Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW INTERFERENCE 8

Facility

$414.00

Service Code	CPT C1713
Hospital Charge Code	8047058
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of IA Commercial	$372.60
Rate for Payer: Aetna of IA Medical Rental Products	$372.60
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$310.50
Rate for Payer: Medical Associates Commercial	$310.50
Rate for Payer: Midlands Choice Commercial	$289.80
Rate for Payer: United Healthcare Commercial	$372.60

SCREW INTERFERENCE 8

Facility

$414.00

Service Code	CPT C1713
Hospital Charge Code	8047058
Hospital Revenue Code	278
Min. Negotiated Rate	$206.92
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of IA Commercial	$372.60
Rate for Payer: Aetna of IA Medical Rental Products	$372.60
Rate for Payer: Aetna of IA Medicare	$235.98
Rate for Payer: Amerigroup Medicaid	$208.95
Rate for Payer: Amerigroup Medicare	$209.07
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$310.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$207.00
Rate for Payer: Iowa Total Care Managed Medicaid	$206.92
Rate for Payer: Medical Associates Commercial	$310.50
Rate for Payer: Medical Associates Managed Medicare	$207.00
Rate for Payer: Midlands Choice Commercial	$289.80
Rate for Payer: Molina Healthcare Managed Medicaid	$210.10
Rate for Payer: Molina Healthcare Managed Medicare	$209.98
Rate for Payer: Oscar Health of IA Commercial	$310.50
Rate for Payer: Partners Health Alliance Commercial	$310.50
Rate for Payer: United Healthcare Commercial	$372.60
Rate for Payer: United Healthcare Managed Medicare	$244.26

SCREW INTERFERENCE 8X23MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8026403
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

SCREW INTERFERENCE 8X23MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8026403
Hospital Revenue Code	278
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$204.40
Rate for Payer: Amerigroup Medicare	$204.52
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$202.50
Rate for Payer: Iowa Total Care Managed Medicaid	$202.42
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$202.50
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$205.54
Rate for Payer: Molina Healthcare Managed Medicare	$205.42
Rate for Payer: Oscar Health of IA Commercial	$303.75
Rate for Payer: Partners Health Alliance Commercial	$303.75
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

SCREW INTERFERENCE 8X28MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8026311
Hospital Revenue Code	278
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$204.40
Rate for Payer: Amerigroup Medicare	$204.52
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$202.50
Rate for Payer: Iowa Total Care Managed Medicaid	$202.42
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$202.50
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$205.54
Rate for Payer: Molina Healthcare Managed Medicare	$205.42
Rate for Payer: Oscar Health of IA Commercial	$303.75
Rate for Payer: Partners Health Alliance Commercial	$303.75
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

SCREW INTERFERENCE 8X28MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8026311
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

SCREW INTERFERENCE 9

Facility

$414.00

Service Code	CPT C1713
Hospital Charge Code	8047059
Hospital Revenue Code	278
Min. Negotiated Rate	$206.92
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of IA Commercial	$372.60
Rate for Payer: Aetna of IA Medical Rental Products	$372.60
Rate for Payer: Aetna of IA Medicare	$235.98
Rate for Payer: Amerigroup Medicaid	$208.95
Rate for Payer: Amerigroup Medicare	$209.07
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$310.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$207.00
Rate for Payer: Iowa Total Care Managed Medicaid	$206.92
Rate for Payer: Medical Associates Commercial	$310.50
Rate for Payer: Medical Associates Managed Medicare	$207.00
Rate for Payer: Midlands Choice Commercial	$289.80
Rate for Payer: Molina Healthcare Managed Medicaid	$210.10
Rate for Payer: Molina Healthcare Managed Medicare	$209.98
Rate for Payer: Oscar Health of IA Commercial	$310.50
Rate for Payer: Partners Health Alliance Commercial	$310.50
Rate for Payer: United Healthcare Commercial	$372.60
Rate for Payer: United Healthcare Managed Medicare	$244.26

SCREW INTERFERENCE 9

Facility

$414.00

Service Code	CPT C1713
Hospital Charge Code	8047059
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of IA Commercial	$372.60
Rate for Payer: Aetna of IA Medical Rental Products	$372.60
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$310.50
Rate for Payer: Medical Associates Commercial	$310.50
Rate for Payer: Midlands Choice Commercial	$289.80
Rate for Payer: United Healthcare Commercial	$372.60

SCREW INTERFERENCE 9X23MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8047060
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: United Healthcare Commercial	$364.50

SCREW INTERFERENCE 9X23MM

Facility

$405.00

Service Code	CPT C1713
Hospital Charge Code	8047060
Hospital Revenue Code	278
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of IA Commercial	$364.50
Rate for Payer: Aetna of IA Medical Rental Products	$364.50
Rate for Payer: Aetna of IA Medicare	$230.85
Rate for Payer: Amerigroup Medicaid	$204.40
Rate for Payer: Amerigroup Medicare	$204.52
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$202.50
Rate for Payer: Iowa Total Care Managed Medicaid	$202.42
Rate for Payer: Medical Associates Commercial	$303.75
Rate for Payer: Medical Associates Managed Medicare	$202.50
Rate for Payer: Midlands Choice Commercial	$283.50
Rate for Payer: Molina Healthcare Managed Medicaid	$205.54
Rate for Payer: Molina Healthcare Managed Medicare	$205.42
Rate for Payer: Oscar Health of IA Commercial	$303.75
Rate for Payer: Partners Health Alliance Commercial	$303.75
Rate for Payer: United Healthcare Commercial	$364.50
Rate for Payer: United Healthcare Managed Medicare	$238.95

SCREW LAG CANN 2.0MM X 10MM

Facility

$267.00

Service Code	CPT C1713
Hospital Charge Code	8046253
Hospital Revenue Code	278
Min. Negotiated Rate	$186.90
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of IA Commercial	$240.30
Rate for Payer: Aetna of IA Medical Rental Products	$240.30
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$200.25
Rate for Payer: Medical Associates Commercial	$200.25
Rate for Payer: Midlands Choice Commercial	$186.90
Rate for Payer: United Healthcare Commercial	$240.30

SCREW LAG CANN 2.0MM X 10MM

Facility

$267.00

Service Code	CPT C1713
Hospital Charge Code	8046253
Hospital Revenue Code	278
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of IA Commercial	$240.30
Rate for Payer: Aetna of IA Medical Rental Products	$240.30
Rate for Payer: Aetna of IA Medicare	$152.19
Rate for Payer: Amerigroup Medicaid	$134.75
Rate for Payer: Amerigroup Medicare	$134.84
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$200.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$133.50
Rate for Payer: Iowa Total Care Managed Medicaid	$133.45
Rate for Payer: Medical Associates Commercial	$200.25
Rate for Payer: Medical Associates Managed Medicare	$133.50
Rate for Payer: Midlands Choice Commercial	$186.90
Rate for Payer: Molina Healthcare Managed Medicaid	$135.50
Rate for Payer: Molina Healthcare Managed Medicare	$135.42
Rate for Payer: Oscar Health of IA Commercial	$200.25
Rate for Payer: Partners Health Alliance Commercial	$200.25
Rate for Payer: United Healthcare Commercial	$240.30
Rate for Payer: United Healthcare Managed Medicare	$157.53

SCREW LAG CANN 2.0MM X 12MM

Facility

$279.00

Service Code	CPT C1713
Hospital Charge Code	8046254
Hospital Revenue Code	278
Min. Negotiated Rate	$139.44
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Aetna of IA Medicare	$159.03
Rate for Payer: Amerigroup Medicaid	$140.81
Rate for Payer: Amerigroup Medicare	$140.90
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$139.50
Rate for Payer: Iowa Total Care Managed Medicaid	$139.44
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Medical Associates Managed Medicare	$139.50
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: Molina Healthcare Managed Medicaid	$141.59
Rate for Payer: Molina Healthcare Managed Medicare	$141.51
Rate for Payer: Oscar Health of IA Commercial	$209.25
Rate for Payer: Partners Health Alliance Commercial	$209.25
Rate for Payer: United Healthcare Commercial	$251.10
Rate for Payer: United Healthcare Managed Medicare	$164.61

SCREW LAG CANN 2.0MM X 12MM

Facility

$279.00

Service Code	CPT C1713
Hospital Charge Code	8046254
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of IA Commercial	$251.10
Rate for Payer: Aetna of IA Medical Rental Products	$251.10
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$209.25
Rate for Payer: Medical Associates Commercial	$209.25
Rate for Payer: Midlands Choice Commercial	$195.30
Rate for Payer: United Healthcare Commercial	$251.10

SCREW LAG CANN 2.0MM X 14MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046255
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW LAG CANN 2.0MM X 14MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046255
Hospital Revenue Code	278
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$131.73
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.45
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$132.46
Rate for Payer: Molina Healthcare Managed Medicare	$132.38
Rate for Payer: Oscar Health of IA Commercial	$195.75
Rate for Payer: Partners Health Alliance Commercial	$195.75
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW LAG CANN 2.0MM X 16MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046256
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW LAG CANN 2.0MM X 16MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046256
Hospital Revenue Code	278
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$131.73
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.45
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$132.46
Rate for Payer: Molina Healthcare Managed Medicare	$132.38
Rate for Payer: Oscar Health of IA Commercial	$195.75
Rate for Payer: Partners Health Alliance Commercial	$195.75
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW LAG CANN 2.0MM X 18MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046257
Hospital Revenue Code	278
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$131.73
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.45
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$132.46
Rate for Payer: Molina Healthcare Managed Medicare	$132.38
Rate for Payer: Oscar Health of IA Commercial	$195.75
Rate for Payer: Partners Health Alliance Commercial	$195.75
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW LAG CANN 2.0MM X 18MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046257
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW LAG CANN 2.0MM X 20MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046258
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW LAG CANN 2.0MM X 20MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046258
Hospital Revenue Code	278
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$131.73
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.45
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$132.46
Rate for Payer: Molina Healthcare Managed Medicare	$132.38
Rate for Payer: Oscar Health of IA Commercial	$195.75
Rate for Payer: Partners Health Alliance Commercial	$195.75
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW LAG CANN 2.0MM X 22MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046259
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

SCREW LAG CANN 2.0MM X 22MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046259
Hospital Revenue Code	278
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Aetna of IA Medicare	$148.77
Rate for Payer: Amerigroup Medicaid	$131.73
Rate for Payer: Amerigroup Medicare	$131.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$130.50
Rate for Payer: Iowa Total Care Managed Medicaid	$130.45
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Medical Associates Managed Medicare	$130.50
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: Molina Healthcare Managed Medicaid	$132.46
Rate for Payer: Molina Healthcare Managed Medicare	$132.38
Rate for Payer: Oscar Health of IA Commercial	$195.75
Rate for Payer: Partners Health Alliance Commercial	$195.75
Rate for Payer: United Healthcare Commercial	$234.90
Rate for Payer: United Healthcare Managed Medicare	$153.99

SCREW LAG CANN 2.0MM X 6MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046251
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$234.90
Rate for Payer: Aetna of IA Commercial	$234.90
Rate for Payer: Aetna of IA Medical Rental Products	$234.90
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$195.75
Rate for Payer: Medical Associates Commercial	$195.75
Rate for Payer: Midlands Choice Commercial	$182.70
Rate for Payer: United Healthcare Commercial	$234.90

Know your out-of-pocket cost for care.

All Charges