Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

IMPLANT TITANIUM LONG NAIL 11X380X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046436
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X380X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046436
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM LONG NAIL 11X400X125L

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X400X125L

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046472
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM LONG NAIL 11X400X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X400X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046437
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM LONG NAIL 11X420X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X420X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046438
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM LONG NAIL 11X440X125L

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046474
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X440X125L

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046474
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM LONG NAIL 11X440X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: United Healthcare Commercial	$1,990.80

IMPLANT TITANIUM LONG NAIL 11X440X125R

Facility

$2,212.00

Service Code	HCPCS C1713
Hospital Charge Code	8046439
Hospital Revenue Code	278
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,990.80
Rate for Payer: Aetna of IA Commercial	$1,990.80
Rate for Payer: Aetna of IA Medical Rental Products	$1,990.80
Rate for Payer: Aetna of IA Medicare	$1,260.84
Rate for Payer: Amerigroup Medicaid	$1,275.88
Rate for Payer: Amerigroup Medicare	$1,005.35
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,659.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$995.40
Rate for Payer: Iowa Total Care Managed Medicaid	$1,263.49
Rate for Payer: Medical Associates Commercial	$1,659.00
Rate for Payer: Medical Associates Managed Medicare	$995.40
Rate for Payer: Midlands Choice Commercial	$1,548.40
Rate for Payer: Molina Healthcare Managed Medicaid	$1,282.08
Rate for Payer: Partners Health Alliance Commercial	$1,144.71
Rate for Payer: United Healthcare Commercial	$1,990.80
Rate for Payer: United Healthcare Managed Medicare	$1,305.08

IMPLANT TITANIUM SET SCREW 8X17.5MM

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	8046405
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 SET SCREW 8X17.5MM

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	8046405
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 TROCHANTERIC 11X180X120

Facility

$1,518.00

Service Code	HCPCS C1713
Hospital Charge Code	8046425
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.60
Max. Negotiated Rate	$1,366.20
Rate for Payer: Aetna of IA Commercial	$1,366.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,366.20
Rate for Payer: Cash Price	$1,214.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,138.50
Rate for Payer: Medical Associates Commercial	$1,138.50
Rate for Payer: Midlands Choice Commercial	$1,062.60
Rate for Payer: United Healthcare Commercial	$1,366.20

IMPLANT TITANIUM TROCHANTERIC 11X180X120

Facility

$1,518.00

Service Code	HCPCS C1713
Hospital Charge Code	8046425
Hospital Revenue Code	278
Min. Negotiated Rate	$683.10
Max. Negotiated Rate	$1,366.20
Rate for Payer: Aetna of IA Commercial	$1,366.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,366.20
Rate for Payer: Aetna of IA Medicare	$865.26
Rate for Payer: Amerigroup Medicaid	$875.58
Rate for Payer: Amerigroup Medicare	$689.93
Rate for Payer: Cash Price	$1,214.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,138.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$683.10
Rate for Payer: Iowa Total Care Managed Medicaid	$867.08
Rate for Payer: Medical Associates Commercial	$1,138.50
Rate for Payer: Medical Associates Managed Medicare	$683.10
Rate for Payer: Midlands Choice Commercial	$1,062.60
Rate for Payer: Molina Healthcare Managed Medicaid	$879.83
Rate for Payer: Partners Health Alliance Commercial	$785.56
Rate for Payer: United Healthcare Commercial	$1,366.20
Rate for Payer: United Healthcare Managed Medicare	$895.62

IMPLANT TITANIUM TROCHANTERIC 11X180X125

Facility

$2,126.00

Service Code	HCPCS C1713
Hospital Charge Code	8046426
Hospital Revenue Code	278
Min. Negotiated Rate	$1,488.20
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of IA Commercial	$1,913.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,913.40
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,594.50
Rate for Payer: Medical Associates Commercial	$1,594.50
Rate for Payer: Midlands Choice Commercial	$1,488.20
Rate for Payer: United Healthcare Commercial	$1,913.40

IMPLANT TITANIUM TROCHANTERIC 11X180X125

Facility

$2,126.00

Service Code	HCPCS C1713
Hospital Charge Code	8046426
Hospital Revenue Code	278
Min. Negotiated Rate	$956.70
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of IA Commercial	$1,913.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,913.40
Rate for Payer: Aetna of IA Medicare	$1,211.82
Rate for Payer: Amerigroup Medicaid	$1,226.28
Rate for Payer: Amerigroup Medicare	$966.27
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,594.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$956.70
Rate for Payer: Iowa Total Care Managed Medicaid	$1,214.37
Rate for Payer: Medical Associates Commercial	$1,594.50
Rate for Payer: Medical Associates Managed Medicare	$956.70
Rate for Payer: Midlands Choice Commercial	$1,488.20
Rate for Payer: Molina Healthcare Managed Medicaid	$1,232.23
Rate for Payer: Partners Health Alliance Commercial	$1,100.20
Rate for Payer: United Healthcare Commercial	$1,913.40
Rate for Payer: United Healthcare Managed Medicare	$1,254.34

IMPLANT TITANIUM TROCHANTERIC 11X180X130

Facility

$1,518.00

Service Code	HCPCS C1713
Hospital Charge Code	8046427
Hospital Revenue Code	278
Min. Negotiated Rate	$683.10
Max. Negotiated Rate	$1,366.20
Rate for Payer: Aetna of IA Commercial	$1,366.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,366.20
Rate for Payer: Aetna of IA Medicare	$865.26
Rate for Payer: Amerigroup Medicaid	$875.58
Rate for Payer: Amerigroup Medicare	$689.93
Rate for Payer: Cash Price	$1,214.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,138.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$683.10
Rate for Payer: Iowa Total Care Managed Medicaid	$867.08
Rate for Payer: Medical Associates Commercial	$1,138.50
Rate for Payer: Medical Associates Managed Medicare	$683.10
Rate for Payer: Midlands Choice Commercial	$1,062.60
Rate for Payer: Molina Healthcare Managed Medicaid	$879.83
Rate for Payer: Partners Health Alliance Commercial	$785.56
Rate for Payer: United Healthcare Commercial	$1,366.20
Rate for Payer: United Healthcare Managed Medicare	$895.62

IMPLANT TITANIUM TROCHANTERIC 11X180X130

Facility

$1,518.00

Service Code	HCPCS C1713
Hospital Charge Code	8046427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.60
Max. Negotiated Rate	$1,366.20
Rate for Payer: Aetna of IA Commercial	$1,366.20
Rate for Payer: Aetna of IA Medical Rental Products	$1,366.20
Rate for Payer: Cash Price	$1,214.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,138.50
Rate for Payer: Medical Associates Commercial	$1,138.50
Rate for Payer: Midlands Choice Commercial	$1,062.60
Rate for Payer: United Healthcare Commercial	$1,366.20

IMPLANT TOTAL KNEE CEMENTED STEM 12X100M

Facility

$2,774.00

Service Code	HCPCS C1776
Hospital Charge Code	8026188
Hospital Revenue Code	278
Min. Negotiated Rate	$1,941.80
Max. Negotiated Rate	$2,496.60
Rate for Payer: Aetna of IA Commercial	$2,496.60
Rate for Payer: Aetna of IA Medical Rental Products	$2,496.60
Rate for Payer: Cash Price	$2,219.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,080.50
Rate for Payer: Medical Associates Commercial	$2,080.50
Rate for Payer: Midlands Choice Commercial	$1,941.80
Rate for Payer: United Healthcare Commercial	$2,496.60

IMPLANT TOTAL KNEE CEMENTED STEM 12X100M

Facility

$2,774.00

Service Code	HCPCS C1776
Hospital Charge Code	8026188
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.30
Max. Negotiated Rate	$2,496.60
Rate for Payer: Aetna of IA Commercial	$2,496.60
Rate for Payer: Aetna of IA Medical Rental Products	$2,496.60
Rate for Payer: Aetna of IA Medicare	$1,581.18
Rate for Payer: Amerigroup Medicaid	$1,600.04
Rate for Payer: Amerigroup Medicare	$1,260.78
Rate for Payer: Cash Price	$2,219.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,080.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,248.30
Rate for Payer: Iowa Total Care Managed Medicaid	$1,584.51
Rate for Payer: Medical Associates Commercial	$2,080.50
Rate for Payer: Medical Associates Managed Medicare	$1,248.30
Rate for Payer: Midlands Choice Commercial	$1,941.80
Rate for Payer: Molina Healthcare Managed Medicaid	$1,607.81
Rate for Payer: Partners Health Alliance Commercial	$1,435.54
Rate for Payer: United Healthcare Commercial	$2,496.60
Rate for Payer: United Healthcare Managed Medicare	$1,636.66

IMPLANT WASHER, 7 MM. SS

Facility

$54.00

Service Code	HCPCS C1713
Hospital Charge Code	8047139
Hospital Revenue Code	278
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of IA Commercial	$48.60
Rate for Payer: Aetna of IA Medical Rental Products	$48.60
Rate for Payer: Aetna of IA Medicare	$30.78
Rate for Payer: Amerigroup Medicaid	$31.15
Rate for Payer: Amerigroup Medicare	$24.54
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.30
Rate for Payer: Iowa Total Care Managed Medicaid	$30.84
Rate for Payer: Medical Associates Commercial	$40.50
Rate for Payer: Medical Associates Managed Medicare	$24.30
Rate for Payer: Midlands Choice Commercial	$37.80
Rate for Payer: Molina Healthcare Managed Medicaid	$31.30
Rate for Payer: Partners Health Alliance Commercial	$27.94
Rate for Payer: United Healthcare Commercial	$48.60
Rate for Payer: United Healthcare Managed Medicare	$31.86

IMPLANT WASHER, 7 MM. SS

Facility

$54.00

Service Code	HCPCS C1713
Hospital Charge Code	8047139
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of IA Commercial	$48.60
Rate for Payer: Aetna of IA Medical Rental Products	$48.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$40.50
Rate for Payer: Medical Associates Commercial	$40.50
Rate for Payer: Midlands Choice Commercial	$37.80
Rate for Payer: United Healthcare Commercial	$48.60

IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE

Facility

$1,755.00

Service Code	HCPCS C1713
Hospital Charge Code	8784972
Hospital Revenue Code	278
Min. Negotiated Rate	$789.75
Max. Negotiated Rate	$1,579.50
Rate for Payer: Aetna of IA Commercial	$1,579.50
Rate for Payer: Aetna of IA Medical Rental Products	$1,579.50
Rate for Payer: Aetna of IA Medicare	$1,000.35
Rate for Payer: Amerigroup Medicaid	$1,012.28
Rate for Payer: Amerigroup Medicare	$797.65
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,316.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$789.75
Rate for Payer: Iowa Total Care Managed Medicaid	$1,002.46
Rate for Payer: Medical Associates Commercial	$1,316.25
Rate for Payer: Medical Associates Managed Medicare	$789.75
Rate for Payer: Midlands Choice Commercial	$1,228.50
Rate for Payer: Molina Healthcare Managed Medicaid	$1,017.20
Rate for Payer: Partners Health Alliance Commercial	$908.21
Rate for Payer: United Healthcare Commercial	$1,579.50
Rate for Payer: United Healthcare Managed Medicare	$1,035.45

Know your out-of-pocket cost for care.

All Charges