Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL 3.5X12 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047095
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X12 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047095
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X12MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046477
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 CORTICAL 3.5X12MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046477
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 CORTICAL 3.5X14MM SELF CUTTING

Facility

$35.00

Service Code	CPT C1713
Hospital Charge Code	8046478
Hospital Revenue Code	278
Min. Negotiated Rate	$17.49
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Aetna of IA Medicare	$19.95
Rate for Payer: Amerigroup Medicaid	$17.66
Rate for Payer: Amerigroup Medicare	$17.68
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$17.50
Rate for Payer: Iowa Total Care Managed Medicaid	$17.49
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Medical Associates Managed Medicare	$17.50
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: Molina Healthcare Managed Medicaid	$17.76
Rate for Payer: Molina Healthcare Managed Medicare	$17.75
Rate for Payer: Oscar Health of IA Commercial	$26.25
Rate for Payer: Partners Health Alliance Commercial	$26.25
Rate for Payer: United Healthcare Commercial	$31.50
Rate for Payer: United Healthcare Managed Medicare	$20.65

SCREW CORTICAL 3.5X14MM SELF CUTTING

Facility

$35.00

Service Code	CPT C1713
Hospital Charge Code	8046478
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: United Healthcare Commercial	$31.50

SCREW CORTICAL 3.5X 16 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047097
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X 16 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047097
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X16MM SELF CUTTING

Facility

$26.00

Service Code	CPT C1713
Hospital Charge Code	8046479
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

SCREW CORTICAL 3.5X16MM SELF CUTTING

Facility

$26.00

Service Code	CPT C1713
Hospital Charge Code	8046479
Hospital Revenue Code	278
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$13.12
Rate for Payer: Amerigroup Medicare	$13.13
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12.99
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$13.00
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$13.20
Rate for Payer: Molina Healthcare Managed Medicare	$13.19
Rate for Payer: Oscar Health of IA Commercial	$19.50
Rate for Payer: Partners Health Alliance Commercial	$19.50
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34

SCREW CORTICAL 3.5X18 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047098
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X18 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047098
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X18MM SELF CUTTING

Facility

$29.00

Service Code	CPT C1713
Hospital Charge Code	8046480
Hospital Revenue Code	278
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of IA Commercial	$26.10
Rate for Payer: Aetna of IA Medical Rental Products	$26.10
Rate for Payer: Cash Price	$23.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.75
Rate for Payer: Medical Associates Commercial	$21.75
Rate for Payer: Midlands Choice Commercial	$20.30
Rate for Payer: United Healthcare Commercial	$26.10

SCREW CORTICAL 3.5X18MM SELF CUTTING

Facility

$29.00

Service Code	CPT C1713
Hospital Charge Code	8046480
Hospital Revenue Code	278
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of IA Commercial	$26.10
Rate for Payer: Aetna of IA Medical Rental Products	$26.10
Rate for Payer: Aetna of IA Medicare	$16.53
Rate for Payer: Amerigroup Medicaid	$14.64
Rate for Payer: Amerigroup Medicare	$14.64
Rate for Payer: Cash Price	$23.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.50
Rate for Payer: Iowa Total Care Managed Medicaid	$14.49
Rate for Payer: Medical Associates Commercial	$21.75
Rate for Payer: Medical Associates Managed Medicare	$14.50
Rate for Payer: Midlands Choice Commercial	$20.30
Rate for Payer: Molina Healthcare Managed Medicaid	$14.72
Rate for Payer: Molina Healthcare Managed Medicare	$14.71
Rate for Payer: Oscar Health of IA Commercial	$21.75
Rate for Payer: Partners Health Alliance Commercial	$21.75
Rate for Payer: United Healthcare Commercial	$26.10
Rate for Payer: United Healthcare Managed Medicare	$17.11

SCREW CORTICAL 3.5X20 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047099
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X20 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047099
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X20MM SELF CUTTING

Facility

$30.00

Service Code	CPT C1713
Hospital Charge Code	8046481
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: United Healthcare Commercial	$27.00

SCREW CORTICAL 3.5X20MM SELF CUTTING

Facility

$30.00

Service Code	CPT C1713
Hospital Charge Code	8046481
Hospital Revenue Code	278
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Aetna of IA Medicare	$17.10
Rate for Payer: Amerigroup Medicaid	$15.14
Rate for Payer: Amerigroup Medicare	$15.15
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.00
Rate for Payer: Iowa Total Care Managed Medicaid	$14.99
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Medical Associates Managed Medicare	$15.00
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: Molina Healthcare Managed Medicaid	$15.22
Rate for Payer: Molina Healthcare Managed Medicare	$15.22
Rate for Payer: Oscar Health of IA Commercial	$22.50
Rate for Payer: Partners Health Alliance Commercial	$22.50
Rate for Payer: United Healthcare Commercial	$27.00
Rate for Payer: United Healthcare Managed Medicare	$17.70

SCREW CORTICAL 3.5X22 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047100
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X22 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047100
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X22MM SELF CUTTING

Facility

$26.00

Service Code	CPT C1713
Hospital Charge Code	8046482
Hospital Revenue Code	278
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$13.12
Rate for Payer: Amerigroup Medicare	$13.13
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.00
Rate for Payer: Iowa Total Care Managed Medicaid	$12.99
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$13.00
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$13.20
Rate for Payer: Molina Healthcare Managed Medicare	$13.19
Rate for Payer: Oscar Health of IA Commercial	$19.50
Rate for Payer: Partners Health Alliance Commercial	$19.50
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34

SCREW CORTICAL 3.5X22MM SELF CUTTING

Facility

$26.00

Service Code	CPT C1713
Hospital Charge Code	8046482
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

SCREW CORTICAL 3.5X24 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047101
Hospital Revenue Code	278
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.00
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$16.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$16.24
Rate for Payer: Molina Healthcare Managed Medicare	$16.23
Rate for Payer: Oscar Health of IA Commercial	$24.00
Rate for Payer: Partners Health Alliance Commercial	$24.00
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTICAL 3.5X24 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047101
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTICAL 3.5X24MM SELF CUTTING

Facility

$27.00

Service Code	CPT C1713
Hospital Charge Code	8046483
Hospital Revenue Code	278
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of IA Commercial	$24.30
Rate for Payer: Aetna of IA Medical Rental Products	$24.30
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.25
Rate for Payer: Medical Associates Commercial	$20.25
Rate for Payer: Midlands Choice Commercial	$18.90
Rate for Payer: United Healthcare Commercial	$24.30

Know your out-of-pocket cost for care.

All Charges