Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTEX 2.0MMX14MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046775
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

SCREW CORTEX 2.0MMX14MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046775
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 2.0MMX16MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046899
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

SCREW CORTEX 2.0MMX16MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046899
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

SCREW CORTEX 2.0MMX18MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046999
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

SCREW CORTEX 2.0MMX18MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046999
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

SCREW CORTEX 2.0MMX20MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046806
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

SCREW CORTEX 2.0MMX20MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046806
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

SCREW CORTEX 2.0MMX6MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8046791
Hospital Revenue Code	278
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of IA Commercial	$11.70
Rate for Payer: Aetna of IA Medical Rental Products	$11.70
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.75
Rate for Payer: Medical Associates Commercial	$9.75
Rate for Payer: Midlands Choice Commercial	$9.10
Rate for Payer: United Healthcare Commercial	$11.70

SCREW CORTEX 2.0MMX6MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8046791
Hospital Revenue Code	278
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of IA Commercial	$11.70
Rate for Payer: Aetna of IA Medical Rental Products	$11.70
Rate for Payer: Aetna of IA Medicare	$7.41
Rate for Payer: Amerigroup Medicaid	$7.50
Rate for Payer: Amerigroup Medicare	$5.91
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$9.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.85
Rate for Payer: Iowa Total Care Managed Medicaid	$7.43
Rate for Payer: Medical Associates Commercial	$9.75
Rate for Payer: Medical Associates Managed Medicare	$5.85
Rate for Payer: Midlands Choice Commercial	$9.10
Rate for Payer: Molina Healthcare Managed Medicaid	$7.53
Rate for Payer: Partners Health Alliance Commercial	$6.73
Rate for Payer: United Healthcare Commercial	$11.70
Rate for Payer: United Healthcare Managed Medicare	$7.67

SCREW CORTEX 2.0MMX8MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047033
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 2.0MMX8MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8047033
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 2.7 14MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8046365
Hospital Revenue Code	278
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Aetna of IA Medicare	$21.09
Rate for Payer: Amerigroup Medicaid	$21.34
Rate for Payer: Amerigroup Medicare	$16.82
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.65
Rate for Payer: Iowa Total Care Managed Medicaid	$21.13
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Medical Associates Managed Medicare	$16.65
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: Molina Healthcare Managed Medicaid	$21.45
Rate for Payer: Partners Health Alliance Commercial	$19.15
Rate for Payer: United Healthcare Commercial	$33.30
Rate for Payer: United Healthcare Managed Medicare	$21.83

SCREW CORTEX 2.7 14MM

Facility

$37.00

Service Code	HCPCS C1713
Hospital Charge Code	8046365
Hospital Revenue Code	278
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of IA Commercial	$33.30
Rate for Payer: Aetna of IA Medical Rental Products	$33.30
Rate for Payer: Cash Price	$29.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.75
Rate for Payer: Medical Associates Commercial	$27.75
Rate for Payer: Midlands Choice Commercial	$25.90
Rate for Payer: United Healthcare Commercial	$33.30

SCREW CORTEX 2.7 16MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046499
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: United Healthcare Commercial	$32.40

SCREW CORTEX 2.7 16MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046499
Hospital Revenue Code	278
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of IA Commercial	$32.40
Rate for Payer: Aetna of IA Medical Rental Products	$32.40
Rate for Payer: Aetna of IA Medicare	$20.52
Rate for Payer: Amerigroup Medicaid	$20.76
Rate for Payer: Amerigroup Medicare	$16.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.20
Rate for Payer: Iowa Total Care Managed Medicaid	$20.56
Rate for Payer: Medical Associates Commercial	$27.00
Rate for Payer: Medical Associates Managed Medicare	$16.20
Rate for Payer: Midlands Choice Commercial	$25.20
Rate for Payer: Molina Healthcare Managed Medicaid	$20.87
Rate for Payer: Partners Health Alliance Commercial	$18.63
Rate for Payer: United Healthcare Commercial	$32.40
Rate for Payer: United Healthcare Managed Medicare	$21.24

SCREW CORTEX 2.7MMX10MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046364
Hospital Revenue Code	278
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Aetna of IA Medicare	$18.24
Rate for Payer: Amerigroup Medicaid	$18.46
Rate for Payer: Amerigroup Medicare	$14.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.40
Rate for Payer: Iowa Total Care Managed Medicaid	$18.28
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Medical Associates Managed Medicare	$14.40
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: Molina Healthcare Managed Medicaid	$18.55
Rate for Payer: Partners Health Alliance Commercial	$16.56
Rate for Payer: United Healthcare Commercial	$28.80
Rate for Payer: United Healthcare Managed Medicare	$18.88

SCREW CORTEX 2.7MMX10MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046364
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

SCREW CORTEX 2.7MMX12MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046718
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 2.7MMX12MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046718
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

SCREW CORTEX 2.7MMX14MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046465
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 2.7MMX14MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046465
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 2.7MMX16MM

Facility

$19.00

Service Code	HCPCS C1713
Hospital Charge Code	8046973
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of IA Commercial	$17.10
Rate for Payer: Aetna of IA Medical Rental Products	$17.10
Rate for Payer: Aetna of IA Medicare	$10.83
Rate for Payer: Amerigroup Medicaid	$10.96
Rate for Payer: Amerigroup Medicare	$8.64
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.55
Rate for Payer: Iowa Total Care Managed Medicaid	$10.85
Rate for Payer: Medical Associates Commercial	$14.25
Rate for Payer: Medical Associates Managed Medicare	$8.55
Rate for Payer: Midlands Choice Commercial	$13.30
Rate for Payer: Molina Healthcare Managed Medicaid	$11.01
Rate for Payer: Partners Health Alliance Commercial	$9.83
Rate for Payer: United Healthcare Commercial	$17.10
Rate for Payer: United Healthcare Managed Medicare	$11.21

SCREW CORTEX 2.7MMX16MM

Facility

$19.00

Service Code	HCPCS C1713
Hospital Charge Code	8046973
Hospital Revenue Code	278
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of IA Commercial	$17.10
Rate for Payer: Aetna of IA Medical Rental Products	$17.10
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$14.25
Rate for Payer: Medical Associates Commercial	$14.25
Rate for Payer: Midlands Choice Commercial	$13.30
Rate for Payer: United Healthcare Commercial	$17.10

SCREW CORTEX 2.7MMX18MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046311
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of IA Commercial	$28.80
Rate for Payer: Aetna of IA Medical Rental Products	$28.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$24.00
Rate for Payer: Medical Associates Commercial	$24.00
Rate for Payer: Midlands Choice Commercial	$22.40
Rate for Payer: United Healthcare Commercial	$28.80

Know your out-of-pocket cost for care.

All Charges