Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED ASNIS III 4.0X20MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046443
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X20MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046443
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X22MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046444
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X22MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046444
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X24MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046445
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X24MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046445
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X26MM

Facility

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	8046446
Hospital Revenue Code	278
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of IA Commercial	$214.20
Rate for Payer: Aetna of IA Medical Rental Products	$214.20
Rate for Payer: Cash Price	$190.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$178.50
Rate for Payer: Medical Associates Commercial	$178.50
Rate for Payer: Midlands Choice Commercial	$166.60
Rate for Payer: United Healthcare Commercial	$214.20

SCREW CANNULATED ASNIS III 4.0X26MM

Facility

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	8046446
Hospital Revenue Code	278
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of IA Commercial	$214.20
Rate for Payer: Aetna of IA Medical Rental Products	$214.20
Rate for Payer: Aetna of IA Medicare	$135.66
Rate for Payer: Amerigroup Medicaid	$137.28
Rate for Payer: Amerigroup Medicare	$108.17
Rate for Payer: Cash Price	$190.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$178.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$107.10
Rate for Payer: Iowa Total Care Managed Medicaid	$135.95
Rate for Payer: Medical Associates Commercial	$178.50
Rate for Payer: Medical Associates Managed Medicare	$107.10
Rate for Payer: Midlands Choice Commercial	$166.60
Rate for Payer: Molina Healthcare Managed Medicaid	$137.94
Rate for Payer: Partners Health Alliance Commercial	$123.16
Rate for Payer: United Healthcare Commercial	$214.20
Rate for Payer: United Healthcare Managed Medicare	$140.42

SCREW CANNULATED ASNIS III 4.0X28MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046447
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X28MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046447
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X30MM

Facility

$243.00

Service Code	HCPCS C1713
Hospital Charge Code	8046448
Hospital Revenue Code	278
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of IA Commercial	$218.70
Rate for Payer: Aetna of IA Medical Rental Products	$218.70
Rate for Payer: Cash Price	$194.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$182.25
Rate for Payer: Medical Associates Commercial	$182.25
Rate for Payer: Midlands Choice Commercial	$170.10
Rate for Payer: United Healthcare Commercial	$218.70

SCREW CANNULATED ASNIS III 4.0X30MM

Facility

$243.00

Service Code	HCPCS C1713
Hospital Charge Code	8046448
Hospital Revenue Code	278
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of IA Commercial	$218.70
Rate for Payer: Aetna of IA Medical Rental Products	$218.70
Rate for Payer: Aetna of IA Medicare	$138.51
Rate for Payer: Amerigroup Medicaid	$140.16
Rate for Payer: Amerigroup Medicare	$110.44
Rate for Payer: Cash Price	$194.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$182.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$109.35
Rate for Payer: Iowa Total Care Managed Medicaid	$138.80
Rate for Payer: Medical Associates Commercial	$182.25
Rate for Payer: Medical Associates Managed Medicare	$109.35
Rate for Payer: Midlands Choice Commercial	$170.10
Rate for Payer: Molina Healthcare Managed Medicaid	$140.84
Rate for Payer: Partners Health Alliance Commercial	$125.75
Rate for Payer: United Healthcare Commercial	$218.70
Rate for Payer: United Healthcare Managed Medicare	$143.37

SCREW CANNULATED ASNIS III 4.0X32MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046449
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X32MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046449
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X34MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046450
Hospital Revenue Code	278
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Aetna of IA Medicare	$112.29
Rate for Payer: Amerigroup Medicaid	$113.63
Rate for Payer: Amerigroup Medicare	$89.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$88.65
Rate for Payer: Iowa Total Care Managed Medicaid	$112.53
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Medical Associates Managed Medicare	$88.65
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: Molina Healthcare Managed Medicaid	$114.18
Rate for Payer: Partners Health Alliance Commercial	$101.95
Rate for Payer: United Healthcare Commercial	$177.30
Rate for Payer: United Healthcare Managed Medicare	$116.23

SCREW CANNULATED ASNIS III 4.0X34MM

Facility

$197.00

Service Code	HCPCS C1713
Hospital Charge Code	8046450
Hospital Revenue Code	278
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of IA Commercial	$177.30
Rate for Payer: Aetna of IA Medical Rental Products	$177.30
Rate for Payer: Cash Price	$157.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$147.75
Rate for Payer: Medical Associates Commercial	$147.75
Rate for Payer: Midlands Choice Commercial	$137.90
Rate for Payer: United Healthcare Commercial	$177.30

SCREW CANNULATED ASNIS III 4.0X36MM

Facility

$249.00

Service Code	HCPCS C1713
Hospital Charge Code	8046451
Hospital Revenue Code	278
Min. Negotiated Rate	$112.05
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of IA Commercial	$224.10
Rate for Payer: Aetna of IA Medical Rental Products	$224.10
Rate for Payer: Aetna of IA Medicare	$141.93
Rate for Payer: Amerigroup Medicaid	$143.62
Rate for Payer: Amerigroup Medicare	$113.17
Rate for Payer: Cash Price	$199.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$186.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$112.05
Rate for Payer: Iowa Total Care Managed Medicaid	$142.23
Rate for Payer: Medical Associates Commercial	$186.75
Rate for Payer: Medical Associates Managed Medicare	$112.05
Rate for Payer: Midlands Choice Commercial	$174.30
Rate for Payer: Molina Healthcare Managed Medicaid	$144.32
Rate for Payer: Partners Health Alliance Commercial	$128.86
Rate for Payer: United Healthcare Commercial	$224.10
Rate for Payer: United Healthcare Managed Medicare	$146.91

SCREW CANNULATED ASNIS III 4.0X36MM

Facility

$249.00

Service Code	HCPCS C1713
Hospital Charge Code	8046451
Hospital Revenue Code	278
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of IA Commercial	$224.10
Rate for Payer: Aetna of IA Medical Rental Products	$224.10
Rate for Payer: Cash Price	$199.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$186.75
Rate for Payer: Medical Associates Commercial	$186.75
Rate for Payer: Midlands Choice Commercial	$174.30
Rate for Payer: United Healthcare Commercial	$224.10

SCREW CANNULATED ASNIS III 4.0X38MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046452
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X38MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046452
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X40MM

Facility

$261.00

Service Code	HCPCS C1713
Hospital Charge Code	8046453
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW CANNULATED ASNIS III 4.0X40MM

Facility

$261.00

Service Code	HCPCS C1713
Hospital Charge Code	8046453
Hospital Revenue Code	278
Min. Negotiated Rate	$117.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$150.54
Rate for Payer: Amerigroup Medicare	$118.62
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$117.45
Rate for Payer: Iowa Total Care Managed Medicaid	$149.08
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$117.45
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$151.28
Rate for Payer: Partners Health Alliance Commercial	$135.07
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW CANNULATED ASNIS III 4.0X42MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046454
Hospital Revenue Code	278
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Aetna of IA Medicare	$115.14
Rate for Payer: Amerigroup Medicaid	$116.51
Rate for Payer: Amerigroup Medicare	$91.81
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$90.90
Rate for Payer: Iowa Total Care Managed Medicaid	$115.38
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Medical Associates Managed Medicare	$90.90
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: Molina Healthcare Managed Medicaid	$117.08
Rate for Payer: Partners Health Alliance Commercial	$104.54
Rate for Payer: United Healthcare Commercial	$181.80
Rate for Payer: United Healthcare Managed Medicare	$119.18

SCREW CANNULATED ASNIS III 4.0X42MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046454
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

SCREW CANNULATED ASNIS III 4.0X44MM

Facility

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	8046455
Hospital Revenue Code	278
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of IA Commercial	$181.80
Rate for Payer: Aetna of IA Medical Rental Products	$181.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$151.50
Rate for Payer: Medical Associates Commercial	$151.50
Rate for Payer: Midlands Choice Commercial	$141.40
Rate for Payer: United Healthcare Commercial	$181.80

Know your out-of-pocket cost for care.

All Charges