Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

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

SCREW CANN COUNTERSINK 3.0/4.0MM

Facility

$464.00

Service Code	CPT C1713
Hospital Charge Code	8046388
Hospital Revenue Code	278
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of IA Commercial	$417.60
Rate for Payer: Aetna of IA Medical Rental Products	$417.60
Rate for Payer: Cash Price	$371.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$348.00
Rate for Payer: Medical Associates Commercial	$348.00
Rate for Payer: Midlands Choice Commercial	$324.80
Rate for Payer: United Healthcare Commercial	$417.60

SCREW CANN COUNTERSINK 3.0/4.0MM

Facility

$464.00

Service Code	CPT C1713
Hospital Charge Code	8046388
Hospital Revenue Code	278
Min. Negotiated Rate	$231.91
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of IA Commercial	$417.60
Rate for Payer: Aetna of IA Medical Rental Products	$417.60
Rate for Payer: Aetna of IA Medicare	$264.48
Rate for Payer: Amerigroup Medicaid	$234.18
Rate for Payer: Amerigroup Medicare	$234.32
Rate for Payer: Cash Price	$371.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$348.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$232.00
Rate for Payer: Iowa Total Care Managed Medicaid	$231.91
Rate for Payer: Medical Associates Commercial	$348.00
Rate for Payer: Medical Associates Managed Medicare	$232.00
Rate for Payer: Midlands Choice Commercial	$324.80
Rate for Payer: Molina Healthcare Managed Medicaid	$235.48
Rate for Payer: Molina Healthcare Managed Medicare	$235.34
Rate for Payer: Oscar Health of IA Commercial	$348.00
Rate for Payer: Partners Health Alliance Commercial	$348.00
Rate for Payer: United Healthcare Commercial	$417.60
Rate for Payer: United Healthcare Managed Medicare	$273.76

SCREW CANN LAG 6.7MMX40MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047234
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 CANN LAG 6.7MMX40MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047234
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 CANN LAG 6.7MMX45MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047235
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 CANN LAG 6.7MMX45MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047235
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 CANN LAG 6.7MMX50MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047236
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 CANN LAG 6.7MMX50MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047236
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 CANN LAG 6.7MMX55MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047237
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 CANN LAG 6.7MMX55MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047237
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 CANN LAG 6.7MMX60MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047238
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 CANN LAG 6.7MMX60MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047238
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 CANN LAG 6.7MMX65MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047239
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 CANN LAG 6.7MMX65MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047239
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 CANN LAG 6.7MMX70MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047240
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 CANN LAG 6.7MMX70MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047240
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 CANN LAG 6.7MMX75MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047241
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 CANN LAG 6.7MMX75MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047241
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 CANN LAG 6.7MMX80MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047242
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 CANN LAG 6.7MMX80MM 18MM THREAD

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047242
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 CANNULATED 3.0 X 14MM

Facility

$351.00

Service Code	CPT C1713
Hospital Charge Code	8046301
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: United Healthcare Commercial	$315.90

SCREW CANNULATED 3.0 X 14MM

Facility

$351.00

Service Code	CPT C1713
Hospital Charge Code	8046301
Hospital Revenue Code	278
Min. Negotiated Rate	$175.43
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of IA Commercial	$315.90
Rate for Payer: Aetna of IA Medical Rental Products	$315.90
Rate for Payer: Aetna of IA Medicare	$200.07
Rate for Payer: Amerigroup Medicaid	$177.15
Rate for Payer: Amerigroup Medicare	$177.26
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$263.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$175.50
Rate for Payer: Iowa Total Care Managed Medicaid	$175.43
Rate for Payer: Medical Associates Commercial	$263.25
Rate for Payer: Medical Associates Managed Medicare	$175.50
Rate for Payer: Midlands Choice Commercial	$245.70
Rate for Payer: Molina Healthcare Managed Medicaid	$178.13
Rate for Payer: Molina Healthcare Managed Medicare	$178.03
Rate for Payer: Oscar Health of IA Commercial	$263.25
Rate for Payer: Partners Health Alliance Commercial	$263.25
Rate for Payer: United Healthcare Commercial	$315.90
Rate for Payer: United Healthcare Managed Medicare	$207.09

SCREW CANNULATED 4.0 X 42

Facility

$369.00

Service Code	CPT C1713
Hospital Charge Code	8046303
Hospital Revenue Code	278
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$332.10
Rate for Payer: Aetna of IA Commercial	$332.10
Rate for Payer: Aetna of IA Medical Rental Products	$332.10
Rate for Payer: Cash Price	$295.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$276.75
Rate for Payer: Medical Associates Commercial	$276.75
Rate for Payer: Midlands Choice Commercial	$258.30
Rate for Payer: United Healthcare Commercial	$332.10

SCREW CANNULATED 4.0 X 42

Facility

$369.00

Service Code	CPT C1713
Hospital Charge Code	8046303
Hospital Revenue Code	278
Min. Negotiated Rate	$184.43
Max. Negotiated Rate	$332.10
Rate for Payer: Aetna of IA Commercial	$332.10
Rate for Payer: Aetna of IA Medical Rental Products	$332.10
Rate for Payer: Aetna of IA Medicare	$210.33
Rate for Payer: Amerigroup Medicaid	$186.23
Rate for Payer: Amerigroup Medicare	$186.34
Rate for Payer: Cash Price	$295.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$276.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$184.50
Rate for Payer: Iowa Total Care Managed Medicaid	$184.43
Rate for Payer: Medical Associates Commercial	$276.75
Rate for Payer: Medical Associates Managed Medicare	$184.50
Rate for Payer: Midlands Choice Commercial	$258.30
Rate for Payer: Molina Healthcare Managed Medicaid	$187.27
Rate for Payer: Molina Healthcare Managed Medicare	$187.16
Rate for Payer: Oscar Health of IA Commercial	$276.75
Rate for Payer: Partners Health Alliance Commercial	$276.75
Rate for Payer: United Healthcare Commercial	$332.10
Rate for Payer: United Healthcare Managed Medicare	$217.71

Know your out-of-pocket cost for care.

All Charges