Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

Kools Solution Compound [VDMC]

Facility

$386.60

Service Code	HCPCS A9270
Hospital Charge Code	11590592
Hospital Revenue Code	259
Min. Negotiated Rate	$173.97
Max. Negotiated Rate	$347.94
Rate for Payer: Aetna of IA Commercial	$347.94
Rate for Payer: Aetna of IA Medical Rental Products	$347.94
Rate for Payer: Aetna of IA Medicare	$220.36
Rate for Payer: Amerigroup Medicaid	$222.99
Rate for Payer: Amerigroup Medicare	$175.71
Rate for Payer: Cash Price	$309.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$289.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$173.97
Rate for Payer: Iowa Total Care Managed Medicaid	$220.83
Rate for Payer: Medical Associates Commercial	$289.95
Rate for Payer: Medical Associates Managed Medicare	$173.97
Rate for Payer: Midlands Choice Commercial	$270.62
Rate for Payer: Molina Healthcare Managed Medicaid	$224.07
Rate for Payer: Partners Health Alliance Commercial	$200.07
Rate for Payer: United Healthcare Commercial	$347.94
Rate for Payer: United Healthcare Managed Medicare	$228.09

Kools Solution Compound [VDMC]

Facility

$386.60

Service Code	HCPCS A9270
Hospital Charge Code	11590592
Hospital Revenue Code	259
Min. Negotiated Rate	$270.62
Max. Negotiated Rate	$347.94
Rate for Payer: Aetna of IA Commercial	$347.94
Rate for Payer: Aetna of IA Medical Rental Products	$347.94
Rate for Payer: Cash Price	$309.28
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$289.95
Rate for Payer: Medical Associates Commercial	$289.95
Rate for Payer: Midlands Choice Commercial	$270.62
Rate for Payer: United Healthcare Commercial	$347.94

K-WIRE 0.062X6

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8750332
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: United Healthcare Commercial	$14.40

K-WIRE 0.062X6

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8750332
Hospital Revenue Code	278
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Aetna of IA Medicare	$9.12
Rate for Payer: Amerigroup Medicaid	$9.23
Rate for Payer: Amerigroup Medicare	$7.27
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$7.20
Rate for Payer: Iowa Total Care Managed Medicaid	$9.14
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Medical Associates Managed Medicare	$7.20
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: Molina Healthcare Managed Medicaid	$9.27
Rate for Payer: Partners Health Alliance Commercial	$8.28
Rate for Payer: United Healthcare Commercial	$14.40
Rate for Payer: United Healthcare Managed Medicare	$9.44

K-WIRE 1.0MM

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8046397
Hospital Revenue Code	278
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Aetna of IA Medicare	$9.12
Rate for Payer: Amerigroup Medicaid	$9.23
Rate for Payer: Amerigroup Medicare	$7.27
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$7.20
Rate for Payer: Iowa Total Care Managed Medicaid	$9.14
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Medical Associates Managed Medicare	$7.20
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: Molina Healthcare Managed Medicaid	$9.27
Rate for Payer: Partners Health Alliance Commercial	$8.28
Rate for Payer: United Healthcare Commercial	$14.40
Rate for Payer: United Healthcare Managed Medicare	$9.44

K-WIRE 1.0MM

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8046397
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: United Healthcare Commercial	$14.40

K-WIRE 1.2MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8047368
Hospital Revenue Code	278
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Aetna of IA Medicare	$21.09
Rate for Payer: Amerigroup Medicaid	$21.34
Rate for Payer: Amerigroup Medicare	$16.82
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.65
Rate for Payer: Iowa Total Care Managed Medicaid	$21.13
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Medical Associates Managed Medicare	$16.65
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: Molina Healthcare Managed Medicaid	$21.45
Rate for Payer: Partners Health Alliance Commercial	$19.15
Rate for Payer: United Healthcare Commercial	$33.30
Rate for Payer: United Healthcare Managed Medicare	$21.83

K-WIRE 1.2MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8047368
Hospital Revenue Code	278
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: United Healthcare Commercial	$33.30

K-WIRE, 1.35MM, THREADED TROCAR TIP

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8047151
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

K-WIRE, 1.35MM, THREADED TROCAR TIP

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8047151
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

K-WIRE, 1.35MM, TROCAR TIP

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8047150
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

K-WIRE, 1.35MM, TROCAR TIP

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8047150
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

K-WIRE 1.5 MM

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8046398
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: United Healthcare Commercial	$14.40

K-WIRE 1.5 MM

Facility

$16.00

Service Code	HCPCS C1713
Hospital Charge Code	8046398
Hospital Revenue Code	278
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of IA Commercial	$14.40
Rate for Payer: Aetna of IA Medical Rental Products	$14.40
Rate for Payer: Aetna of IA Medicare	$9.12
Rate for Payer: Amerigroup Medicaid	$9.23
Rate for Payer: Amerigroup Medicare	$7.27
Rate for Payer: Cash Price	$12.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$7.20
Rate for Payer: Iowa Total Care Managed Medicaid	$9.14
Rate for Payer: Medical Associates Commercial	$12.00
Rate for Payer: Medical Associates Managed Medicare	$7.20
Rate for Payer: Midlands Choice Commercial	$11.20
Rate for Payer: Molina Healthcare Managed Medicaid	$9.27
Rate for Payer: Partners Health Alliance Commercial	$8.28
Rate for Payer: United Healthcare Commercial	$14.40
Rate for Payer: United Healthcare Managed Medicare	$9.44

K-WIRE, 1.60MM, TROCAR TIP

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8047149
Hospital Revenue Code	278
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of IA Commercial	$11.70
Rate for Payer: Aetna of IA Medical Rental Products	$11.70
Rate for Payer: Aetna of IA Medicare	$7.41
Rate for Payer: Amerigroup Medicaid	$7.50
Rate for Payer: Amerigroup Medicare	$5.91
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.85
Rate for Payer: Iowa Total Care Managed Medicaid	$7.43
Rate for Payer: Medical Associates Commercial	$9.75
Rate for Payer: Medical Associates Managed Medicare	$5.85
Rate for Payer: Midlands Choice Commercial	$9.10
Rate for Payer: Molina Healthcare Managed Medicaid	$7.53
Rate for Payer: Partners Health Alliance Commercial	$6.73
Rate for Payer: United Healthcare Commercial	$11.70
Rate for Payer: United Healthcare Managed Medicare	$7.67

K-WIRE, 1.60MM, TROCAR TIP

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8047149
Hospital Revenue Code	278
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of IA Commercial	$11.70
Rate for Payer: Aetna of IA Medical Rental Products	$11.70
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.75
Rate for Payer: Medical Associates Commercial	$9.75
Rate for Payer: Midlands Choice Commercial	$9.10
Rate for Payer: United Healthcare Commercial	$11.70

K-WIRE, 1.60MM, TROCAR TIP-1

Facility

$18.00

Service Code	HCPCS C1713
Hospital Charge Code	8047217
Hospital Revenue Code	278
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of IA Commercial	$16.20
Rate for Payer: Aetna of IA Medical Rental Products	$16.20
Rate for Payer: Aetna of IA Medicare	$10.26
Rate for Payer: Amerigroup Medicaid	$10.38
Rate for Payer: Amerigroup Medicare	$8.18
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.10
Rate for Payer: Iowa Total Care Managed Medicaid	$10.28
Rate for Payer: Medical Associates Commercial	$13.50
Rate for Payer: Medical Associates Managed Medicare	$8.10
Rate for Payer: Midlands Choice Commercial	$12.60
Rate for Payer: Molina Healthcare Managed Medicaid	$10.43
Rate for Payer: Partners Health Alliance Commercial	$9.32
Rate for Payer: United Healthcare Commercial	$16.20
Rate for Payer: United Healthcare Managed Medicare	$10.62

K-WIRE, 1.60MM, TROCAR TIP-1

Facility

$18.00

Service Code	HCPCS C1713
Hospital Charge Code	8047217
Hospital Revenue Code	278
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of IA Commercial	$16.20
Rate for Payer: Aetna of IA Medical Rental Products	$16.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.50
Rate for Payer: Medical Associates Commercial	$13.50
Rate for Payer: Midlands Choice Commercial	$12.60
Rate for Payer: United Healthcare Commercial	$16.20

K-WIRE 1.6MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8047369
Hospital Revenue Code	278
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Aetna of IA Medicare	$21.09
Rate for Payer: Amerigroup Medicaid	$21.34
Rate for Payer: Amerigroup Medicare	$16.82
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.65
Rate for Payer: Iowa Total Care Managed Medicaid	$21.13
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Medical Associates Managed Medicare	$16.65
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: Molina Healthcare Managed Medicaid	$21.45
Rate for Payer: Partners Health Alliance Commercial	$19.15
Rate for Payer: United Healthcare Commercial	$33.30
Rate for Payer: United Healthcare Managed Medicare	$21.83

K-WIRE 1.6MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8047369
Hospital Revenue Code	278
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: United Healthcare Commercial	$33.30

K-WIRE 1.8X310MM IMPLANT

Facility

$284.00

Service Code	HCPCS C1713
Hospital Charge Code	8025848
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of IA Commercial	$255.60
Rate for Payer: Aetna of IA Medical Rental Products	$255.60
Rate for Payer: Aetna of IA Medicare	$161.88
Rate for Payer: Amerigroup Medicaid	$163.81
Rate for Payer: Amerigroup Medicare	$129.08
Rate for Payer: Cash Price	$227.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$213.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$127.80
Rate for Payer: Iowa Total Care Managed Medicaid	$162.22
Rate for Payer: Medical Associates Commercial	$213.00
Rate for Payer: Medical Associates Managed Medicare	$127.80
Rate for Payer: Midlands Choice Commercial	$198.80
Rate for Payer: Molina Healthcare Managed Medicaid	$164.61
Rate for Payer: Partners Health Alliance Commercial	$146.97
Rate for Payer: United Healthcare Commercial	$255.60
Rate for Payer: United Healthcare Managed Medicare	$167.56

K-WIRE 1.8X310MM IMPLANT

Facility

$284.00

Service Code	HCPCS C1713
Hospital Charge Code	8025848
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of IA Commercial	$255.60
Rate for Payer: Aetna of IA Medical Rental Products	$255.60
Rate for Payer: Cash Price	$227.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$213.00
Rate for Payer: Medical Associates Commercial	$213.00
Rate for Payer: Midlands Choice Commercial	$198.80
Rate for Payer: United Healthcare Commercial	$255.60

K-WIRE 4X.028 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046945
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 4X.028 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046945
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 4X.035 TROCAR POINTS STERILE

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046725
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

Know your out-of-pocket cost for care.

All Charges