Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED LAG 6.7X75MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047258
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED LAG 6.7X75MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047258
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X85MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047260
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED LAG 6.7X85MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047260
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X85MM-1

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047243
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X85MM-1

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047243
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED LAG 6.7X90MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047261
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X90MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047261
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED LAG 6.7X90MM-1

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	8047244
Hospital Revenue Code	278
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$356.40
Rate for Payer: Aetna of IA Commercial	$356.40
Rate for Payer: Aetna of IA Medical Rental Products	$356.40
Rate for Payer: Aetna of IA Medicare	$225.72
Rate for Payer: Amerigroup Medicaid	$228.41
Rate for Payer: Amerigroup Medicare	$179.98
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$297.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$178.20
Rate for Payer: Iowa Total Care Managed Medicaid	$226.20
Rate for Payer: Medical Associates Commercial	$297.00
Rate for Payer: Medical Associates Managed Medicare	$178.20
Rate for Payer: Midlands Choice Commercial	$277.20
Rate for Payer: Molina Healthcare Managed Medicaid	$229.52
Rate for Payer: Partners Health Alliance Commercial	$204.93
Rate for Payer: United Healthcare Commercial	$356.40
Rate for Payer: United Healthcare Managed Medicare	$233.64

SCREW CANNULATED LAG 6.7X90MM-1

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	8047244
Hospital Revenue Code	278
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$356.40
Rate for Payer: Aetna of IA Commercial	$356.40
Rate for Payer: Aetna of IA Medical Rental Products	$356.40
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$297.00
Rate for Payer: Medical Associates Commercial	$297.00
Rate for Payer: Midlands Choice Commercial	$277.20
Rate for Payer: United Healthcare Commercial	$356.40

SCREW CANNULATED LAG 6.7X95MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047262
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X95MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047262
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED LAG 6.7X95MM-1

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047245
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED LAG 6.7X95MM-1

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8047245
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED TI 4.0X42MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046891
Hospital Revenue Code	278
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: United Healthcare Commercial	$221.40

SCREW CANNULATED TI 4.0X42MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046891
Hospital Revenue Code	278
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Aetna of IA Medicare	$140.22
Rate for Payer: Amerigroup Medicaid	$141.89
Rate for Payer: Amerigroup Medicare	$111.81
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$110.70
Rate for Payer: Iowa Total Care Managed Medicaid	$140.52
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Medical Associates Managed Medicare	$110.70
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: Molina Healthcare Managed Medicaid	$142.58
Rate for Payer: Partners Health Alliance Commercial	$127.30
Rate for Payer: United Healthcare Commercial	$221.40
Rate for Payer: United Healthcare Managed Medicare	$145.14

SCREW CANNULATED TI 4.0X46MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046892
Hospital Revenue Code	278
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: United Healthcare Commercial	$221.40

SCREW CANNULATED TI 4.0X46MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046892
Hospital Revenue Code	278
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Aetna of IA Medicare	$140.22
Rate for Payer: Amerigroup Medicaid	$141.89
Rate for Payer: Amerigroup Medicare	$111.81
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$110.70
Rate for Payer: Iowa Total Care Managed Medicaid	$140.52
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Medical Associates Managed Medicare	$110.70
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: Molina Healthcare Managed Medicaid	$142.58
Rate for Payer: Partners Health Alliance Commercial	$127.30
Rate for Payer: United Healthcare Commercial	$221.40
Rate for Payer: United Healthcare Managed Medicare	$145.14

SCREW CANNULATED TI 4.0X48MM

Facility

$224.00

Service Code	HCPCS C1713
Hospital Charge Code	8046893
Hospital Revenue Code	278
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of IA Commercial	$201.60
Rate for Payer: Aetna of IA Medical Rental Products	$201.60
Rate for Payer: Cash Price	$179.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$168.00
Rate for Payer: Medical Associates Commercial	$168.00
Rate for Payer: Midlands Choice Commercial	$156.80
Rate for Payer: United Healthcare Commercial	$201.60

SCREW CANNULATED TI 4.0X48MM

Facility

$224.00

Service Code	HCPCS C1713
Hospital Charge Code	8046893
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of IA Commercial	$201.60
Rate for Payer: Aetna of IA Medical Rental Products	$201.60
Rate for Payer: Aetna of IA Medicare	$127.68
Rate for Payer: Amerigroup Medicaid	$129.20
Rate for Payer: Amerigroup Medicare	$101.81
Rate for Payer: Cash Price	$179.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$168.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$100.80
Rate for Payer: Iowa Total Care Managed Medicaid	$127.95
Rate for Payer: Medical Associates Commercial	$168.00
Rate for Payer: Medical Associates Managed Medicare	$100.80
Rate for Payer: Midlands Choice Commercial	$156.80
Rate for Payer: Molina Healthcare Managed Medicaid	$129.83
Rate for Payer: Partners Health Alliance Commercial	$115.92
Rate for Payer: United Healthcare Commercial	$201.60
Rate for Payer: United Healthcare Managed Medicare	$132.16

SCREW CANNULATED TI 4.0X70MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046894
Hospital Revenue Code	278
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Aetna of IA Medicare	$140.22
Rate for Payer: Amerigroup Medicaid	$141.89
Rate for Payer: Amerigroup Medicare	$111.81
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$110.70
Rate for Payer: Iowa Total Care Managed Medicaid	$140.52
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Medical Associates Managed Medicare	$110.70
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: Molina Healthcare Managed Medicaid	$142.58
Rate for Payer: Partners Health Alliance Commercial	$127.30
Rate for Payer: United Healthcare Commercial	$221.40
Rate for Payer: United Healthcare Managed Medicare	$145.14

SCREW CANNULATED TI 4.0X70MM

Facility

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	8046894
Hospital Revenue Code	278
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of IA Commercial	$221.40
Rate for Payer: Aetna of IA Medical Rental Products	$221.40
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$184.50
Rate for Payer: Medical Associates Commercial	$184.50
Rate for Payer: Midlands Choice Commercial	$172.20
Rate for Payer: United Healthcare Commercial	$221.40

SCREW CANNULATED TIGER 2.4MMX28MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8734814
Hospital Revenue Code	278
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Aetna of IA Medicare	$112.86
Rate for Payer: Amerigroup Medicaid	$114.21
Rate for Payer: Amerigroup Medicare	$89.99
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.10
Rate for Payer: Iowa Total Care Managed Medicaid	$113.10
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Medical Associates Managed Medicare	$89.10
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: Molina Healthcare Managed Medicaid	$114.76
Rate for Payer: Partners Health Alliance Commercial	$102.46
Rate for Payer: United Healthcare Commercial	$178.20
Rate for Payer: United Healthcare Managed Medicare	$116.82

SCREW CANNULATED TIGER 2.4MMX28MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8734814
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

SCREW CANNULATED TIGER 4.00MMX30MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713569
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of IA Commercial	$178.20
Rate for Payer: Aetna of IA Medical Rental Products	$178.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$148.50
Rate for Payer: Medical Associates Commercial	$148.50
Rate for Payer: Midlands Choice Commercial	$138.60
Rate for Payer: United Healthcare Commercial	$178.20

Know your out-of-pocket cost for care.

All Charges