Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

IMPLANT TITANIUM +5 END CAP

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	8046407
Hospital Revenue Code	278
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of IA Commercial	$193.50
Rate for Payer: Aetna of IA Medical Rental Products	$193.50
Rate for Payer: Cash Price	$172.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$161.25
Rate for Payer: Medical Associates Commercial	$161.25
Rate for Payer: Midlands Choice Commercial	$150.50
Rate for Payer: United Healthcare Commercial	$193.50

IMPLANT TITANIUM END CAP STANDARD

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	8046406
Hospital Revenue Code	278
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of IA Commercial	$193.50
Rate for Payer: Aetna of IA Medical Rental Products	$193.50
Rate for Payer: Aetna of IA Medicare	$122.55
Rate for Payer: Amerigroup Medicaid	$124.01
Rate for Payer: Amerigroup Medicare	$97.72
Rate for Payer: Cash Price	$172.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$161.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$96.75
Rate for Payer: Iowa Total Care Managed Medicaid	$122.81
Rate for Payer: Medical Associates Commercial	$161.25
Rate for Payer: Medical Associates Managed Medicare	$96.75
Rate for Payer: Midlands Choice Commercial	$150.50
Rate for Payer: Molina Healthcare Managed Medicaid	$124.61
Rate for Payer: Partners Health Alliance Commercial	$111.26
Rate for Payer: United Healthcare Commercial	$193.50
Rate for Payer: United Healthcare Managed Medicare	$126.85

IMPLANT TITANIUM END CAP STANDARD

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	8046406
Hospital Revenue Code	278
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of IA Commercial	$193.50
Rate for Payer: Aetna of IA Medical Rental Products	$193.50
Rate for Payer: Cash Price	$172.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$161.25
Rate for Payer: Medical Associates Commercial	$161.25
Rate for Payer: Midlands Choice Commercial	$150.50
Rate for Payer: United Healthcare Commercial	$193.50

IMPLANT TITANIUM LAG SCREW 10.5X100MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046417
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X100MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046417
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X105MM

Facility

$816.00

Service Code	HCPCS C1713
Hospital Charge Code	8046418
Hospital Revenue Code	278
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of IA Commercial	$734.40
Rate for Payer: Aetna of IA Medical Rental Products	$734.40
Rate for Payer: Aetna of IA Medicare	$465.12
Rate for Payer: Amerigroup Medicaid	$470.67
Rate for Payer: Amerigroup Medicare	$370.87
Rate for Payer: Cash Price	$652.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$612.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$367.20
Rate for Payer: Iowa Total Care Managed Medicaid	$466.10
Rate for Payer: Medical Associates Commercial	$612.00
Rate for Payer: Medical Associates Managed Medicare	$367.20
Rate for Payer: Midlands Choice Commercial	$571.20
Rate for Payer: Molina Healthcare Managed Medicaid	$472.95
Rate for Payer: Partners Health Alliance Commercial	$422.28
Rate for Payer: United Healthcare Commercial	$734.40
Rate for Payer: United Healthcare Managed Medicare	$481.44

IMPLANT TITANIUM LAG SCREW 10.5X105MM

Facility

$816.00

Service Code	HCPCS C1713
Hospital Charge Code	8046418
Hospital Revenue Code	278
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of IA Commercial	$734.40
Rate for Payer: Aetna of IA Medical Rental Products	$734.40
Rate for Payer: Cash Price	$652.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$612.00
Rate for Payer: Medical Associates Commercial	$612.00
Rate for Payer: Midlands Choice Commercial	$571.20
Rate for Payer: United Healthcare Commercial	$734.40

IMPLANT TITANIUM LAG SCREW 10.5X110MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046419
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X110MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046419
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X115MM

Facility

$867.00

Service Code	HCPCS C1713
Hospital Charge Code	8046420
Hospital Revenue Code	278
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$780.30
Rate for Payer: Aetna of IA Commercial	$780.30
Rate for Payer: Aetna of IA Medical Rental Products	$780.30
Rate for Payer: Cash Price	$693.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$650.25
Rate for Payer: Medical Associates Commercial	$650.25
Rate for Payer: Midlands Choice Commercial	$606.90
Rate for Payer: United Healthcare Commercial	$780.30

IMPLANT TITANIUM LAG SCREW 10.5X115MM

Facility

$867.00

Service Code	HCPCS C1713
Hospital Charge Code	8046420
Hospital Revenue Code	278
Min. Negotiated Rate	$390.15
Max. Negotiated Rate	$780.30
Rate for Payer: Aetna of IA Commercial	$780.30
Rate for Payer: Aetna of IA Medical Rental Products	$780.30
Rate for Payer: Aetna of IA Medicare	$494.19
Rate for Payer: Amerigroup Medicaid	$500.09
Rate for Payer: Amerigroup Medicare	$394.05
Rate for Payer: Cash Price	$693.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$650.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$390.15
Rate for Payer: Iowa Total Care Managed Medicaid	$495.23
Rate for Payer: Medical Associates Commercial	$650.25
Rate for Payer: Medical Associates Managed Medicare	$390.15
Rate for Payer: Midlands Choice Commercial	$606.90
Rate for Payer: Molina Healthcare Managed Medicaid	$502.51
Rate for Payer: Partners Health Alliance Commercial	$448.67
Rate for Payer: United Healthcare Commercial	$780.30
Rate for Payer: United Healthcare Managed Medicare	$511.53

IMPLANT TITANIUM LAG SCREW 10.5X120MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046421
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X120MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046421
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X125MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046422
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X125MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046422
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X130MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046423
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X130MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046423
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X70MM

Facility

$536.00

Service Code	HCPCS C1713
Hospital Charge Code	8046411
Hospital Revenue Code	278
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$482.40
Rate for Payer: Aetna of IA Commercial	$482.40
Rate for Payer: Aetna of IA Medical Rental Products	$482.40
Rate for Payer: Aetna of IA Medicare	$305.52
Rate for Payer: Amerigroup Medicaid	$309.16
Rate for Payer: Amerigroup Medicare	$243.61
Rate for Payer: Cash Price	$428.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$402.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$241.20
Rate for Payer: Iowa Total Care Managed Medicaid	$306.16
Rate for Payer: Medical Associates Commercial	$402.00
Rate for Payer: Medical Associates Managed Medicare	$241.20
Rate for Payer: Midlands Choice Commercial	$375.20
Rate for Payer: Molina Healthcare Managed Medicaid	$310.67
Rate for Payer: Partners Health Alliance Commercial	$277.38
Rate for Payer: United Healthcare Commercial	$482.40
Rate for Payer: United Healthcare Managed Medicare	$316.24

IMPLANT TITANIUM LAG SCREW 10.5X70MM

Facility

$536.00

Service Code	HCPCS C1713
Hospital Charge Code	8046411
Hospital Revenue Code	278
Min. Negotiated Rate	$375.20
Max. Negotiated Rate	$482.40
Rate for Payer: Aetna of IA Commercial	$482.40
Rate for Payer: Aetna of IA Medical Rental Products	$482.40
Rate for Payer: Cash Price	$428.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$402.00
Rate for Payer: Medical Associates Commercial	$402.00
Rate for Payer: Midlands Choice Commercial	$375.20
Rate for Payer: United Healthcare Commercial	$482.40

IMPLANT TITANIUM LAG SCREW 10.5X75MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046412
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X75MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046412
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X80MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046413
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

IMPLANT TITANIUM LAG SCREW 10.5X80MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046413
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X85MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046414
Hospital Revenue Code	278
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Aetna of IA Medicare	$352.83
Rate for Payer: Amerigroup Medicaid	$357.04
Rate for Payer: Amerigroup Medicare	$281.34
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$278.55
Rate for Payer: Iowa Total Care Managed Medicaid	$353.57
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Medical Associates Managed Medicare	$278.55
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: Molina Healthcare Managed Medicaid	$358.77
Rate for Payer: Partners Health Alliance Commercial	$320.33
Rate for Payer: United Healthcare Commercial	$557.10
Rate for Payer: United Healthcare Managed Medicare	$365.21

IMPLANT TITANIUM LAG SCREW 10.5X85MM

Facility

$619.00

Service Code	HCPCS C1713
Hospital Charge Code	8046414
Hospital Revenue Code	278
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$557.10
Rate for Payer: Aetna of IA Commercial	$557.10
Rate for Payer: Aetna of IA Medical Rental Products	$557.10
Rate for Payer: Cash Price	$495.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$464.25
Rate for Payer: Medical Associates Commercial	$464.25
Rate for Payer: Midlands Choice Commercial	$433.30
Rate for Payer: United Healthcare Commercial	$557.10

Know your out-of-pocket cost for care.

All Charges