Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

PLATE LOCKING RECON 4 HOLE / L 62MM

Facility

$504.00

Service Code	HCPCS C1713
Hospital Charge Code	8046763
Hospital Revenue Code	278
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of IA Commercial	$453.60
Rate for Payer: Aetna of IA Medical Rental Products	$453.60
Rate for Payer: Cash Price	$403.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$378.00
Rate for Payer: Medical Associates Commercial	$378.00
Rate for Payer: Midlands Choice Commercial	$352.80
Rate for Payer: United Healthcare Commercial	$453.60

PLATE LOCKING RECON 4 HOLE / L 62MM

Facility

$504.00

Service Code	HCPCS C1713
Hospital Charge Code	8046763
Hospital Revenue Code	278
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of IA Commercial	$453.60
Rate for Payer: Aetna of IA Medical Rental Products	$453.60
Rate for Payer: Aetna of IA Medicare	$287.28
Rate for Payer: Amerigroup Medicaid	$290.71
Rate for Payer: Amerigroup Medicare	$229.07
Rate for Payer: Cash Price	$403.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$378.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$226.80
Rate for Payer: Iowa Total Care Managed Medicaid	$287.88
Rate for Payer: Medical Associates Commercial	$378.00
Rate for Payer: Medical Associates Managed Medicare	$226.80
Rate for Payer: Midlands Choice Commercial	$352.80
Rate for Payer: Molina Healthcare Managed Medicaid	$292.12
Rate for Payer: Partners Health Alliance Commercial	$260.82
Rate for Payer: United Healthcare Commercial	$453.60
Rate for Payer: United Healthcare Managed Medicare	$297.36

PLATE LOCKING RECON 6 HOLE / L 94MM

Facility

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	8046764
Hospital Revenue Code	278
Min. Negotiated Rate	$357.70
Max. Negotiated Rate	$459.90
Rate for Payer: Aetna of IA Commercial	$459.90
Rate for Payer: Aetna of IA Medical Rental Products	$459.90
Rate for Payer: Cash Price	$408.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$383.25
Rate for Payer: Medical Associates Commercial	$383.25
Rate for Payer: Midlands Choice Commercial	$357.70
Rate for Payer: United Healthcare Commercial	$459.90

PLATE LOCKING RECON 6 HOLE / L 94MM

Facility

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	8046764
Hospital Revenue Code	278
Min. Negotiated Rate	$229.95
Max. Negotiated Rate	$459.90
Rate for Payer: Aetna of IA Commercial	$459.90
Rate for Payer: Aetna of IA Medical Rental Products	$459.90
Rate for Payer: Aetna of IA Medicare	$291.27
Rate for Payer: Amerigroup Medicaid	$294.74
Rate for Payer: Amerigroup Medicare	$232.25
Rate for Payer: Cash Price	$408.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$383.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$229.95
Rate for Payer: Iowa Total Care Managed Medicaid	$291.88
Rate for Payer: Medical Associates Commercial	$383.25
Rate for Payer: Medical Associates Managed Medicare	$229.95
Rate for Payer: Midlands Choice Commercial	$357.70
Rate for Payer: Molina Healthcare Managed Medicaid	$296.18
Rate for Payer: Partners Health Alliance Commercial	$264.44
Rate for Payer: United Healthcare Commercial	$459.90
Rate for Payer: United Healthcare Managed Medicare	$301.49

PLATE LOCKING RECON 8 HOLE / L 126MM

Facility

$591.00

Service Code	HCPCS C1713
Hospital Charge Code	8046765
Hospital Revenue Code	278
Min. Negotiated Rate	$265.95
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of IA Commercial	$531.90
Rate for Payer: Aetna of IA Medical Rental Products	$531.90
Rate for Payer: Aetna of IA Medicare	$336.87
Rate for Payer: Amerigroup Medicaid	$340.89
Rate for Payer: Amerigroup Medicare	$268.61
Rate for Payer: Cash Price	$472.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$443.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$265.95
Rate for Payer: Iowa Total Care Managed Medicaid	$337.58
Rate for Payer: Medical Associates Commercial	$443.25
Rate for Payer: Medical Associates Managed Medicare	$265.95
Rate for Payer: Midlands Choice Commercial	$413.70
Rate for Payer: Molina Healthcare Managed Medicaid	$342.54
Rate for Payer: Partners Health Alliance Commercial	$305.84
Rate for Payer: United Healthcare Commercial	$531.90
Rate for Payer: United Healthcare Managed Medicare	$348.69

PLATE LOCKING RECON 8 HOLE / L 126MM

Facility

$591.00

Service Code	HCPCS C1713
Hospital Charge Code	8046765
Hospital Revenue Code	278
Min. Negotiated Rate	$413.70
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of IA Commercial	$531.90
Rate for Payer: Aetna of IA Medical Rental Products	$531.90
Rate for Payer: Cash Price	$472.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$443.25
Rate for Payer: Medical Associates Commercial	$443.25
Rate for Payer: Midlands Choice Commercial	$413.70
Rate for Payer: United Healthcare Commercial	$531.90

PLATE LOCKING STRAIGHT, SS, 10H

Facility

$803.00

Service Code	HCPCS C1713
Hospital Charge Code	8047164
Hospital Revenue Code	278
Min. Negotiated Rate	$361.35
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of IA Commercial	$722.70
Rate for Payer: Aetna of IA Medical Rental Products	$722.70
Rate for Payer: Aetna of IA Medicare	$457.71
Rate for Payer: Amerigroup Medicaid	$463.17
Rate for Payer: Amerigroup Medicare	$364.96
Rate for Payer: Cash Price	$642.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$602.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$361.35
Rate for Payer: Iowa Total Care Managed Medicaid	$458.67
Rate for Payer: Medical Associates Commercial	$602.25
Rate for Payer: Medical Associates Managed Medicare	$361.35
Rate for Payer: Midlands Choice Commercial	$562.10
Rate for Payer: Molina Healthcare Managed Medicaid	$465.42
Rate for Payer: Partners Health Alliance Commercial	$415.55
Rate for Payer: United Healthcare Commercial	$722.70
Rate for Payer: United Healthcare Managed Medicare	$473.77

PLATE LOCKING STRAIGHT, SS, 10H

Facility

$803.00

Service Code	HCPCS C1713
Hospital Charge Code	8047164
Hospital Revenue Code	278
Min. Negotiated Rate	$562.10
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of IA Commercial	$722.70
Rate for Payer: Aetna of IA Medical Rental Products	$722.70
Rate for Payer: Cash Price	$642.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$602.25
Rate for Payer: Medical Associates Commercial	$602.25
Rate for Payer: Midlands Choice Commercial	$562.10
Rate for Payer: United Healthcare Commercial	$722.70

PLATE LOCKING STRAIGHT, SS, 12H

Facility

$922.00

Service Code	HCPCS C1713
Hospital Charge Code	8047165
Hospital Revenue Code	278
Min. Negotiated Rate	$645.40
Max. Negotiated Rate	$829.80
Rate for Payer: Aetna of IA Commercial	$829.80
Rate for Payer: Aetna of IA Medical Rental Products	$829.80
Rate for Payer: Cash Price	$737.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$691.50
Rate for Payer: Medical Associates Commercial	$691.50
Rate for Payer: Midlands Choice Commercial	$645.40
Rate for Payer: United Healthcare Commercial	$829.80

PLATE LOCKING STRAIGHT, SS, 12H

Facility

$922.00

Service Code	HCPCS C1713
Hospital Charge Code	8047165
Hospital Revenue Code	278
Min. Negotiated Rate	$414.90
Max. Negotiated Rate	$829.80
Rate for Payer: Aetna of IA Commercial	$829.80
Rate for Payer: Aetna of IA Medical Rental Products	$829.80
Rate for Payer: Aetna of IA Medicare	$525.54
Rate for Payer: Amerigroup Medicaid	$531.81
Rate for Payer: Amerigroup Medicare	$419.05
Rate for Payer: Cash Price	$737.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$691.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$414.90
Rate for Payer: Iowa Total Care Managed Medicaid	$526.65
Rate for Payer: Medical Associates Commercial	$691.50
Rate for Payer: Medical Associates Managed Medicare	$414.90
Rate for Payer: Midlands Choice Commercial	$645.40
Rate for Payer: Molina Healthcare Managed Medicaid	$534.39
Rate for Payer: Partners Health Alliance Commercial	$477.14
Rate for Payer: United Healthcare Commercial	$829.80
Rate for Payer: United Healthcare Managed Medicare	$543.98

PLATE LOCKING STRAIGHT, SS, 4H

Facility

$608.00

Service Code	HCPCS C1713
Hospital Charge Code	8047160
Hospital Revenue Code	278
Min. Negotiated Rate	$425.60
Max. Negotiated Rate	$547.20
Rate for Payer: Aetna of IA Commercial	$547.20
Rate for Payer: Aetna of IA Medical Rental Products	$547.20
Rate for Payer: Cash Price	$486.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$456.00
Rate for Payer: Medical Associates Commercial	$456.00
Rate for Payer: Midlands Choice Commercial	$425.60
Rate for Payer: United Healthcare Commercial	$547.20

PLATE LOCKING STRAIGHT, SS, 4H

Facility

$608.00

Service Code	HCPCS C1713
Hospital Charge Code	8047160
Hospital Revenue Code	278
Min. Negotiated Rate	$273.60
Max. Negotiated Rate	$547.20
Rate for Payer: Aetna of IA Commercial	$547.20
Rate for Payer: Aetna of IA Medical Rental Products	$547.20
Rate for Payer: Aetna of IA Medicare	$346.56
Rate for Payer: Amerigroup Medicaid	$350.69
Rate for Payer: Amerigroup Medicare	$276.34
Rate for Payer: Cash Price	$486.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$456.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$273.60
Rate for Payer: Iowa Total Care Managed Medicaid	$347.29
Rate for Payer: Medical Associates Commercial	$456.00
Rate for Payer: Medical Associates Managed Medicare	$273.60
Rate for Payer: Midlands Choice Commercial	$425.60
Rate for Payer: Molina Healthcare Managed Medicaid	$352.40
Rate for Payer: Partners Health Alliance Commercial	$314.64
Rate for Payer: United Healthcare Commercial	$547.20
Rate for Payer: United Healthcare Managed Medicare	$358.72

PLATE LOCKING STRAIGHT, SS, 6H

Facility

$641.00

Service Code	HCPCS C1713
Hospital Charge Code	8047161
Hospital Revenue Code	278
Min. Negotiated Rate	$288.45
Max. Negotiated Rate	$576.90
Rate for Payer: Aetna of IA Commercial	$576.90
Rate for Payer: Aetna of IA Medical Rental Products	$576.90
Rate for Payer: Aetna of IA Medicare	$365.37
Rate for Payer: Amerigroup Medicaid	$369.73
Rate for Payer: Amerigroup Medicare	$291.33
Rate for Payer: Cash Price	$512.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$480.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$288.45
Rate for Payer: Iowa Total Care Managed Medicaid	$366.14
Rate for Payer: Medical Associates Commercial	$480.75
Rate for Payer: Medical Associates Managed Medicare	$288.45
Rate for Payer: Midlands Choice Commercial	$448.70
Rate for Payer: Molina Healthcare Managed Medicaid	$371.52
Rate for Payer: Partners Health Alliance Commercial	$331.72
Rate for Payer: United Healthcare Commercial	$576.90
Rate for Payer: United Healthcare Managed Medicare	$378.19

PLATE LOCKING STRAIGHT, SS, 6H

Facility

$641.00

Service Code	HCPCS C1713
Hospital Charge Code	8047161
Hospital Revenue Code	278
Min. Negotiated Rate	$448.70
Max. Negotiated Rate	$576.90
Rate for Payer: Aetna of IA Commercial	$576.90
Rate for Payer: Aetna of IA Medical Rental Products	$576.90
Rate for Payer: Cash Price	$512.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$480.75
Rate for Payer: Medical Associates Commercial	$480.75
Rate for Payer: Midlands Choice Commercial	$448.70
Rate for Payer: United Healthcare Commercial	$576.90

PLATE LOCKING STRAIGHT, SS, 7H

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	8047162
Hospital Revenue Code	278
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of IA Commercial	$850.50
Rate for Payer: Aetna of IA Medical Rental Products	$850.50
Rate for Payer: Aetna of IA Medicare	$538.65
Rate for Payer: Amerigroup Medicaid	$545.08
Rate for Payer: Amerigroup Medicare	$429.50
Rate for Payer: Cash Price	$756.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$708.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$425.25
Rate for Payer: Iowa Total Care Managed Medicaid	$539.78
Rate for Payer: Medical Associates Commercial	$708.75
Rate for Payer: Medical Associates Managed Medicare	$425.25
Rate for Payer: Midlands Choice Commercial	$661.50
Rate for Payer: Molina Healthcare Managed Medicaid	$547.72
Rate for Payer: Partners Health Alliance Commercial	$489.04
Rate for Payer: United Healthcare Commercial	$850.50
Rate for Payer: United Healthcare Managed Medicare	$557.55

PLATE LOCKING STRAIGHT, SS, 7H

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	8047162
Hospital Revenue Code	278
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of IA Commercial	$850.50
Rate for Payer: Aetna of IA Medical Rental Products	$850.50
Rate for Payer: Cash Price	$756.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$708.75
Rate for Payer: Medical Associates Commercial	$708.75
Rate for Payer: Midlands Choice Commercial	$661.50
Rate for Payer: United Healthcare Commercial	$850.50

PLATE LOCKING STRAIGHT, SS, 8H

Facility

$743.00

Service Code	HCPCS C1713
Hospital Charge Code	8047163
Hospital Revenue Code	278
Min. Negotiated Rate	$334.35
Max. Negotiated Rate	$668.70
Rate for Payer: Aetna of IA Commercial	$668.70
Rate for Payer: Aetna of IA Medical Rental Products	$668.70
Rate for Payer: Aetna of IA Medicare	$423.51
Rate for Payer: Amerigroup Medicaid	$428.56
Rate for Payer: Amerigroup Medicare	$337.69
Rate for Payer: Cash Price	$594.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$557.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$334.35
Rate for Payer: Iowa Total Care Managed Medicaid	$424.40
Rate for Payer: Medical Associates Commercial	$557.25
Rate for Payer: Medical Associates Managed Medicare	$334.35
Rate for Payer: Midlands Choice Commercial	$520.10
Rate for Payer: Molina Healthcare Managed Medicaid	$430.64
Rate for Payer: Partners Health Alliance Commercial	$384.50
Rate for Payer: United Healthcare Commercial	$668.70
Rate for Payer: United Healthcare Managed Medicare	$438.37

PLATE LOCKING STRAIGHT, SS, 8H

Facility

$743.00

Service Code	HCPCS C1713
Hospital Charge Code	8047163
Hospital Revenue Code	278
Min. Negotiated Rate	$520.10
Max. Negotiated Rate	$668.70
Rate for Payer: Aetna of IA Commercial	$668.70
Rate for Payer: Aetna of IA Medical Rental Products	$668.70
Rate for Payer: Cash Price	$594.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$557.25
Rate for Payer: Medical Associates Commercial	$557.25
Rate for Payer: Midlands Choice Commercial	$520.10
Rate for Payer: United Healthcare Commercial	$668.70

PLATE LOCKING THIRD TUBULAR, SS, 10H

Facility

$378.00

Service Code	HCPCS C1713
Hospital Charge Code	8047174
Hospital Revenue Code	278
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$340.20
Rate for Payer: Aetna of IA Commercial	$340.20
Rate for Payer: Aetna of IA Medical Rental Products	$340.20
Rate for Payer: Aetna of IA Medicare	$215.46
Rate for Payer: Amerigroup Medicaid	$218.03
Rate for Payer: Amerigroup Medicare	$171.80
Rate for Payer: Cash Price	$302.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$283.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$170.10
Rate for Payer: Iowa Total Care Managed Medicaid	$215.91
Rate for Payer: Medical Associates Commercial	$283.50
Rate for Payer: Medical Associates Managed Medicare	$170.10
Rate for Payer: Midlands Choice Commercial	$264.60
Rate for Payer: Molina Healthcare Managed Medicaid	$219.09
Rate for Payer: Partners Health Alliance Commercial	$195.62
Rate for Payer: United Healthcare Commercial	$340.20
Rate for Payer: United Healthcare Managed Medicare	$223.02

PLATE LOCKING THIRD TUBULAR, SS, 10H

Facility

$378.00

Service Code	HCPCS C1713
Hospital Charge Code	8047174
Hospital Revenue Code	278
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$340.20
Rate for Payer: Aetna of IA Commercial	$340.20
Rate for Payer: Aetna of IA Medical Rental Products	$340.20
Rate for Payer: Cash Price	$302.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$283.50
Rate for Payer: Medical Associates Commercial	$283.50
Rate for Payer: Midlands Choice Commercial	$264.60
Rate for Payer: United Healthcare Commercial	$340.20

PLATE LOCKING THIRD TUBULAR, SS, 12H

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8047175
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

PLATE LOCKING THIRD TUBULAR, SS, 12H

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	8047175
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

PLATE LOCKING THIRD TUBULAR, SS, 4H

Facility

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	8047169
Hospital Revenue Code	278
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna of IA Commercial	$273.60
Rate for Payer: Aetna of IA Medical Rental Products	$273.60
Rate for Payer: Aetna of IA Medicare	$173.28
Rate for Payer: Amerigroup Medicaid	$175.35
Rate for Payer: Amerigroup Medicare	$138.17
Rate for Payer: Cash Price	$243.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$228.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$136.80
Rate for Payer: Iowa Total Care Managed Medicaid	$173.64
Rate for Payer: Medical Associates Commercial	$228.00
Rate for Payer: Medical Associates Managed Medicare	$136.80
Rate for Payer: Midlands Choice Commercial	$212.80
Rate for Payer: Molina Healthcare Managed Medicaid	$176.20
Rate for Payer: Partners Health Alliance Commercial	$157.32
Rate for Payer: United Healthcare Commercial	$273.60
Rate for Payer: United Healthcare Managed Medicare	$179.36

PLATE LOCKING THIRD TUBULAR, SS, 4H

Facility

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	8047169
Hospital Revenue Code	278
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna of IA Commercial	$273.60
Rate for Payer: Aetna of IA Medical Rental Products	$273.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$228.00
Rate for Payer: Medical Associates Commercial	$228.00
Rate for Payer: Midlands Choice Commercial	$212.80
Rate for Payer: United Healthcare Commercial	$273.60

PLATE LOCKING THIRD TUBULAR, SS, 5H

Facility

$317.00

Service Code	HCPCS C1713
Hospital Charge Code	8047170
Hospital Revenue Code	278
Min. Negotiated Rate	$142.65
Max. Negotiated Rate	$285.30
Rate for Payer: Aetna of IA Commercial	$285.30
Rate for Payer: Aetna of IA Medical Rental Products	$285.30
Rate for Payer: Aetna of IA Medicare	$180.69
Rate for Payer: Amerigroup Medicaid	$182.85
Rate for Payer: Amerigroup Medicare	$144.08
Rate for Payer: Cash Price	$253.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$237.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$142.65
Rate for Payer: Iowa Total Care Managed Medicaid	$181.07
Rate for Payer: Medical Associates Commercial	$237.75
Rate for Payer: Medical Associates Managed Medicare	$142.65
Rate for Payer: Midlands Choice Commercial	$221.90
Rate for Payer: Molina Healthcare Managed Medicaid	$183.73
Rate for Payer: Partners Health Alliance Commercial	$164.05
Rate for Payer: United Healthcare Commercial	$285.30
Rate for Payer: United Healthcare Managed Medicare	$187.03

Know your out-of-pocket cost for care.

All Charges