Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW LOCKING 3.5 X 20 MM LPS, SS

Facility

$99.00

Service Code	HCPCS C1713
Hospital Charge Code	8047116
Hospital Revenue Code	278
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Aetna of IA Medicare	$56.43
Rate for Payer: Amerigroup Medicaid	$57.10
Rate for Payer: Amerigroup Medicare	$45.00
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$44.55
Rate for Payer: Iowa Total Care Managed Medicaid	$56.55
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Medical Associates Managed Medicare	$44.55
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: Molina Healthcare Managed Medicaid	$57.38
Rate for Payer: Partners Health Alliance Commercial	$51.23
Rate for Payer: United Healthcare Commercial	$89.10
Rate for Payer: United Healthcare Managed Medicare	$58.41

SCREW LOCKING 3.5 X 20 MM LPS, SS

Facility

$99.00

Service Code	HCPCS C1713
Hospital Charge Code	8047116
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of IA Commercial	$89.10
Rate for Payer: Aetna of IA Medical Rental Products	$89.10
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$74.25
Rate for Payer: Medical Associates Commercial	$74.25
Rate for Payer: Midlands Choice Commercial	$69.30
Rate for Payer: United Healthcare Commercial	$89.10

SCREW LOCKING 3.5X22MM

Facility

$338.00

Service Code	HCPCS C1713
Hospital Charge Code	8047366
Hospital Revenue Code	278
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Aetna of IA Medicare	$192.66
Rate for Payer: Amerigroup Medicaid	$194.96
Rate for Payer: Amerigroup Medicare	$153.62
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$152.10
Rate for Payer: Iowa Total Care Managed Medicaid	$193.07
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Medical Associates Managed Medicare	$152.10
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: Molina Healthcare Managed Medicaid	$195.90
Rate for Payer: Partners Health Alliance Commercial	$174.92
Rate for Payer: United Healthcare Commercial	$304.20
Rate for Payer: United Healthcare Managed Medicare	$199.42

SCREW LOCKING 3.5X22MM

Facility

$338.00

Service Code	HCPCS C1713
Hospital Charge Code	8047366
Hospital Revenue Code	278
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of IA Commercial	$304.20
Rate for Payer: Aetna of IA Medical Rental Products	$304.20
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$253.50
Rate for Payer: Medical Associates Commercial	$253.50
Rate for Payer: Midlands Choice Commercial	$236.60
Rate for Payer: United Healthcare Commercial	$304.20

SCREW LOCKING 3MMX10MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026150
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

SCREW LOCKING 3MMX10MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026150
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

SCREW LOCKING 3MMX14MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026151
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

SCREW LOCKING 3MMX14MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026151
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

SCREW LOCKING 3MMX20MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026152
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

SCREW LOCKING 3MMX20MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026152
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

SCREW LOCKING 3MMX8MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026149
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

SCREW LOCKING 3MMX8MM

Facility

$279.00

Service Code	HCPCS C1713
Hospital Charge Code	8026149
Hospital Revenue Code	278
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$160.93
Rate for Payer: Amerigroup Medicare	$126.81
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$125.55
Rate for Payer: Iowa Total Care Managed Medicaid	$159.36
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$125.55
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$161.71
Rate for Payer: Partners Health Alliance Commercial	$144.38
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

SCREW LOCKING 3X10 MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047146
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW LOCKING 3X10 MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047146
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW LOCKING 3X14 MM

Facility

$122.00

Service Code	HCPCS C1713
Hospital Charge Code	8047147
Hospital Revenue Code	278
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of IA Commercial	$109.80
Rate for Payer: Aetna of IA Medical Rental Products	$109.80
Rate for Payer: Cash Price	$97.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$91.50
Rate for Payer: Medical Associates Commercial	$91.50
Rate for Payer: Midlands Choice Commercial	$85.40
Rate for Payer: United Healthcare Commercial	$109.80

SCREW LOCKING 3X14 MM

Facility

$122.00

Service Code	HCPCS C1713
Hospital Charge Code	8047147
Hospital Revenue Code	278
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of IA Commercial	$109.80
Rate for Payer: Aetna of IA Medical Rental Products	$109.80
Rate for Payer: Aetna of IA Medicare	$69.54
Rate for Payer: Amerigroup Medicaid	$70.37
Rate for Payer: Amerigroup Medicare	$55.45
Rate for Payer: Cash Price	$97.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$91.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$54.90
Rate for Payer: Iowa Total Care Managed Medicaid	$69.69
Rate for Payer: Medical Associates Commercial	$91.50
Rate for Payer: Medical Associates Managed Medicare	$54.90
Rate for Payer: Midlands Choice Commercial	$85.40
Rate for Payer: Molina Healthcare Managed Medicaid	$70.71
Rate for Payer: Partners Health Alliance Commercial	$63.14
Rate for Payer: United Healthcare Commercial	$109.80
Rate for Payer: United Healthcare Managed Medicare	$71.98

SCREW LOCKING AXSOS 4.0XL14MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046679
Hospital Revenue Code	278
Min. Negotiated Rate	$67.05
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Aetna of IA Medicare	$84.93
Rate for Payer: Amerigroup Medicaid	$85.94
Rate for Payer: Amerigroup Medicare	$67.72
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.05
Rate for Payer: Iowa Total Care Managed Medicaid	$85.11
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Medical Associates Managed Medicare	$67.05
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: Molina Healthcare Managed Medicaid	$86.36
Rate for Payer: Partners Health Alliance Commercial	$77.11
Rate for Payer: United Healthcare Commercial	$134.10
Rate for Payer: United Healthcare Managed Medicare	$87.91

SCREW LOCKING AXSOS 4.0XL14MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046679
Hospital Revenue Code	278
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: United Healthcare Commercial	$134.10

SCREW LOCKING AXSOS 4.0XL16MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046680
Hospital Revenue Code	278
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: United Healthcare Commercial	$134.10

SCREW LOCKING AXSOS 4.0XL16MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046680
Hospital Revenue Code	278
Min. Negotiated Rate	$67.05
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Aetna of IA Medicare	$84.93
Rate for Payer: Amerigroup Medicaid	$85.94
Rate for Payer: Amerigroup Medicare	$67.72
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.05
Rate for Payer: Iowa Total Care Managed Medicaid	$85.11
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Medical Associates Managed Medicare	$67.05
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: Molina Healthcare Managed Medicaid	$86.36
Rate for Payer: Partners Health Alliance Commercial	$77.11
Rate for Payer: United Healthcare Commercial	$134.10
Rate for Payer: United Healthcare Managed Medicare	$87.91

SCREW LOCKING AXSOS 4.0XL18MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046681
Hospital Revenue Code	278
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: United Healthcare Commercial	$134.10

SCREW LOCKING AXSOS 4.0XL18MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046681
Hospital Revenue Code	278
Min. Negotiated Rate	$67.05
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Aetna of IA Medicare	$84.93
Rate for Payer: Amerigroup Medicaid	$85.94
Rate for Payer: Amerigroup Medicare	$67.72
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.05
Rate for Payer: Iowa Total Care Managed Medicaid	$85.11
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Medical Associates Managed Medicare	$67.05
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: Molina Healthcare Managed Medicaid	$86.36
Rate for Payer: Partners Health Alliance Commercial	$77.11
Rate for Payer: United Healthcare Commercial	$134.10
Rate for Payer: United Healthcare Managed Medicare	$87.91

SCREW LOCKING AXSOS 4.0XL20MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046682
Hospital Revenue Code	278
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: United Healthcare Commercial	$134.10

SCREW LOCKING AXSOS 4.0XL20MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046682
Hospital Revenue Code	278
Min. Negotiated Rate	$67.05
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Aetna of IA Medicare	$84.93
Rate for Payer: Amerigroup Medicaid	$85.94
Rate for Payer: Amerigroup Medicare	$67.72
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.05
Rate for Payer: Iowa Total Care Managed Medicaid	$85.11
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Medical Associates Managed Medicare	$67.05
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: Molina Healthcare Managed Medicaid	$86.36
Rate for Payer: Partners Health Alliance Commercial	$77.11
Rate for Payer: United Healthcare Commercial	$134.10
Rate for Payer: United Healthcare Managed Medicare	$87.91

SCREW LOCKING AXSOS 4.0XL22MM

Facility

$149.00

Service Code	HCPCS C1713
Hospital Charge Code	8046683
Hospital Revenue Code	278
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of IA Commercial	$134.10
Rate for Payer: Aetna of IA Medical Rental Products	$134.10
Rate for Payer: Cash Price	$119.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$111.75
Rate for Payer: Medical Associates Commercial	$111.75
Rate for Payer: Midlands Choice Commercial	$104.30
Rate for Payer: United Healthcare Commercial	$134.10

Know your out-of-pocket cost for care.

All Charges