Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED LAG, 4.5MM X 60MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047207
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 60MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047207
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 60MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047208
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 60MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047208
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 65MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047209
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 65MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047209
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 65MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047210
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 65MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047210
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 70MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047211
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 70MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047211
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 70MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047212
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 70MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047212
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 75MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047213
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 75MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047213
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 75MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047214
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 75MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047214
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 80MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047215
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 80MM-FT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047215
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 80MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047216
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 80MM-PT

Facility

$135.00

Service Code	CPT C1713
Hospital Charge Code	8047216
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 6.7X100MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047246
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 LAG 6.7X100MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047246
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 CANNULATED LAG 6.7X100MM-1

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047229
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 LAG 6.7X100MM-1

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047229
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 CANNULATED LAG 6.7X105MM

Facility

$198.00

Service Code	CPT C1713
Hospital Charge Code	8047247
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

Know your out-of-pocket cost for care.

All Charges