Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

3.5MMX15MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8758434
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

3.5MMX15MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8758434
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

3.5MM X 16MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8812776
Hospital Revenue Code	278
Min. Negotiated Rate	$149.85
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Aetna of IA Medicare	$189.81
Rate for Payer: Amerigroup Medicaid	$192.07
Rate for Payer: Amerigroup Medicare	$151.35
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$149.85
Rate for Payer: Iowa Total Care Managed Medicaid	$190.21
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Medical Associates Managed Medicare	$149.85
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: Molina Healthcare Managed Medicaid	$193.01
Rate for Payer: Partners Health Alliance Commercial	$172.33
Rate for Payer: United Healthcare Commercial	$299.70
Rate for Payer: United Healthcare Managed Medicare	$196.47

3.5MM X 16MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8812776
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: United Healthcare Commercial	$299.70

3.5MMX18MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8758436
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

3.5MMX18MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8758436
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

3.5MMX20MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760635
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

3.5MMX20MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760635
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

3.5MM X 20MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8812778
Hospital Revenue Code	278
Min. Negotiated Rate	$149.85
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Aetna of IA Medicare	$189.81
Rate for Payer: Amerigroup Medicaid	$192.07
Rate for Payer: Amerigroup Medicare	$151.35
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$149.85
Rate for Payer: Iowa Total Care Managed Medicaid	$190.21
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Medical Associates Managed Medicare	$149.85
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: Molina Healthcare Managed Medicaid	$193.01
Rate for Payer: Partners Health Alliance Commercial	$172.33
Rate for Payer: United Healthcare Commercial	$299.70
Rate for Payer: United Healthcare Managed Medicare	$196.47

3.5MM X 20MM LOCKING SCREW

Facility

$333.00

Service Code	HCPCS C1713
Hospital Charge Code	8812778
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of IA Commercial	$299.70
Rate for Payer: Aetna of IA Medical Rental Products	$299.70
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$249.75
Rate for Payer: Medical Associates Commercial	$249.75
Rate for Payer: Midlands Choice Commercial	$233.10
Rate for Payer: United Healthcare Commercial	$299.70

3.5 MM X 22MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8812770
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

3.5 MM X 22MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8812770
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

3.5MM X 2.2MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8955189
Hospital Revenue Code	276
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 2.2MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8955189
Hospital Revenue Code	276
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5MMX22MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760637
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

3.5MMX22MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760637
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

3.5MMX24MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760639
Hospital Revenue Code	278
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Aetna of IA Medicare	$184.68
Rate for Payer: Amerigroup Medicaid	$186.88
Rate for Payer: Amerigroup Medicare	$147.26
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.80
Rate for Payer: Iowa Total Care Managed Medicaid	$185.07
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Medical Associates Managed Medicare	$145.80
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: Molina Healthcare Managed Medicaid	$187.79
Rate for Payer: Partners Health Alliance Commercial	$167.67
Rate for Payer: United Healthcare Commercial	$291.60
Rate for Payer: United Healthcare Managed Medicare	$191.16

3.5MMX24MM GL ANKLE LOCKING SCREW

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	8760639
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of IA Commercial	$291.60
Rate for Payer: Aetna of IA Medical Rental Products	$291.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$243.00
Rate for Payer: Medical Associates Commercial	$243.00
Rate for Payer: Midlands Choice Commercial	$226.80
Rate for Payer: United Healthcare Commercial	$291.60

3.5MM X 30MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968468
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5MM X 30MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968468
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 32MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968470
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 32MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968470
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5MM X 36MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968472
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

3.5MM X 36MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968472
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$233.60
Rate for Payer: Amerigroup Medicare	$184.07
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$182.25
Rate for Payer: Iowa Total Care Managed Medicaid	$231.34
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$182.25
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$234.74
Rate for Payer: Partners Health Alliance Commercial	$209.59
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

3.5MM X 38MM ARSENAL LOCKING SCREW

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8968474
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

Know your out-of-pocket cost for care.

All Charges