Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

LOCKING COMPR BROAD 6 HOLE / L 119MM

Facility

$224.00

Service Code	HCPCS C1713
Hospital Charge Code	8046754
Hospital Revenue Code	278
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of IA Commercial	$201.60
Rate for Payer: Aetna of IA Medical Rental Products	$201.60
Rate for Payer: Cash Price	$179.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$168.00
Rate for Payer: Medical Associates Commercial	$168.00
Rate for Payer: Midlands Choice Commercial	$156.80
Rate for Payer: United Healthcare Commercial	$201.60

LOCKING COMPR BROAD 7 HOLE / L 137MM

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	8046755
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of IA Commercial	$225.00
Rate for Payer: Aetna of IA Medical Rental Products	$225.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$187.50
Rate for Payer: Medical Associates Commercial	$187.50
Rate for Payer: Midlands Choice Commercial	$175.00
Rate for Payer: United Healthcare Commercial	$225.00

LOCKING COMPR BROAD 7 HOLE / L 137MM

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	8046755
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of IA Commercial	$225.00
Rate for Payer: Aetna of IA Medical Rental Products	$225.00
Rate for Payer: Aetna of IA Medicare	$142.50
Rate for Payer: Amerigroup Medicaid	$144.20
Rate for Payer: Amerigroup Medicare	$113.62
Rate for Payer: Cash Price	$200.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$187.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$112.50
Rate for Payer: Iowa Total Care Managed Medicaid	$142.80
Rate for Payer: Medical Associates Commercial	$187.50
Rate for Payer: Medical Associates Managed Medicare	$112.50
Rate for Payer: Midlands Choice Commercial	$175.00
Rate for Payer: Molina Healthcare Managed Medicaid	$144.90
Rate for Payer: Partners Health Alliance Commercial	$129.38
Rate for Payer: United Healthcare Commercial	$225.00
Rate for Payer: United Healthcare Managed Medicare	$147.50

LOCKING COMPR BROAD 8 HOLE / L 155MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046756
Hospital Revenue Code	278
Min. Negotiated Rate	$112.95
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Aetna of IA Medicare	$143.07
Rate for Payer: Amerigroup Medicaid	$144.78
Rate for Payer: Amerigroup Medicare	$114.08
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$112.95
Rate for Payer: Iowa Total Care Managed Medicaid	$143.37
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Medical Associates Managed Medicare	$112.95
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: Molina Healthcare Managed Medicaid	$145.48
Rate for Payer: Partners Health Alliance Commercial	$129.89
Rate for Payer: United Healthcare Commercial	$225.90
Rate for Payer: United Healthcare Managed Medicare	$148.09

LOCKING COMPR BROAD 8 HOLE / L 155MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046756
Hospital Revenue Code	278
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: United Healthcare Commercial	$225.90

LOCKING COMPR BROAD 9 HOLE / L 173MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046757
Hospital Revenue Code	278
Min. Negotiated Rate	$112.95
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Aetna of IA Medicare	$143.07
Rate for Payer: Amerigroup Medicaid	$144.78
Rate for Payer: Amerigroup Medicare	$114.08
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$112.95
Rate for Payer: Iowa Total Care Managed Medicaid	$143.37
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Medical Associates Managed Medicare	$112.95
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: Molina Healthcare Managed Medicaid	$145.48
Rate for Payer: Partners Health Alliance Commercial	$129.89
Rate for Payer: United Healthcare Commercial	$225.90
Rate for Payer: United Healthcare Managed Medicare	$148.09

LOCKING COMPR BROAD 9 HOLE / L 173MM

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	8046757
Hospital Revenue Code	278
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$225.90
Rate for Payer: Aetna of IA Commercial	$225.90
Rate for Payer: Aetna of IA Medical Rental Products	$225.90
Rate for Payer: Cash Price	$200.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$188.25
Rate for Payer: Medical Associates Commercial	$188.25
Rate for Payer: Midlands Choice Commercial	$175.70
Rate for Payer: United Healthcare Commercial	$225.90

LOCKING COMPR NARROW 10 HOLE / L 187MM

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	8046751
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of IA Commercial	$169.20
Rate for Payer: Aetna of IA Medical Rental Products	$169.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.00
Rate for Payer: Medical Associates Commercial	$141.00
Rate for Payer: Midlands Choice Commercial	$131.60
Rate for Payer: United Healthcare Commercial	$169.20

LOCKING COMPR NARROW 10 HOLE / L 187MM

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	8046751
Hospital Revenue Code	278
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of IA Commercial	$169.20
Rate for Payer: Aetna of IA Medical Rental Products	$169.20
Rate for Payer: Aetna of IA Medicare	$107.16
Rate for Payer: Amerigroup Medicaid	$108.44
Rate for Payer: Amerigroup Medicare	$85.45
Rate for Payer: Cash Price	$150.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$84.60
Rate for Payer: Iowa Total Care Managed Medicaid	$107.39
Rate for Payer: Medical Associates Commercial	$141.00
Rate for Payer: Medical Associates Managed Medicare	$84.60
Rate for Payer: Midlands Choice Commercial	$131.60
Rate for Payer: Molina Healthcare Managed Medicaid	$108.96
Rate for Payer: Partners Health Alliance Commercial	$97.29
Rate for Payer: United Healthcare Commercial	$169.20
Rate for Payer: United Healthcare Managed Medicare	$110.92

LOCKING COMPR NARROW 12 HOLE / L 223MM

Facility

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	8046752
Hospital Revenue Code	278
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

LOCKING COMPR NARROW 12 HOLE / L 223MM

Facility

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	8046752
Hospital Revenue Code	278
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Aetna of IA Medicare	$136.23
Rate for Payer: Amerigroup Medicaid	$137.86
Rate for Payer: Amerigroup Medicare	$108.63
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$107.55
Rate for Payer: Iowa Total Care Managed Medicaid	$136.52
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Medical Associates Managed Medicare	$107.55
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: Molina Healthcare Managed Medicaid	$138.52
Rate for Payer: Partners Health Alliance Commercial	$123.68
Rate for Payer: United Healthcare Commercial	$215.10
Rate for Payer: United Healthcare Managed Medicare	$141.01

LOCKING COMPR NARROW 14 HOLE / L 259MM

Facility

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	8046753
Hospital Revenue Code	278
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: United Healthcare Commercial	$215.10

LOCKING COMPR NARROW 14 HOLE / L 259MM

Facility

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	8046753
Hospital Revenue Code	278
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of IA Commercial	$215.10
Rate for Payer: Aetna of IA Medical Rental Products	$215.10
Rate for Payer: Aetna of IA Medicare	$136.23
Rate for Payer: Amerigroup Medicaid	$137.86
Rate for Payer: Amerigroup Medicare	$108.63
Rate for Payer: Cash Price	$191.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$179.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$107.55
Rate for Payer: Iowa Total Care Managed Medicaid	$136.52
Rate for Payer: Medical Associates Commercial	$179.25
Rate for Payer: Medical Associates Managed Medicare	$107.55
Rate for Payer: Midlands Choice Commercial	$167.30
Rate for Payer: Molina Healthcare Managed Medicaid	$138.52
Rate for Payer: Partners Health Alliance Commercial	$123.68
Rate for Payer: United Healthcare Commercial	$215.10
Rate for Payer: United Healthcare Managed Medicare	$141.01

LOCKING COMPR NARROW 2 HOLE / L 43MM

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	8046743
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of IA Commercial	$144.00
Rate for Payer: Aetna of IA Medical Rental Products	$144.00
Rate for Payer: Aetna of IA Medicare	$91.20
Rate for Payer: Amerigroup Medicaid	$92.29
Rate for Payer: Amerigroup Medicare	$72.72
Rate for Payer: Cash Price	$128.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.00
Rate for Payer: Iowa Total Care Managed Medicaid	$91.39
Rate for Payer: Medical Associates Commercial	$120.00
Rate for Payer: Medical Associates Managed Medicare	$72.00
Rate for Payer: Midlands Choice Commercial	$112.00
Rate for Payer: Molina Healthcare Managed Medicaid	$92.74
Rate for Payer: Partners Health Alliance Commercial	$82.80
Rate for Payer: United Healthcare Commercial	$144.00
Rate for Payer: United Healthcare Managed Medicare	$94.40

LOCKING COMPR NARROW 2 HOLE / L 43MM

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	8046743
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of IA Commercial	$144.00
Rate for Payer: Aetna of IA Medical Rental Products	$144.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.00
Rate for Payer: Medical Associates Commercial	$120.00
Rate for Payer: Midlands Choice Commercial	$112.00
Rate for Payer: United Healthcare Commercial	$144.00

LOCKING COMPR NARROW 3 HOLE / L 61MM

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	8046744
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of IA Commercial	$144.00
Rate for Payer: Aetna of IA Medical Rental Products	$144.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.00
Rate for Payer: Medical Associates Commercial	$120.00
Rate for Payer: Midlands Choice Commercial	$112.00
Rate for Payer: United Healthcare Commercial	$144.00

LOCKING COMPR NARROW 3 HOLE / L 61MM

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	8046744
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of IA Commercial	$144.00
Rate for Payer: Aetna of IA Medical Rental Products	$144.00
Rate for Payer: Aetna of IA Medicare	$91.20
Rate for Payer: Amerigroup Medicaid	$92.29
Rate for Payer: Amerigroup Medicare	$72.72
Rate for Payer: Cash Price	$128.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$120.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.00
Rate for Payer: Iowa Total Care Managed Medicaid	$91.39
Rate for Payer: Medical Associates Commercial	$120.00
Rate for Payer: Medical Associates Managed Medicare	$72.00
Rate for Payer: Midlands Choice Commercial	$112.00
Rate for Payer: Molina Healthcare Managed Medicaid	$92.74
Rate for Payer: Partners Health Alliance Commercial	$82.80
Rate for Payer: United Healthcare Commercial	$144.00
Rate for Payer: United Healthcare Managed Medicare	$94.40

LOCKING COMPR NARROW 4 HOLE / L 79MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046745
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Aetna of IA Medicare	$85.50
Rate for Payer: Amerigroup Medicaid	$86.52
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$85.68
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.94
Rate for Payer: Partners Health Alliance Commercial	$77.62
Rate for Payer: United Healthcare Commercial	$135.00
Rate for Payer: United Healthcare Managed Medicare	$88.50

LOCKING COMPR NARROW 4 HOLE / L 79MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046745
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: United Healthcare Commercial	$135.00

LOCKING COMPR NARROW 5 HOLE / L 97MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046746
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Aetna of IA Medicare	$85.50
Rate for Payer: Amerigroup Medicaid	$86.52
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$85.68
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.94
Rate for Payer: Partners Health Alliance Commercial	$77.62
Rate for Payer: United Healthcare Commercial	$135.00
Rate for Payer: United Healthcare Managed Medicare	$88.50

LOCKING COMPR NARROW 5 HOLE / L 97MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046746
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: United Healthcare Commercial	$135.00

LOCKING COMPR NARROW 6 HOLE / L 115MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046747
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Aetna of IA Medicare	$85.50
Rate for Payer: Amerigroup Medicaid	$86.52
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$85.68
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: Molina Healthcare Managed Medicaid	$86.94
Rate for Payer: Partners Health Alliance Commercial	$77.62
Rate for Payer: United Healthcare Commercial	$135.00
Rate for Payer: United Healthcare Managed Medicare	$88.50

LOCKING COMPR NARROW 6 HOLE / L 115MM

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	8046747
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of IA Commercial	$135.00
Rate for Payer: Aetna of IA Medical Rental Products	$135.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$112.50
Rate for Payer: Medical Associates Commercial	$112.50
Rate for Payer: Midlands Choice Commercial	$105.00
Rate for Payer: United Healthcare Commercial	$135.00

LOCKING COMPR NARROW 7 HOLE / L 133MM

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	8046748
Hospital Revenue Code	278
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of IA Commercial	$169.20
Rate for Payer: Aetna of IA Medical Rental Products	$169.20
Rate for Payer: Aetna of IA Medicare	$107.16
Rate for Payer: Amerigroup Medicaid	$108.44
Rate for Payer: Amerigroup Medicare	$85.45
Rate for Payer: Cash Price	$150.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$84.60
Rate for Payer: Iowa Total Care Managed Medicaid	$107.39
Rate for Payer: Medical Associates Commercial	$141.00
Rate for Payer: Medical Associates Managed Medicare	$84.60
Rate for Payer: Midlands Choice Commercial	$131.60
Rate for Payer: Molina Healthcare Managed Medicaid	$108.96
Rate for Payer: Partners Health Alliance Commercial	$97.29
Rate for Payer: United Healthcare Commercial	$169.20
Rate for Payer: United Healthcare Managed Medicare	$110.92

LOCKING COMPR NARROW 7 HOLE / L 133MM

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	8046748
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of IA Commercial	$169.20
Rate for Payer: Aetna of IA Medical Rental Products	$169.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$141.00
Rate for Payer: Medical Associates Commercial	$141.00
Rate for Payer: Midlands Choice Commercial	$131.60
Rate for Payer: United Healthcare Commercial	$169.20

Know your out-of-pocket cost for care.

All Charges