Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED TIGER 4.00MMX30MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	8713569
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 4.0MMX30MM

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8814826
Hospital Revenue Code	278
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: United Healthcare Commercial	$153.90

SCREW CANNULATED TIGER 4.0MMX30MM

Facility

$171.00

Service Code	HCPCS C1713
Hospital Charge Code	8814826
Hospital Revenue Code	278
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of IA Commercial	$153.90
Rate for Payer: Aetna of IA Medical Rental Products	$153.90
Rate for Payer: Aetna of IA Medicare	$97.47
Rate for Payer: Amerigroup Medicaid	$98.63
Rate for Payer: Amerigroup Medicare	$77.72
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$128.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$76.95
Rate for Payer: Iowa Total Care Managed Medicaid	$97.68
Rate for Payer: Medical Associates Commercial	$128.25
Rate for Payer: Medical Associates Managed Medicare	$76.95
Rate for Payer: Midlands Choice Commercial	$119.70
Rate for Payer: Molina Healthcare Managed Medicaid	$99.11
Rate for Payer: Partners Health Alliance Commercial	$88.49
Rate for Payer: United Healthcare Commercial	$153.90
Rate for Payer: United Healthcare Managed Medicare	$100.89

SCREW CANNULTAED TIGER 4.0MMX38MM

Facility

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	9002592
Hospital Revenue Code	278
Min. Negotiated Rate	$133.65
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna of IA Commercial	$267.30
Rate for Payer: Aetna of IA Medical Rental Products	$267.30
Rate for Payer: Aetna of IA Medicare	$169.29
Rate for Payer: Amerigroup Medicaid	$171.31
Rate for Payer: Amerigroup Medicare	$134.99
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$222.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$133.65
Rate for Payer: Iowa Total Care Managed Medicaid	$169.65
Rate for Payer: Medical Associates Commercial	$222.75
Rate for Payer: Medical Associates Managed Medicare	$133.65
Rate for Payer: Midlands Choice Commercial	$207.90
Rate for Payer: Molina Healthcare Managed Medicaid	$172.14
Rate for Payer: Partners Health Alliance Commercial	$153.70
Rate for Payer: United Healthcare Commercial	$267.30
Rate for Payer: United Healthcare Managed Medicare	$175.23

SCREW CANNULTAED TIGER 4.0MMX38MM

Facility

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	9002592
Hospital Revenue Code	278
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna of IA Commercial	$267.30
Rate for Payer: Aetna of IA Medical Rental Products	$267.30
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$222.75
Rate for Payer: Medical Associates Commercial	$222.75
Rate for Payer: Midlands Choice Commercial	$207.90
Rate for Payer: United Healthcare Commercial	$267.30

SCREW CORTEX 1.5MMX10MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046971
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: United Healthcare Commercial	$10.80

SCREW CORTEX 1.5MMX10MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046971
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Aetna of IA Medicare	$6.84
Rate for Payer: Amerigroup Medicaid	$6.92
Rate for Payer: Amerigroup Medicare	$5.45
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.40
Rate for Payer: Iowa Total Care Managed Medicaid	$6.85
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Medical Associates Managed Medicare	$5.40
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: Molina Healthcare Managed Medicaid	$6.96
Rate for Payer: Partners Health Alliance Commercial	$6.21
Rate for Payer: United Healthcare Commercial	$10.80
Rate for Payer: United Healthcare Managed Medicare	$7.08

SCREW CORTEX 1.5MMX11MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046996
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Aetna of IA Medicare	$6.84
Rate for Payer: Amerigroup Medicaid	$6.92
Rate for Payer: Amerigroup Medicare	$5.45
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.40
Rate for Payer: Iowa Total Care Managed Medicaid	$6.85
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Medical Associates Managed Medicare	$5.40
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: Molina Healthcare Managed Medicaid	$6.96
Rate for Payer: Partners Health Alliance Commercial	$6.21
Rate for Payer: United Healthcare Commercial	$10.80
Rate for Payer: United Healthcare Managed Medicare	$7.08

SCREW CORTEX 1.5MMX11MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046996
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: United Healthcare Commercial	$10.80

SCREW CORTEX 1.5MMX12MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046898
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Aetna of IA Medicare	$6.84
Rate for Payer: Amerigroup Medicaid	$6.92
Rate for Payer: Amerigroup Medicare	$5.45
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.40
Rate for Payer: Iowa Total Care Managed Medicaid	$6.85
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Medical Associates Managed Medicare	$5.40
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: Molina Healthcare Managed Medicaid	$6.96
Rate for Payer: Partners Health Alliance Commercial	$6.21
Rate for Payer: United Healthcare Commercial	$10.80
Rate for Payer: United Healthcare Managed Medicare	$7.08

SCREW CORTEX 1.5MMX12MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046898
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: United Healthcare Commercial	$10.80

SCREW CORTEX 1.5MMX14MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046998
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: United Healthcare Commercial	$10.80

SCREW CORTEX 1.5MMX14MM

Facility

$12.00

Service Code	HCPCS C1713
Hospital Charge Code	8046998
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of IA Commercial	$10.80
Rate for Payer: Aetna of IA Medical Rental Products	$10.80
Rate for Payer: Aetna of IA Medicare	$6.84
Rate for Payer: Amerigroup Medicaid	$6.92
Rate for Payer: Amerigroup Medicare	$5.45
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.40
Rate for Payer: Iowa Total Care Managed Medicaid	$6.85
Rate for Payer: Medical Associates Commercial	$9.00
Rate for Payer: Medical Associates Managed Medicare	$5.40
Rate for Payer: Midlands Choice Commercial	$8.40
Rate for Payer: Molina Healthcare Managed Medicaid	$6.96
Rate for Payer: Partners Health Alliance Commercial	$6.21
Rate for Payer: United Healthcare Commercial	$10.80
Rate for Payer: United Healthcare Managed Medicare	$7.08

SCREW CORTEX 1.5MMX16MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8047029
Hospital Revenue Code	278
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of IA Commercial	$15.30
Rate for Payer: Aetna of IA Medical Rental Products	$15.30
Rate for Payer: Cash Price	$13.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.75
Rate for Payer: Medical Associates Commercial	$12.75
Rate for Payer: Midlands Choice Commercial	$11.90
Rate for Payer: United Healthcare Commercial	$15.30

SCREW CORTEX 1.5MMX16MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8047029
Hospital Revenue Code	278
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of IA Commercial	$15.30
Rate for Payer: Aetna of IA Medical Rental Products	$15.30
Rate for Payer: Aetna of IA Medicare	$9.69
Rate for Payer: Amerigroup Medicaid	$9.81
Rate for Payer: Amerigroup Medicare	$7.73
Rate for Payer: Cash Price	$13.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$12.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$7.65
Rate for Payer: Iowa Total Care Managed Medicaid	$9.71
Rate for Payer: Medical Associates Commercial	$12.75
Rate for Payer: Medical Associates Managed Medicare	$7.65
Rate for Payer: Midlands Choice Commercial	$11.90
Rate for Payer: Molina Healthcare Managed Medicaid	$9.85
Rate for Payer: Partners Health Alliance Commercial	$8.80
Rate for Payer: United Healthcare Commercial	$15.30
Rate for Payer: United Healthcare Managed Medicare	$10.03

SCREW CORTEX 1.5MMX7MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047018
Hospital Revenue Code	278
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$30.60

SCREW CORTEX 1.5MMX7MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047018
Hospital Revenue Code	278
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Aetna of IA Medicare	$19.38
Rate for Payer: Amerigroup Medicaid	$19.61
Rate for Payer: Amerigroup Medicare	$15.45
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.30
Rate for Payer: Iowa Total Care Managed Medicaid	$19.42
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Medical Associates Managed Medicare	$15.30
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: Molina Healthcare Managed Medicaid	$19.71
Rate for Payer: Partners Health Alliance Commercial	$17.60
Rate for Payer: United Healthcare Commercial	$30.60
Rate for Payer: United Healthcare Managed Medicare	$20.06

SCREW CORTEX 1.5MMX8MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047023
Hospital Revenue Code	278
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Aetna of IA Medicare	$19.38
Rate for Payer: Amerigroup Medicaid	$19.61
Rate for Payer: Amerigroup Medicare	$15.45
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.30
Rate for Payer: Iowa Total Care Managed Medicaid	$19.42
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Medical Associates Managed Medicare	$15.30
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: Molina Healthcare Managed Medicaid	$19.71
Rate for Payer: Partners Health Alliance Commercial	$17.60
Rate for Payer: United Healthcare Commercial	$30.60
Rate for Payer: United Healthcare Managed Medicare	$20.06

SCREW CORTEX 1.5MMX8MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047023
Hospital Revenue Code	278
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$30.60

SCREW CORTEX 1.5MMX9MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047034
Hospital Revenue Code	278
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: United Healthcare Commercial	$30.60

SCREW CORTEX 1.5MMX9MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047034
Hospital Revenue Code	278
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of IA Commercial	$30.60
Rate for Payer: Aetna of IA Medical Rental Products	$30.60
Rate for Payer: Aetna of IA Medicare	$19.38
Rate for Payer: Amerigroup Medicaid	$19.61
Rate for Payer: Amerigroup Medicare	$15.45
Rate for Payer: Cash Price	$27.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$25.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.30
Rate for Payer: Iowa Total Care Managed Medicaid	$19.42
Rate for Payer: Medical Associates Commercial	$25.50
Rate for Payer: Medical Associates Managed Medicare	$15.30
Rate for Payer: Midlands Choice Commercial	$23.80
Rate for Payer: Molina Healthcare Managed Medicaid	$19.71
Rate for Payer: Partners Health Alliance Commercial	$17.60
Rate for Payer: United Healthcare Commercial	$30.60
Rate for Payer: United Healthcare Managed Medicare	$20.06

SCREW CORTEX 2.0MMX10MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8047008
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 CORTEX 2.0MMX10MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8047008
Hospital Revenue Code	278
Min. Negotiated Rate	$12.15
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	$15.57
Rate for Payer: Amerigroup Medicare	$12.27
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	$12.15
Rate for Payer: Iowa Total Care Managed Medicaid	$15.42
Rate for Payer: Medical Associates Commercial	$20.25
Rate for Payer: Medical Associates Managed Medicare	$12.15
Rate for Payer: Midlands Choice Commercial	$18.90
Rate for Payer: Molina Healthcare Managed Medicaid	$15.65
Rate for Payer: Partners Health Alliance Commercial	$13.97
Rate for Payer: United Healthcare Commercial	$24.30
Rate for Payer: United Healthcare Managed Medicare	$15.93

SCREW CORTEX 2.0MMX12MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046939
Hospital Revenue Code	278
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of IA Commercial	$20.70
Rate for Payer: Aetna of IA Medical Rental Products	$20.70
Rate for Payer: Cash Price	$18.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.25
Rate for Payer: Medical Associates Commercial	$17.25
Rate for Payer: Midlands Choice Commercial	$16.10
Rate for Payer: United Healthcare Commercial	$20.70

SCREW CORTEX 2.0MMX12MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046939
Hospital Revenue Code	278
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of IA Commercial	$20.70
Rate for Payer: Aetna of IA Medical Rental Products	$20.70
Rate for Payer: Aetna of IA Medicare	$13.11
Rate for Payer: Amerigroup Medicaid	$13.27
Rate for Payer: Amerigroup Medicare	$10.45
Rate for Payer: Cash Price	$18.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.35
Rate for Payer: Iowa Total Care Managed Medicaid	$13.14
Rate for Payer: Medical Associates Commercial	$17.25
Rate for Payer: Medical Associates Managed Medicare	$10.35
Rate for Payer: Midlands Choice Commercial	$16.10
Rate for Payer: Molina Healthcare Managed Medicaid	$13.33
Rate for Payer: Partners Health Alliance Commercial	$11.90
Rate for Payer: United Healthcare Commercial	$20.70
Rate for Payer: United Healthcare Managed Medicare	$13.57

Know your out-of-pocket cost for care.

All Charges