Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED LAG, 4.5MM X 34MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047194
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 36MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047195
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 36MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047195
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 36MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047196
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 36MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047196
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 38MM

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047198
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 38MM

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047198
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 38MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047197
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 38MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047197
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 40MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047199
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 40MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047199
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 40MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047200
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 40MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047200
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047201
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 45MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047201
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047202
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047202
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 50MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047203
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 50MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047203
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 50MM-PT

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8047204
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW CANNULATED LAG, 4.5MM X 50MM-PT

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8047204
Hospital Revenue Code	278
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$136.27
Rate for Payer: Amerigroup Medicare	$136.35
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$135.00
Rate for Payer: Iowa Total Care Managed Medicaid	$134.95
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$135.00
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$137.02
Rate for Payer: Molina Healthcare Managed Medicare	$136.94
Rate for Payer: Oscar Health of IA Commercial	$202.50
Rate for Payer: Partners Health Alliance Commercial	$202.50
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW CANNULATED LAG, 4.5MM X 55MM-FT

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8047205
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW CANNULATED LAG, 4.5MM X 55MM-FT

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8047205
Hospital Revenue Code	278
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$136.27
Rate for Payer: Amerigroup Medicare	$136.35
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$135.00
Rate for Payer: Iowa Total Care Managed Medicaid	$134.95
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$135.00
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$137.02
Rate for Payer: Molina Healthcare Managed Medicare	$136.94
Rate for Payer: Oscar Health of IA Commercial	$202.50
Rate for Payer: Partners Health Alliance Commercial	$202.50
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW CANNULATED LAG, 4.5MM X 55MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047206
Hospital Revenue Code	278
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$68.13
Rate for Payer: Amerigroup Medicare	$68.18
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$67.50
Rate for Payer: Iowa Total Care Managed Medicaid	$67.47
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$67.50
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$68.51
Rate for Payer: Molina Healthcare Managed Medicare	$68.47
Rate for Payer: Oscar Health of IA Commercial	$101.25
Rate for Payer: Partners Health Alliance Commercial	$101.25
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 55MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047206
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

Know your out-of-pocket cost for care.

All Charges