Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$92,669.03

Service Code	MSDRG 215
Min. Negotiated Rate	$91,325.96
Max. Negotiated Rate	$92,669.03
Rate for Payer: Amerigroup Medicaid	$92,221.32
Rate for Payer: Iowa Total Care Managed Medicaid	$91,325.96
Rate for Payer: Molina Healthcare Managed Medicaid	$92,669.03

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$25,697.05

Service Code	MSDRG 424
Min. Negotiated Rate	$25,324.61
Max. Negotiated Rate	$25,697.05
Rate for Payer: Amerigroup Medicaid	$25,572.90
Rate for Payer: Iowa Total Care Managed Medicaid	$25,324.61
Rate for Payer: Molina Healthcare Managed Medicaid	$25,697.05

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$39,715.46

Service Code	MSDRG 423
Min. Negotiated Rate	$39,139.86
Max. Negotiated Rate	$39,715.46
Rate for Payer: Amerigroup Medicaid	$39,523.58
Rate for Payer: Iowa Total Care Managed Medicaid	$39,139.86
Rate for Payer: Molina Healthcare Managed Medicaid	$39,715.46

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$15,750.17

Service Code	MSDRG 425
Min. Negotiated Rate	$15,521.90
Max. Negotiated Rate	$15,750.17
Rate for Payer: Amerigroup Medicaid	$15,674.07
Rate for Payer: Iowa Total Care Managed Medicaid	$15,521.90
Rate for Payer: Molina Healthcare Managed Medicaid	$15,750.17

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$10,270.04

Service Code	MSDRG 868
Min. Negotiated Rate	$10,121.19
Max. Negotiated Rate	$10,270.04
Rate for Payer: Amerigroup Medicaid	$10,220.42
Rate for Payer: Iowa Total Care Managed Medicaid	$10,121.19
Rate for Payer: Molina Healthcare Managed Medicaid	$10,270.04

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$17,576.50

Service Code	MSDRG 867
Min. Negotiated Rate	$17,321.76
Max. Negotiated Rate	$17,576.50
Rate for Payer: Amerigroup Medicaid	$17,491.58
Rate for Payer: Iowa Total Care Managed Medicaid	$17,321.76
Rate for Payer: Molina Healthcare Managed Medicaid	$17,576.50

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$6,209.76

Service Code	MSDRG 869
Min. Negotiated Rate	$6,119.76
Max. Negotiated Rate	$6,209.76
Rate for Payer: Amerigroup Medicaid	$6,179.76
Rate for Payer: Iowa Total Care Managed Medicaid	$6,119.76
Rate for Payer: Molina Healthcare Managed Medicaid	$6,209.76

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$14,303.29

Service Code	MSDRG 922
Min. Negotiated Rate	$14,095.99
Max. Negotiated Rate	$14,303.29
Rate for Payer: Amerigroup Medicaid	$14,234.18
Rate for Payer: Iowa Total Care Managed Medicaid	$14,095.99
Rate for Payer: Molina Healthcare Managed Medicaid	$14,303.29

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$7,834.55

Service Code	MSDRG 923
Min. Negotiated Rate	$7,721.00
Max. Negotiated Rate	$7,834.55
Rate for Payer: Amerigroup Medicaid	$7,796.70
Rate for Payer: Iowa Total Care Managed Medicaid	$7,721.00
Rate for Payer: Molina Healthcare Managed Medicaid	$7,834.55

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$10,447.94

Service Code	MSDRG 699
Min. Negotiated Rate	$10,296.52
Max. Negotiated Rate	$10,447.94
Rate for Payer: Amerigroup Medicaid	$10,397.46
Rate for Payer: Iowa Total Care Managed Medicaid	$10,296.52
Rate for Payer: Molina Healthcare Managed Medicaid	$10,447.94

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$13,732.42

Service Code	MSDRG 698
Min. Negotiated Rate	$13,533.39
Max. Negotiated Rate	$13,732.42
Rate for Payer: Amerigroup Medicaid	$13,666.07
Rate for Payer: Iowa Total Care Managed Medicaid	$13,533.39
Rate for Payer: Molina Healthcare Managed Medicaid	$13,732.42

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$5,154.72

Service Code	MSDRG 700
Min. Negotiated Rate	$5,080.01
Max. Negotiated Rate	$5,154.72
Rate for Payer: Amerigroup Medicaid	$5,129.82
Rate for Payer: Iowa Total Care Managed Medicaid	$5,080.01
Rate for Payer: Molina Healthcare Managed Medicaid	$5,154.72

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$24,837.93

Service Code	MSDRG 674
Min. Negotiated Rate	$24,477.95
Max. Negotiated Rate	$24,837.93
Rate for Payer: Amerigroup Medicaid	$24,717.93
Rate for Payer: Iowa Total Care Managed Medicaid	$24,477.95
Rate for Payer: Molina Healthcare Managed Medicaid	$24,837.93

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$28,703.41

Service Code	MSDRG 673
Min. Negotiated Rate	$28,287.40
Max. Negotiated Rate	$28,703.41
Rate for Payer: Amerigroup Medicaid	$28,564.73
Rate for Payer: Iowa Total Care Managed Medicaid	$28,287.40
Rate for Payer: Molina Healthcare Managed Medicaid	$28,703.41

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$19,732.75

Service Code	MSDRG 675
Min. Negotiated Rate	$19,446.76
Max. Negotiated Rate	$19,732.75
Rate for Payer: Amerigroup Medicaid	$19,637.41
Rate for Payer: Iowa Total Care Managed Medicaid	$19,446.76
Rate for Payer: Molina Healthcare Managed Medicaid	$19,732.75

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$38,330.51

Service Code	MSDRG 271
Min. Negotiated Rate	$37,774.98
Max. Negotiated Rate	$38,330.51
Rate for Payer: Amerigroup Medicaid	$38,145.32
Rate for Payer: Iowa Total Care Managed Medicaid	$37,774.98
Rate for Payer: Molina Healthcare Managed Medicaid	$38,330.51

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$53,455.76

Service Code	MSDRG 270
Min. Negotiated Rate	$52,681.01
Max. Negotiated Rate	$53,455.76
Rate for Payer: Amerigroup Medicaid	$53,197.49
Rate for Payer: Iowa Total Care Managed Medicaid	$52,681.01
Rate for Payer: Molina Healthcare Managed Medicaid	$53,455.76

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$25,173.47

Service Code	MSDRG 272
Min. Negotiated Rate	$24,808.62
Max. Negotiated Rate	$25,173.47
Rate for Payer: Amerigroup Medicaid	$25,051.85
Rate for Payer: Iowa Total Care Managed Medicaid	$24,808.62
Rate for Payer: Molina Healthcare Managed Medicaid	$25,173.47

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$11,317.19

Service Code	MSDRG 729
Min. Negotiated Rate	$11,153.17
Max. Negotiated Rate	$11,317.19
Rate for Payer: Amerigroup Medicaid	$11,262.52
Rate for Payer: Iowa Total Care Managed Medicaid	$11,153.17
Rate for Payer: Molina Healthcare Managed Medicaid	$11,317.19

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$6,370.78

Service Code	MSDRG 730
Min. Negotiated Rate	$6,278.44
Max. Negotiated Rate	$6,370.78
Rate for Payer: Amerigroup Medicaid	$6,340.00
Rate for Payer: Iowa Total Care Managed Medicaid	$6,278.44
Rate for Payer: Molina Healthcare Managed Medicaid	$6,370.78

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$15,414.63

Service Code	MSDRG 717
Min. Negotiated Rate	$15,191.22
Max. Negotiated Rate	$15,414.63
Rate for Payer: Amerigroup Medicaid	$15,340.15
Rate for Payer: Iowa Total Care Managed Medicaid	$15,191.22
Rate for Payer: Molina Healthcare Managed Medicaid	$15,414.63

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$7,586.83

Service Code	MSDRG 718
Min. Negotiated Rate	$7,476.88
Max. Negotiated Rate	$7,586.83
Rate for Payer: Amerigroup Medicaid	$7,550.18
Rate for Payer: Iowa Total Care Managed Medicaid	$7,476.88
Rate for Payer: Molina Healthcare Managed Medicaid	$7,586.83

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$22,737.98

Service Code	MSDRG 715
Min. Negotiated Rate	$22,408.43
Max. Negotiated Rate	$22,737.98
Rate for Payer: Amerigroup Medicaid	$22,628.12
Rate for Payer: Iowa Total Care Managed Medicaid	$22,408.43
Rate for Payer: Molina Healthcare Managed Medicaid	$22,737.98

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$13,434.03

Service Code	MSDRG 716
Min. Negotiated Rate	$13,239.33
Max. Negotiated Rate	$13,434.03
Rate for Payer: Amerigroup Medicaid	$13,369.13
Rate for Payer: Iowa Total Care Managed Medicaid	$13,239.33
Rate for Payer: Molina Healthcare Managed Medicaid	$13,434.03

OTHER MENTAL DISORDER DIAGNOSES

Facility

$14,647.83

Service Code	MSDRG 887
Min. Negotiated Rate	$14,435.54
Max. Negotiated Rate	$14,647.83
Rate for Payer: Amerigroup Medicaid	$14,577.07
Rate for Payer: Iowa Total Care Managed Medicaid	$14,435.54
Rate for Payer: Molina Healthcare Managed Medicaid	$14,647.83

Know your out-of-pocket cost for care.

All Charges