigroup Medicaid	$8,640.46
Rate for Payer: Iowa Total Care Managed Medicaid	$8,556.57
Rate for Payer: Molina Healthcare Managed Medicaid	$8,682.41

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$16,671.22

Service Code	MSDRG 091
Min. Negotiated Rate	$16,429.60
Max. Negotiated Rate	$16,671.22
Rate for Payer: Amerigroup Medicaid	$16,590.67
Rate for Payer: Iowa Total Care Managed Medicaid	$16,429.60
Rate for Payer: Molina Healthcare Managed Medicaid	$16,671.22

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$6,460.86

Service Code	MSDRG 093
Min. Negotiated Rate	$6,367.22
Max. Negotiated Rate	$6,460.86
Rate for Payer: Amerigroup Medicaid	$6,429.64
Rate for Payer: Iowa Total Care Managed Medicaid	$6,367.22
Rate for Payer: Molina Healthcare Managed Medicaid	$6,460.86

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$10,333.09

Service Code	MSDRG 124
Min. Negotiated Rate	$10,183.33
Max. Negotiated Rate	$10,333.09
Rate for Payer: Amerigroup Medicaid	$10,283.17
Rate for Payer: Iowa Total Care Managed Medicaid	$10,183.33
Rate for Payer: Molina Healthcare Managed Medicaid	$10,333.09

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$4,729.10

Service Code	MSDRG 125
Min. Negotiated Rate	$4,660.56
Max. Negotiated Rate	$4,729.10
Rate for Payer: Amerigroup Medicaid	$4,706.26
Rate for Payer: Iowa Total Care Managed Medicaid	$4,660.56
Rate for Payer: Molina Healthcare Managed Medicaid	$4,729.10

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$8,408.80

Service Code	MSDRG 155
Min. Negotiated Rate	$8,286.93
Max. Negotiated Rate	$8,408.80
Rate for Payer: Amerigroup Medicaid	$8,368.17
Rate for Payer: Iowa Total Care Managed Medicaid	$8,286.93
Rate for Payer: Molina Healthcare Managed Medicaid	$8,408.80

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$11,575.04

Service Code	MSDRG 154
Min. Negotiated Rate	$11,407.28
Max. Negotiated Rate	$11,575.04
Rate for Payer: Amerigroup Medicaid	$11,519.12
Rate for Payer: Iowa Total Care Managed Medicaid	$11,407.28
Rate for Payer: Molina Healthcare Managed Medicaid	$11,575.04

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$7,024.97

Service Code	MSDRG 156
Min. Negotiated Rate	$6,923.16
Max. Negotiated Rate	$7,024.97
Rate for Payer: Amerigroup Medicaid	$6,991.03
Rate for Payer: Iowa Total Care Managed Medicaid	$6,923.16
Rate for Payer: Molina Healthcare Managed Medicaid	$7,024.97

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$11,406.15

Service Code	MSDRG 144
Min. Negotiated Rate	$11,240.84
Max. Negotiated Rate	$11,406.15
Rate for Payer: Amerigroup Medicaid	$11,351.04
Rate for Payer: Iowa Total Care Managed Medicaid	$11,240.84
Rate for Payer: Molina Healthcare Managed Medicaid	$11,406.15

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$27,905.09

Service Code	MSDRG 143
Min. Negotiated Rate	$27,500.65
Max. Negotiated Rate	$27,905.09
Rate for Payer: Amerigroup Medicaid	$27,770.27
Rate for Payer: Iowa Total Care Managed Medicaid	$27,500.65
Rate for Payer: Molina Healthcare Managed Medicaid	$27,905.09

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,521.26

Service Code	MSDRG 145
Min. Negotiated Rate	$9,383.27
Max. Negotiated Rate	$9,521.26
Rate for Payer: Amerigroup Medicaid	$9,475.26
Rate for Payer: Iowa Total Care Managed Medicaid	$9,383.27
Rate for Payer: Molina Healthcare Managed Medicaid	$9,521.26

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$18,700.23

Service Code	MSDRG 629
Min. Negotiated Rate	$18,429.20
Max. Negotiated Rate	$18,700.23
Rate for Payer: Amerigroup Medicaid	$18,609.88
Rate for Payer: Iowa Total Care Managed Medicaid	$18,429.20
Rate for Payer: Molina Healthcare Managed Medicaid	$18,700.23

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$23,593.72

Service Code	MSDRG 628
Min. Negotiated Rate	$23,251.77
Max. Negotiated Rate	$23,593.72
Rate for Payer: Amerigroup Medicaid	$23,479.73
Rate for Payer: Iowa Total Care Managed Medicaid	$23,251.77
Rate for Payer: Molina Healthcare Managed Medicaid	$23,593.72

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$15,845.87

Service Code	MSDRG 630
Min. Negotiated Rate	$15,616.22
Max. Negotiated Rate	$15,845.87
Rate for Payer: Amerigroup Medicaid	$15,769.32
Rate for Payer: Iowa Total Care Managed Medicaid	$15,616.22
Rate for Payer: Molina Healthcare Managed Medicaid	$15,845.87

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$48,607.30

Service Code	MSDRG 319
Min. Negotiated Rate	$47,902.83
Max. Negotiated Rate	$48,607.30
Rate for Payer: Amerigroup Medicaid	$48,372.46
Rate for Payer: Iowa Total Care Managed Medicaid	$47,902.83
Rate for Payer: Molina Healthcare Managed Medicaid	$48,607.30

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$27,522.26

Service Code	MSDRG 320
Min. Negotiated Rate	$27,123.37
Max. Negotiated Rate	$27,522.26
Rate for Payer: Amerigroup Medicaid	$27,389.29
Rate for Payer: Iowa Total Care Managed Medicaid	$27,123.37
Rate for Payer: Molina Healthcare Managed Medicaid	$27,522.26

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$4,954.30

Service Code	MSDRG 951
Min. Negotiated Rate	$4,882.50
Max. Negotiated Rate	$4,954.30
Rate for Payer: Amerigroup Medicaid	$4,930.36
Rate for Payer: Iowa Total Care Managed Medicaid	$4,882.50
Rate for Payer: Molina Healthcare Managed Medicaid	$4,954.30

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$24,580.08

Service Code	MSDRG 749
Min. Negotiated Rate	$24,223.83
Max. Negotiated Rate	$24,580.08
Rate for Payer: Amerigroup Medicaid	$24,461.32
Rate for Payer: Iowa Total Care Managed Medicaid	$24,223.83
Rate for Payer: Molina Healthcare Managed Medicaid	$24,580.08

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,510.20

Service Code	MSDRG 750
Min. Negotiated Rate	$16,270.92
Max. Negotiated Rate	$16,510.20
Rate for Payer: Amerigroup Medicaid	$16,430.43
Rate for Payer: Iowa Total Care Managed Medicaid	$16,270.92
Rate for Payer: Molina Healthcare Managed Medicaid	$16,510.20

Know your out-of-pocket cost for care.

All Charges