Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANCELLOUS FULL THREAD X 24

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046580
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

SCREW CANCELLOUS FULL THREAD X 24

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046580
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 FULL THREAD X 26

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046581
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

SCREW CANCELLOUS FULL THREAD X 26

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046581
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 FULL THREAD X 28

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046582
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

SCREW CANCELLOUS FULL THREAD X 28

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046582
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 FULL THREAD X 30

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046583
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 FULL THREAD X 30

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046583
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

SCREW CANCELLOUS FULL THREAD X 32

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046584
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 FULL THREAD X 32

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046584
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

SCREW CANCELLOUS FULL THREAD X 34

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046585
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 FULL THREAD X 34

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046585
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

SCREW CANCELLOUS FULL THREAD X 36

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046586
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 FULL THREAD X 36

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046586
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

SCREW CANCELLOUS FULL THREAD X38

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046587
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 FULL THREAD X38

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046587
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

SCREW CANCELLOUS FULL THREAD X 40

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046588
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

SCREW CANCELLOUS FULL THREAD X 40

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046588
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 FULL THREAD X 45

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046589
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

SCREW CANCELLOUS FULL THREAD X 45

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046589
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 FULL THREAD X 50

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046590
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

SCREW CANCELLOUS FULL THREAD X 50

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046590
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 FULL THREAD X 55

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046591
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

SCREW CANCELLOUS FULL THREAD X 55

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046591
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 CANN COUNTERSINK 2.0/2.4MM

Facility

$423.00

Service Code	CPT C1713
Hospital Charge Code	8046947
Hospital Revenue Code	278
Min. Negotiated Rate	$296.10
Max. Negotiated Rate	$380.70
Rate for Payer: Aetna of IA Commercial	$380.70
Rate for Payer: Aetna of IA Medical Rental Products	$380.70
Rate for Payer: Cash Price	$338.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$317.25
Rate for Payer: Medical Associates Commercial	$317.25
Rate for Payer: Midlands Choice Commercial	$296.10
Rate for Payer: United Healthcare Commercial	$380.70

Know your out-of-pocket cost for care.

All Charges