Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$15,142.14

Service Code	MSDRG 964
Min. Negotiated Rate	$14,922.68
Max. Negotiated Rate	$15,142.14
Rate for Payer: Amerigroup Medicaid	$15,068.98
Rate for Payer: Iowa Total Care Managed Medicaid	$14,922.68
Rate for Payer: Molina Healthcare Managed Medicaid	$15,142.14

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$21,877.73

Service Code	MSDRG 963
Min. Negotiated Rate	$21,560.65
Max. Negotiated Rate	$21,877.73
Rate for Payer: Amerigroup Medicaid	$21,772.03
Rate for Payer: Iowa Total Care Managed Medicaid	$21,560.65
Rate for Payer: Molina Healthcare Managed Medicaid	$21,877.73

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$10,753.08

Service Code	MSDRG 965
Min. Negotiated Rate	$10,597.23
Max. Negotiated Rate	$10,753.08
Rate for Payer: Amerigroup Medicaid	$10,701.13
Rate for Payer: Iowa Total Care Managed Medicaid	$10,597.23
Rate for Payer: Molina Healthcare Managed Medicaid	$10,753.08

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$10,157.44

Service Code	MSDRG 565
Min. Negotiated Rate	$10,010.22
Max. Negotiated Rate	$10,157.44
Rate for Payer: Amerigroup Medicaid	$10,108.36
Rate for Payer: Iowa Total Care Managed Medicaid	$10,010.22
Rate for Payer: Molina Healthcare Managed Medicaid	$10,157.44

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$11,299.18

Service Code	MSDRG 564
Min. Negotiated Rate	$11,135.42
Max. Negotiated Rate	$11,299.18
Rate for Payer: Amerigroup Medicaid	$11,244.59
Rate for Payer: Iowa Total Care Managed Medicaid	$11,135.42
Rate for Payer: Molina Healthcare Managed Medicaid	$11,299.18

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$5,910.25

Service Code	MSDRG 566
Min. Negotiated Rate	$5,824.59
Max. Negotiated Rate	$5,910.25
Rate for Payer: Amerigroup Medicaid	$5,881.70
Rate for Payer: Iowa Total Care Managed Medicaid	$5,824.59
Rate for Payer: Molina Healthcare Managed Medicaid	$5,910.25

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$20,554.71

Service Code	MSDRG 516
Min. Negotiated Rate	$20,256.81
Max. Negotiated Rate	$20,554.71
Rate for Payer: Amerigroup Medicaid	$20,455.40
Rate for Payer: Iowa Total Care Managed Medicaid	$20,256.81
Rate for Payer: Molina Healthcare Managed Medicaid	$20,554.71

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$29,747.19

Service Code	MSDRG 515
Min. Negotiated Rate	$29,316.05
Max. Negotiated Rate	$29,747.19
Rate for Payer: Amerigroup Medicaid	$29,603.47
Rate for Payer: Iowa Total Care Managed Medicaid	$29,316.05
Rate for Payer: Molina Healthcare Managed Medicaid	$29,747.19

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,442.64

Service Code	MSDRG 517
Min. Negotiated Rate	$16,204.34
Max. Negotiated Rate	$16,442.64
Rate for Payer: Amerigroup Medicaid	$16,363.20
Rate for Payer: Iowa Total Care Managed Medicaid	$16,204.34
Rate for Payer: Molina Healthcare Managed Medicaid	$16,442.64

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$9,967.15

Service Code	MSDRG 844
Min. Negotiated Rate	$9,822.69
Max. Negotiated Rate	$9,967.15
Rate for Payer: Amerigroup Medicaid	$9,918.99
Rate for Payer: Iowa Total Care Managed Medicaid	$9,822.69
Rate for Payer: Molina Healthcare Managed Medicaid	$9,967.15

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$14,867.40

Service Code	MSDRG 843
Min. Negotiated Rate	$14,651.92
Max. Negotiated Rate	$14,867.40
Rate for Payer: Amerigroup Medicaid	$14,795.57
Rate for Payer: Iowa Total Care Managed Medicaid	$14,651.92
Rate for Payer: Molina Healthcare Managed Medicaid	$14,867.40

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$9,543.78

Service Code	MSDRG 845
Min. Negotiated Rate	$9,405.46
Max. Negotiated Rate	$9,543.78
Rate for Payer: Amerigroup Medicaid	$9,497.67
Rate for Payer: Iowa Total Care Managed Medicaid	$9,405.46
Rate for Payer: Molina Healthcare Managed Medicaid	$9,543.78

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$17,530.34

Service Code	MSDRG 908
Min. Negotiated Rate	$17,276.27
Max. Negotiated Rate	$17,530.34
Rate for Payer: Amerigroup Medicaid	$17,445.64
Rate for Payer: Iowa Total Care Managed Medicaid	$17,276.27
Rate for Payer: Molina Healthcare Managed Medicaid	$17,530.34

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$32,626.31

Service Code	MSDRG 907
Min. Negotiated Rate	$32,153.45
Max. Negotiated Rate	$32,626.31
Rate for Payer: Amerigroup Medicaid	$32,468.68
Rate for Payer: Iowa Total Care Managed Medicaid	$32,153.45
Rate for Payer: Molina Healthcare Managed Medicaid	$32,626.31

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$10,453.57

Service Code	MSDRG 909
Min. Negotiated Rate	$10,302.06
Max. Negotiated Rate	$10,453.57
Rate for Payer: Amerigroup Medicaid	$10,403.07
Rate for Payer: Iowa Total Care Managed Medicaid	$10,302.06
Rate for Payer: Molina Healthcare Managed Medicaid	$10,453.57

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$36,715.86

Service Code	MSDRG 958
Min. Negotiated Rate	$36,183.73
Max. Negotiated Rate	$36,715.86
Rate for Payer: Amerigroup Medicaid	$36,538.47
Rate for Payer: Iowa Total Care Managed Medicaid	$36,183.73
Rate for Payer: Molina Healthcare Managed Medicaid	$36,715.86

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$66,649.96

Service Code	MSDRG 957
Min. Negotiated Rate	$65,683.99
Max. Negotiated Rate	$66,649.96
Rate for Payer: Amerigroup Medicaid	$66,327.95
Rate for Payer: Iowa Total Care Managed Medicaid	$65,683.99
Rate for Payer: Molina Healthcare Managed Medicaid	$66,649.96

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$24,951.65

Service Code	MSDRG 959
Min. Negotiated Rate	$24,590.02
Max. Negotiated Rate	$24,951.65
Rate for Payer: Amerigroup Medicaid	$24,831.10
Rate for Payer: Iowa Total Care Managed Medicaid	$24,590.02
Rate for Payer: Molina Healthcare Managed Medicaid	$24,951.65

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$18,847.73

Service Code	MSDRG 803
Min. Negotiated Rate	$18,574.57
Max. Negotiated Rate	$18,847.73
Rate for Payer: Amerigroup Medicaid	$18,756.67
Rate for Payer: Iowa Total Care Managed Medicaid	$18,574.57
Rate for Payer: Molina Healthcare Managed Medicaid	$18,847.73

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$41,770.37

Service Code	MSDRG 802
Min. Negotiated Rate	$41,164.98
Max. Negotiated Rate	$41,770.37
Rate for Payer: Amerigroup Medicaid	$41,568.56
Rate for Payer: Iowa Total Care Managed Medicaid	$41,164.98
Rate for Payer: Molina Healthcare Managed Medicaid	$41,770.37

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$13,307.92

Service Code	MSDRG 804
Min. Negotiated Rate	$13,115.05
Max. Negotiated Rate	$13,307.92
Rate for Payer: Amerigroup Medicaid	$13,243.63
Rate for Payer: Iowa Total Care Managed Medicaid	$13,115.05
Rate for Payer: Molina Healthcare Managed Medicaid	$13,307.92

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$13,095.11

Service Code	MSDRG 205
Min. Negotiated Rate	$12,905.32
Max. Negotiated Rate	$13,095.11
Rate for Payer: Amerigroup Medicaid	$13,031.85
Rate for Payer: Iowa Total Care Managed Medicaid	$12,905.32
Rate for Payer: Molina Healthcare Managed Medicaid	$13,095.11

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$7,715.19

Service Code	MSDRG 206
Min. Negotiated Rate	$7,603.38
Max. Negotiated Rate	$7,715.19
Rate for Payer: Amerigroup Medicaid	$7,677.92
Rate for Payer: Iowa Total Care Managed Medicaid	$7,603.38
Rate for Payer: Molina Healthcare Managed Medicaid	$7,715.19

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$18,932.18

Service Code	MSDRG 167
Min. Negotiated Rate	$18,657.79
Max. Negotiated Rate	$18,932.18
Rate for Payer: Amerigroup Medicaid	$18,840.71
Rate for Payer: Iowa Total Care Managed Medicaid	$18,657.79
Rate for Payer: Molina Healthcare Managed Medicaid	$18,932.18

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$35,004.37

Service Code	MSDRG 166
Min. Negotiated Rate	$34,497.05
Max. Negotiated Rate	$35,004.37
Rate for Payer: Amerigroup Medicaid	$34,835.25
Rate for Payer: Iowa Total Care Managed Medicaid	$34,497.05
Rate for Payer: Molina Healthcare Managed Medicaid	$35,004.37

Know your out-of-pocket cost for care.

All Charges