Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTEX 2.7MMX18MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046311
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 2.7MMX20MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8047024
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 2.7MMX20MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8047024
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 2.7MMX22MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047036
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 2.7MMX22MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047036
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 2.7MMX24MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047030
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 2.7MMX24MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047030
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 2.7MMX6MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8046954
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 2.7MMX6MM

Facility

$13.00

Service Code	HCPCS C1713
Hospital Charge Code	8046954
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 2.7MMX8MM

Facility

$15.00

Service Code	HCPCS C1713
Hospital Charge Code	8046941
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of IA Commercial	$13.50
Rate for Payer: Aetna of IA Medical Rental Products	$13.50
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.25
Rate for Payer: Medical Associates Commercial	$11.25
Rate for Payer: Midlands Choice Commercial	$10.50
Rate for Payer: United Healthcare Commercial	$13.50

SCREW CORTEX 2.7MMX8MM

Facility

$15.00

Service Code	HCPCS C1713
Hospital Charge Code	8046941
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of IA Commercial	$13.50
Rate for Payer: Aetna of IA Medical Rental Products	$13.50
Rate for Payer: Aetna of IA Medicare	$8.55
Rate for Payer: Amerigroup Medicaid	$8.65
Rate for Payer: Amerigroup Medicare	$6.82
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$11.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.75
Rate for Payer: Iowa Total Care Managed Medicaid	$8.57
Rate for Payer: Medical Associates Commercial	$11.25
Rate for Payer: Medical Associates Managed Medicare	$6.75
Rate for Payer: Midlands Choice Commercial	$10.50
Rate for Payer: Molina Healthcare Managed Medicaid	$8.69
Rate for Payer: Partners Health Alliance Commercial	$7.76
Rate for Payer: United Healthcare Commercial	$13.50
Rate for Payer: United Healthcare Managed Medicare	$8.85

SCREW CORTEX 3.5MMX10MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8046994
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 3.5MMX10MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8046994
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 3.5MMX12MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046378
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 3.5MMX12MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046378
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 3.5MMX14MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046796
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 3.5MMX14MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	8046796
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 3.5MMX16MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047009
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 3.5MMX16MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047009
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 3.5MMX18MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8046965
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 3.5MMX18MM

Facility

$17.00

Service Code	HCPCS C1713
Hospital Charge Code	8046965
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 3.5MMX20MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046392
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 3.5MMX20MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046392
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 3.5MMX22MM

Facility

$18.00

Service Code	HCPCS C1713
Hospital Charge Code	8046722
Hospital Revenue Code	278
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of IA Commercial	$16.20
Rate for Payer: Aetna of IA Medical Rental Products	$16.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.50
Rate for Payer: Medical Associates Commercial	$13.50
Rate for Payer: Midlands Choice Commercial	$12.60
Rate for Payer: United Healthcare Commercial	$16.20

SCREW CORTEX 3.5MMX22MM

Facility

$18.00

Service Code	HCPCS C1713
Hospital Charge Code	8046722
Hospital Revenue Code	278
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of IA Commercial	$16.20
Rate for Payer: Aetna of IA Medical Rental Products	$16.20
Rate for Payer: Aetna of IA Medicare	$10.26
Rate for Payer: Amerigroup Medicaid	$10.38
Rate for Payer: Amerigroup Medicare	$8.18
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.10
Rate for Payer: Iowa Total Care Managed Medicaid	$10.28
Rate for Payer: Medical Associates Commercial	$13.50
Rate for Payer: Medical Associates Managed Medicare	$8.10
Rate for Payer: Midlands Choice Commercial	$12.60
Rate for Payer: Molina Healthcare Managed Medicaid	$10.43
Rate for Payer: Partners Health Alliance Commercial	$9.32
Rate for Payer: United Healthcare Commercial	$16.20
Rate for Payer: United Healthcare Managed Medicare	$10.62

Know your out-of-pocket cost for care.

All Charges