Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW 2.2MMX20MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8814834
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 2.2X14MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8814830
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 2.2X14MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8814830
Hospital Revenue Code	278
Min. Negotiated Rate	$98.96
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	$99.93
Rate for Payer: Amerigroup Medicare	$99.99
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	$99.00
Rate for Payer: Iowa Total Care Managed Medicaid	$98.96
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$99.00
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$100.48
Rate for Payer: Molina Healthcare Managed Medicare	$100.43
Rate for Payer: Oscar Health of IA Commercial	$148.50
Rate for Payer: Partners Health Alliance Commercial	$148.50
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW 2.2X18MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8815108
Hospital Revenue Code	278
Min. Negotiated Rate	$98.96
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	$99.93
Rate for Payer: Amerigroup Medicare	$99.99
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	$99.00
Rate for Payer: Iowa Total Care Managed Medicaid	$98.96
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$99.00
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$100.48
Rate for Payer: Molina Healthcare Managed Medicare	$100.43
Rate for Payer: Oscar Health of IA Commercial	$148.50
Rate for Payer: Partners Health Alliance Commercial	$148.50
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW 2.2X18MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8815108
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 4.5MMX22MM STTCS

Facility

$513.00

Service Code	CPT C1713
Hospital Charge Code	8897831
Hospital Revenue Code	278
Min. Negotiated Rate	$359.10
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of IA Commercial	$461.70
Rate for Payer: Aetna of IA Medical Rental Products	$461.70
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$384.75
Rate for Payer: Medical Associates Commercial	$384.75
Rate for Payer: Midlands Choice Commercial	$359.10
Rate for Payer: United Healthcare Commercial	$461.70

SCREW 4.5MMX22MM STTCS

Facility

$513.00

Service Code	CPT C1713
Hospital Charge Code	8897831
Hospital Revenue Code	278
Min. Negotiated Rate	$256.40
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of IA Commercial	$461.70
Rate for Payer: Aetna of IA Medical Rental Products	$461.70
Rate for Payer: Aetna of IA Medicare	$292.41
Rate for Payer: Amerigroup Medicaid	$258.91
Rate for Payer: Amerigroup Medicare	$259.06
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$384.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$256.50
Rate for Payer: Iowa Total Care Managed Medicaid	$256.40
Rate for Payer: Medical Associates Commercial	$384.75
Rate for Payer: Medical Associates Managed Medicare	$256.50
Rate for Payer: Midlands Choice Commercial	$359.10
Rate for Payer: Molina Healthcare Managed Medicaid	$260.35
Rate for Payer: Molina Healthcare Managed Medicare	$260.19
Rate for Payer: Oscar Health of IA Commercial	$384.75
Rate for Payer: Partners Health Alliance Commercial	$384.75
Rate for Payer: United Healthcare Commercial	$461.70
Rate for Payer: United Healthcare Managed Medicare	$302.67

SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND

Facility

$599.00

Service Code	CPT C1713
Hospital Charge Code	8047019
Hospital Revenue Code	278
Min. Negotiated Rate	$419.30
Max. Negotiated Rate	$539.10
Rate for Payer: Aetna of IA Commercial	$539.10
Rate for Payer: Aetna of IA Medical Rental Products	$539.10
Rate for Payer: Cash Price	$479.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$449.25
Rate for Payer: Medical Associates Commercial	$449.25
Rate for Payer: Midlands Choice Commercial	$419.30
Rate for Payer: United Healthcare Commercial	$539.10

SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND

Facility

$599.00

Service Code	CPT C1713
Hospital Charge Code	8047019
Hospital Revenue Code	278
Min. Negotiated Rate	$299.38
Max. Negotiated Rate	$539.10
Rate for Payer: Aetna of IA Commercial	$539.10
Rate for Payer: Aetna of IA Medical Rental Products	$539.10
Rate for Payer: Aetna of IA Medicare	$341.43
Rate for Payer: Amerigroup Medicaid	$302.32
Rate for Payer: Amerigroup Medicare	$302.50
Rate for Payer: Cash Price	$479.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$449.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$299.50
Rate for Payer: Iowa Total Care Managed Medicaid	$299.38
Rate for Payer: Medical Associates Commercial	$449.25
Rate for Payer: Medical Associates Managed Medicare	$299.50
Rate for Payer: Midlands Choice Commercial	$419.30
Rate for Payer: Molina Healthcare Managed Medicaid	$303.99
Rate for Payer: Molina Healthcare Managed Medicare	$303.81
Rate for Payer: Oscar Health of IA Commercial	$449.25
Rate for Payer: Partners Health Alliance Commercial	$449.25
Rate for Payer: United Healthcare Commercial	$539.10
Rate for Payer: United Healthcare Managed Medicare	$353.41

SCREW BONE 6.5MM X 50MM

Facility

$290.00

Service Code	CPT C1713
Hospital Charge Code	8047032
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of IA Commercial	$261.00
Rate for Payer: Aetna of IA Medical Rental Products	$261.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$217.50
Rate for Payer: Medical Associates Commercial	$217.50
Rate for Payer: Midlands Choice Commercial	$203.00
Rate for Payer: United Healthcare Commercial	$261.00

SCREW BONE 6.5MM X 50MM

Facility

$290.00

Service Code	CPT C1713
Hospital Charge Code	8047032
Hospital Revenue Code	278
Min. Negotiated Rate	$144.94
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of IA Commercial	$261.00
Rate for Payer: Aetna of IA Medical Rental Products	$261.00
Rate for Payer: Aetna of IA Medicare	$165.30
Rate for Payer: Amerigroup Medicaid	$146.36
Rate for Payer: Amerigroup Medicare	$146.45
Rate for Payer: Cash Price	$232.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$217.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$145.00
Rate for Payer: Iowa Total Care Managed Medicaid	$144.94
Rate for Payer: Medical Associates Commercial	$217.50
Rate for Payer: Medical Associates Managed Medicare	$145.00
Rate for Payer: Midlands Choice Commercial	$203.00
Rate for Payer: Molina Healthcare Managed Medicaid	$147.18
Rate for Payer: Molina Healthcare Managed Medicare	$147.09
Rate for Payer: Oscar Health of IA Commercial	$217.50
Rate for Payer: Partners Health Alliance Commercial	$217.50
Rate for Payer: United Healthcare Commercial	$261.00
Rate for Payer: United Healthcare Managed Medicare	$171.10

SCREW BONE T10 3.5X12MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046712
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T10 3.5X12MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046712
Hospital Revenue Code	278
Min. Negotiated Rate	$51.98
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$52.49
Rate for Payer: Amerigroup Medicare	$52.52
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.00
Rate for Payer: Iowa Total Care Managed Medicaid	$51.98
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$52.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$52.78
Rate for Payer: Molina Healthcare Managed Medicare	$52.75
Rate for Payer: Oscar Health of IA Commercial	$78.00
Rate for Payer: Partners Health Alliance Commercial	$78.00
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T10 3.5X30MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046713
Hospital Revenue Code	278
Min. Negotiated Rate	$51.98
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$52.49
Rate for Payer: Amerigroup Medicare	$52.52
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.00
Rate for Payer: Iowa Total Care Managed Medicaid	$51.98
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$52.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$52.78
Rate for Payer: Molina Healthcare Managed Medicare	$52.75
Rate for Payer: Oscar Health of IA Commercial	$78.00
Rate for Payer: Partners Health Alliance Commercial	$78.00
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T10 3.5X30MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046713
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T10 3.5X55MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046714
Hospital Revenue Code	278
Min. Negotiated Rate	$51.98
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$52.49
Rate for Payer: Amerigroup Medicare	$52.52
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.00
Rate for Payer: Iowa Total Care Managed Medicaid	$51.98
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$52.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$52.78
Rate for Payer: Molina Healthcare Managed Medicare	$52.75
Rate for Payer: Oscar Health of IA Commercial	$78.00
Rate for Payer: Partners Health Alliance Commercial	$78.00
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SCREW BONE T10 3.5X55MM

Facility

$104.00

Service Code	CPT C1713
Hospital Charge Code	8046714
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SCREW BONE T7 2.7X14MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046809
Hospital Revenue Code	278
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$42.39
Rate for Payer: Amerigroup Medicare	$42.42
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.00
Rate for Payer: Iowa Total Care Managed Medicaid	$41.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$42.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$42.63
Rate for Payer: Molina Healthcare Managed Medicare	$42.60
Rate for Payer: Oscar Health of IA Commercial	$63.00
Rate for Payer: Partners Health Alliance Commercial	$63.00
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW BONE T7 2.7X14MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046809
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW BONE T7 2.7X16MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046810
Hospital Revenue Code	278
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$42.39
Rate for Payer: Amerigroup Medicare	$42.42
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.00
Rate for Payer: Iowa Total Care Managed Medicaid	$41.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$42.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$42.63
Rate for Payer: Molina Healthcare Managed Medicare	$42.60
Rate for Payer: Oscar Health of IA Commercial	$63.00
Rate for Payer: Partners Health Alliance Commercial	$63.00
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW BONE T7 2.7X16MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046810
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW BONE T7 2.7X18MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046811
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: United Healthcare Commercial	$75.60

SCREW BONE T7 2.7X18MM

Facility

$84.00

Service Code	CPT C1713
Hospital Charge Code	8046811
Hospital Revenue Code	278
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of IA Commercial	$75.60
Rate for Payer: Aetna of IA Medical Rental Products	$75.60
Rate for Payer: Aetna of IA Medicare	$47.88
Rate for Payer: Amerigroup Medicaid	$42.39
Rate for Payer: Amerigroup Medicare	$42.42
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$63.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$42.00
Rate for Payer: Iowa Total Care Managed Medicaid	$41.98
Rate for Payer: Medical Associates Commercial	$63.00
Rate for Payer: Medical Associates Managed Medicare	$42.00
Rate for Payer: Midlands Choice Commercial	$58.80
Rate for Payer: Molina Healthcare Managed Medicaid	$42.63
Rate for Payer: Molina Healthcare Managed Medicare	$42.60
Rate for Payer: Oscar Health of IA Commercial	$63.00
Rate for Payer: Partners Health Alliance Commercial	$63.00
Rate for Payer: United Healthcare Commercial	$75.60
Rate for Payer: United Healthcare Managed Medicare	$49.56

SCREW CANCELLOUS

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046595
Hospital Revenue Code	278
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: United Healthcare Commercial	$21.60

SCREW CANCELLOUS

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046595
Hospital Revenue Code	278
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Aetna of IA Medicare	$13.68
Rate for Payer: Amerigroup Medicaid	$12.11
Rate for Payer: Amerigroup Medicare	$12.12
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12.00
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Medical Associates Managed Medicare	$12.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: Molina Healthcare Managed Medicaid	$12.18
Rate for Payer: Molina Healthcare Managed Medicare	$12.17
Rate for Payer: Oscar Health of IA Commercial	$18.00
Rate for Payer: Partners Health Alliance Commercial	$18.00
Rate for Payer: United Healthcare Commercial	$21.60
Rate for Payer: United Healthcare Managed Medicare	$14.16

Know your out-of-pocket cost for care.

All Charges