Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL 3.5X24MM SELF CUTTING

Facility

$27.00

Service Code	CPT C1713
Hospital Charge Code	8046483
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
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: Aetna of IA Medicare	$15.39
Rate for Payer: Amerigroup Medicaid	$13.63
Rate for Payer: Amerigroup Medicare	$13.64
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.50
Rate for Payer: Iowa Total Care Managed Medicaid	$13.49
Rate for Payer: Medical Associates Commercial	$20.25
Rate for Payer: Medical Associates Managed Medicare	$13.50
Rate for Payer: Midlands Choice Commercial	$18.90
Rate for Payer: Molina Healthcare Managed Medicaid	$13.70
Rate for Payer: Molina Healthcare Managed Medicare	$13.69
Rate for Payer: Oscar Health of IA Commercial	$20.25
Rate for Payer: Partners Health Alliance Commercial	$20.25
Rate for Payer: United Healthcare Commercial	$24.30
Rate for Payer: United Healthcare Managed Medicare	$15.93

SCREW CORTICAL 3.5X26 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047102
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 3.5X26 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047102
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 3.5X26MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046484
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 3.5X26MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046484
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 3.5X28 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047103
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 3.5X28 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047103
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 3.5X28MM SELF CUTTING

Facility

$27.00

Service Code	CPT C1713
Hospital Charge Code	8046485
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
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: Aetna of IA Medicare	$15.39
Rate for Payer: Amerigroup Medicaid	$13.63
Rate for Payer: Amerigroup Medicare	$13.64
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$20.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.50
Rate for Payer: Iowa Total Care Managed Medicaid	$13.49
Rate for Payer: Medical Associates Commercial	$20.25
Rate for Payer: Medical Associates Managed Medicare	$13.50
Rate for Payer: Midlands Choice Commercial	$18.90
Rate for Payer: Molina Healthcare Managed Medicaid	$13.70
Rate for Payer: Molina Healthcare Managed Medicare	$13.69
Rate for Payer: Oscar Health of IA Commercial	$20.25
Rate for Payer: Partners Health Alliance Commercial	$20.25
Rate for Payer: United Healthcare Commercial	$24.30
Rate for Payer: United Healthcare Managed Medicare	$15.93

SCREW CORTICAL 3.5X28MM SELF CUTTING

Facility

$27.00

Service Code	CPT C1713
Hospital Charge Code	8046485
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

SCREW CORTICAL 3.5X30 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047104
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 3.5X30 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047104
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 3.5X30MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046486
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 3.5X30MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046486
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 3.5X32MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046487
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 3.5X32MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046487
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 3.5X34MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046488
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 3.5X34MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046488
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 3.5X35 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047105
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 3.5X35 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047105
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 3.5X36MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046489
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 3.5X36MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046489
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 3.5X38MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046490
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 3.5X38MM SELF CUTTING

Facility

$24.00

Service Code	CPT C1713
Hospital Charge Code	8046490
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 3.5X40 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047106
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 3.5X40 MM, LPS, SS

Facility

$32.00

Service Code	CPT C1713
Hospital Charge Code	8047106
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

Know your out-of-pocket cost for care.

All Charges