Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANCELLOUS 6.5 X 75MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046552
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 75MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046552
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 75MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046571
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 75MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046571
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 80MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046539
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 80MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046539
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 80MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046553
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 80MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046553
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 80MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046572
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 80MM FULLY THREAD

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046572
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 85MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046540
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 85MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046540
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 85MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046554
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 85MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046554
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 90MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046541
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 90MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046541
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 90MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046555
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 90MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046555
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 95MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046542
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS 6.5 X 95MM 16MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046542
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 95MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046556
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Aetna of IA Medicare	$22.80
Rate for Payer: Amerigroup Medicaid	$23.07
Rate for Payer: Amerigroup Medicare	$18.18
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$18.00
Rate for Payer: Iowa Total Care Managed Medicaid	$22.85
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Medical Associates Managed Medicare	$18.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: Molina Healthcare Managed Medicaid	$23.18
Rate for Payer: Partners Health Alliance Commercial	$20.70
Rate for Payer: United Healthcare Commercial	$36.00
Rate for Payer: United Healthcare Managed Medicare	$23.60

SCREW CANCELLOUS 6.5 X 95MM 32MMT/L

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	8046556
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of IA Commercial	$36.00
Rate for Payer: Aetna of IA Medical Rental Products	$36.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$30.00
Rate for Payer: Medical Associates Commercial	$30.00
Rate for Payer: Midlands Choice Commercial	$28.00
Rate for Payer: United Healthcare Commercial	$36.00

SCREW CANCELLOUS BONE 6.5MM X 20MM

Facility

$293.00

Service Code	HCPCS C1713
Hospital Charge Code	8026020
Hospital Revenue Code	278
Min. Negotiated Rate	$205.10
Max. Negotiated Rate	$263.70
Rate for Payer: Aetna of IA Commercial	$263.70
Rate for Payer: Aetna of IA Medical Rental Products	$263.70
Rate for Payer: Cash Price	$234.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$219.75
Rate for Payer: Medical Associates Commercial	$219.75
Rate for Payer: Midlands Choice Commercial	$205.10
Rate for Payer: United Healthcare Commercial	$263.70

SCREW CANCELLOUS BONE 6.5MM X 20MM

Facility

$293.00

Service Code	HCPCS C1713
Hospital Charge Code	8026020
Hospital Revenue Code	278
Min. Negotiated Rate	$131.85
Max. Negotiated Rate	$263.70
Rate for Payer: Aetna of IA Commercial	$263.70
Rate for Payer: Aetna of IA Medical Rental Products	$263.70
Rate for Payer: Aetna of IA Medicare	$167.01
Rate for Payer: Amerigroup Medicaid	$169.00
Rate for Payer: Amerigroup Medicare	$133.17
Rate for Payer: Cash Price	$234.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$219.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$131.85
Rate for Payer: Iowa Total Care Managed Medicaid	$167.36
Rate for Payer: Medical Associates Commercial	$219.75
Rate for Payer: Medical Associates Managed Medicare	$131.85
Rate for Payer: Midlands Choice Commercial	$205.10
Rate for Payer: Molina Healthcare Managed Medicaid	$169.82
Rate for Payer: Partners Health Alliance Commercial	$151.63
Rate for Payer: United Healthcare Commercial	$263.70
Rate for Payer: United Healthcare Managed Medicare	$172.87

SCREW CANCELLOUS BONE 6.5MM X 25MM

Facility

$284.00

Service Code	HCPCS C1713
Hospital Charge Code	8026021
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of IA Commercial	$255.60
Rate for Payer: Aetna of IA Medical Rental Products	$255.60
Rate for Payer: Cash Price	$227.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$213.00
Rate for Payer: Medical Associates Commercial	$213.00
Rate for Payer: Midlands Choice Commercial	$198.80
Rate for Payer: United Healthcare Commercial	$255.60

Know your out-of-pocket cost for care.

All Charges