Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

K-WIRE 6X.045 TROCAR POINTS STERILE

Facility

$33.00

Service Code	HCPCS C1713
Hospital Charge Code	8046383
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of IA Commercial	$29.70
Rate for Payer: Aetna of IA Medical Rental Products	$29.70
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.75
Rate for Payer: Medical Associates Commercial	$24.75
Rate for Payer: Midlands Choice Commercial	$23.10
Rate for Payer: United Healthcare Commercial	$29.70

K-WIRE 6X.045 TROCAR POINTS STERILE

Facility

$33.00

Service Code	HCPCS C1713
Hospital Charge Code	8046383
Hospital Revenue Code	278
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of IA Commercial	$29.70
Rate for Payer: Aetna of IA Medical Rental Products	$29.70
Rate for Payer: Aetna of IA Medicare	$18.81
Rate for Payer: Amerigroup Medicaid	$19.03
Rate for Payer: Amerigroup Medicare	$15.00
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.85
Rate for Payer: Iowa Total Care Managed Medicaid	$18.85
Rate for Payer: Medical Associates Commercial	$24.75
Rate for Payer: Medical Associates Managed Medicare	$14.85
Rate for Payer: Midlands Choice Commercial	$23.10
Rate for Payer: Molina Healthcare Managed Medicaid	$19.13
Rate for Payer: Partners Health Alliance Commercial	$17.08
Rate for Payer: United Healthcare Commercial	$29.70
Rate for Payer: United Healthcare Managed Medicare	$19.47

K-WIRE 6X.054 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046249
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: United Healthcare Commercial	$31.50

K-WIRE 6X.054 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046249
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Aetna of IA Medicare	$19.95
Rate for Payer: Amerigroup Medicaid	$20.19
Rate for Payer: Amerigroup Medicare	$15.91
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.75
Rate for Payer: Iowa Total Care Managed Medicaid	$19.99
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Medical Associates Managed Medicare	$15.75
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: Molina Healthcare Managed Medicaid	$20.29
Rate for Payer: Partners Health Alliance Commercial	$18.11
Rate for Payer: United Healthcare Commercial	$31.50
Rate for Payer: United Healthcare Managed Medicare	$20.65

K-WIRE 6X.062 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046896
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Aetna of IA Medicare	$19.95
Rate for Payer: Amerigroup Medicaid	$20.19
Rate for Payer: Amerigroup Medicare	$15.91
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.75
Rate for Payer: Iowa Total Care Managed Medicaid	$19.99
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Medical Associates Managed Medicare	$15.75
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: Molina Healthcare Managed Medicaid	$20.29
Rate for Payer: Partners Health Alliance Commercial	$18.11
Rate for Payer: United Healthcare Commercial	$31.50
Rate for Payer: United Healthcare Managed Medicare	$20.65

K-WIRE 6X.062 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046896
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: United Healthcare Commercial	$31.50

K-WIRE 9X.028 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047038
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

K-WIRE 9X.028 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047038
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

K-WIRE 9X.035 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046319
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

K-WIRE 9X.035 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046319
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

K-WIRE 9X.045 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046401
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

K-WIRE 9X.045 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046401
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

K-WIRE 9X.054 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046424
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

K-WIRE 9X.054 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046424
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

K-WIRE 9X.062 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046984
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

K-WIRE 9X.062 TROCAR POINTS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046984
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

K-WIRE GAMMA 3.2X450

Facility

$138.00

Service Code	HCPCS C1713
Hospital Charge Code	8046315
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of IA Commercial	$124.20
Rate for Payer: Aetna of IA Medical Rental Products	$124.20
Rate for Payer: Aetna of IA Medicare	$78.66
Rate for Payer: Amerigroup Medicaid	$79.60
Rate for Payer: Amerigroup Medicare	$62.72
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$103.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$62.10
Rate for Payer: Iowa Total Care Managed Medicaid	$78.83
Rate for Payer: Medical Associates Commercial	$103.50
Rate for Payer: Medical Associates Managed Medicare	$62.10
Rate for Payer: Midlands Choice Commercial	$96.60
Rate for Payer: Molina Healthcare Managed Medicaid	$79.98
Rate for Payer: Partners Health Alliance Commercial	$71.42
Rate for Payer: United Healthcare Commercial	$124.20
Rate for Payer: United Healthcare Managed Medicare	$81.42

K-WIRE GAMMA 3.2X450

Facility

$138.00

Service Code	HCPCS C1713
Hospital Charge Code	8046315
Hospital Revenue Code	278
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of IA Commercial	$124.20
Rate for Payer: Aetna of IA Medical Rental Products	$124.20
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$103.50
Rate for Payer: Medical Associates Commercial	$103.50
Rate for Payer: Midlands Choice Commercial	$96.60
Rate for Payer: United Healthcare Commercial	$124.20

K-WIRE STANDARD 0.035

Facility

$25.00

Service Code	HCPCS C1713
Hospital Charge Code	8463427
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of IA Commercial	$22.50
Rate for Payer: Aetna of IA Medical Rental Products	$22.50
Rate for Payer: Aetna of IA Medicare	$14.25
Rate for Payer: Amerigroup Medicaid	$14.42
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: Cash Price	$20.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.25
Rate for Payer: Iowa Total Care Managed Medicaid	$14.28
Rate for Payer: Medical Associates Commercial	$18.75
Rate for Payer: Medical Associates Managed Medicare	$11.25
Rate for Payer: Midlands Choice Commercial	$17.50
Rate for Payer: Molina Healthcare Managed Medicaid	$14.49
Rate for Payer: Partners Health Alliance Commercial	$12.94
Rate for Payer: United Healthcare Commercial	$22.50
Rate for Payer: United Healthcare Managed Medicare	$14.75

K-WIRE STANDARD 0.035

Facility

$25.00

Service Code	HCPCS C1713
Hospital Charge Code	8463427
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of IA Commercial	$22.50
Rate for Payer: Aetna of IA Medical Rental Products	$22.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.75
Rate for Payer: Medical Associates Commercial	$18.75
Rate for Payer: Midlands Choice Commercial	$17.50
Rate for Payer: United Healthcare Commercial	$22.50

K-WIRE W/17MM STOP

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046885
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

K-WIRE W/17MM STOP

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046885
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

K-WIRE W/LENGTH MARKINGS .045IN (1.143MM

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046302
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

K-WIRE W/LENGTH MARKINGS .045IN (1.143MM

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046302
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

L15 FRAME PLATE

Facility

$2,006.00

Service Code	HCPCS C1713
Hospital Charge Code	8955187
Hospital Revenue Code	276
Min. Negotiated Rate	$902.70
Max. Negotiated Rate	$1,805.40
Rate for Payer: Aetna of IA Commercial	$1,805.40
Rate for Payer: Aetna of IA Medical Rental Products	$1,805.40
Rate for Payer: Aetna of IA Medicare	$1,143.42
Rate for Payer: Amerigroup Medicaid	$1,157.06
Rate for Payer: Amerigroup Medicare	$911.73
Rate for Payer: Cash Price	$1,604.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,504.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$902.70
Rate for Payer: Iowa Total Care Managed Medicaid	$1,145.83
Rate for Payer: Medical Associates Commercial	$1,504.50
Rate for Payer: Medical Associates Managed Medicare	$902.70
Rate for Payer: Midlands Choice Commercial	$1,404.20
Rate for Payer: Molina Healthcare Managed Medicaid	$1,162.68
Rate for Payer: Partners Health Alliance Commercial	$1,038.11
Rate for Payer: United Healthcare Commercial	$1,805.40
Rate for Payer: United Healthcare Managed Medicare	$1,183.54

Know your out-of-pocket cost for care.

All Charges