Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

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	$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 8MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046252
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 8MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046252
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 2.4MM X 10MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046262
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 2.4MM X 10MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046262
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 2.4MM X 12MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046263
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 2.4MM X 12MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046263
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 2.4MM X 14MM

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8046264
Hospital Revenue Code	278
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$136.27
Rate for Payer: Amerigroup Medicare	$136.35
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$135.00
Rate for Payer: Iowa Total Care Managed Medicaid	$134.95
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$135.00
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$137.02
Rate for Payer: Molina Healthcare Managed Medicare	$136.94
Rate for Payer: Oscar Health of IA Commercial	$202.50
Rate for Payer: Partners Health Alliance Commercial	$202.50
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW LAG CANN 2.4MM X 14MM

Facility

$270.00

Service Code	CPT C1713
Hospital Charge Code	8046264
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW LAG CANN 2.4MM X 16MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046409
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 2.4MM X 16MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046409
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 2.4MM X 18MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046265
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 2.4MM X 18MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046265
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 2.4MM X 20MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046266
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 2.4MM X 20MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046266
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 2.4MM X 22MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046267
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 2.4MM X 22MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046267
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 2.4MM X 24MM

Facility

$279.00

Service Code	CPT C1713
Hospital Charge Code	8046268
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 2.4MM X 24MM

Facility

$279.00

Service Code	CPT C1713
Hospital Charge Code	8046268
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 2.4MM X 26MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046269
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 2.4MM X 26MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046269
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 2.4MM X 28MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046270
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 2.4MM X 28MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046270
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 2.4MM X 30MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046271
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 2.4MM X 30MM

Facility

$261.00

Service Code	CPT C1713
Hospital Charge Code	8046271
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

Know your out-of-pocket cost for care.

All Charges