Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTEX 3.5MMX24MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046921
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 3.5MMX24MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046921
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 3.5MMX26MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8047020
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 3.5MMX26MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8047020
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 3.5MMX28MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046369
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 3.5MMX28MM

Facility

$23.00

Service Code	HCPCS C1713
Hospital Charge Code	8046369
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 3.5MMX32MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8046370
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 3.5MMX32MM

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8046370
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 3.5MMX34MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046242
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 3.5MMX34MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046242
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 3.5MMX36MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046368
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 3.5MMX36MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8046368
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 3.5MMX40MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046371
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 3.5MMX40MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046371
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 3.5MMX45MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046372
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 3.5MMX45MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046372
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 3.5MMX50MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046374
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 3.5MMX50MM

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046374
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 CORTICAL 2.7X10MM SELF CUTTING

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8046614
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 CORTICAL 2.7X10MM SELF CUTTING

Facility

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	8046614
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 CORTICAL 2.7X12MM

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046615
Hospital Revenue Code	278
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: United Healthcare Commercial	$21.60

SCREW CORTICAL 2.7X12MM

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046615
Hospital Revenue Code	278
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Aetna of IA Medicare	$13.68
Rate for Payer: Amerigroup Medicaid	$13.84
Rate for Payer: Amerigroup Medicare	$10.91
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.80
Rate for Payer: Iowa Total Care Managed Medicaid	$13.71
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Medical Associates Managed Medicare	$10.80
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: Molina Healthcare Managed Medicaid	$13.91
Rate for Payer: Partners Health Alliance Commercial	$12.42
Rate for Payer: United Healthcare Commercial	$21.60
Rate for Payer: United Healthcare Managed Medicare	$14.16

SCREW CORTICAL 2.7X14

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046616
Hospital Revenue Code	278
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Aetna of IA Medicare	$13.68
Rate for Payer: Amerigroup Medicaid	$13.84
Rate for Payer: Amerigroup Medicare	$10.91
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$10.80
Rate for Payer: Iowa Total Care Managed Medicaid	$13.71
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Medical Associates Managed Medicare	$10.80
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: Molina Healthcare Managed Medicaid	$13.91
Rate for Payer: Partners Health Alliance Commercial	$12.42
Rate for Payer: United Healthcare Commercial	$21.60
Rate for Payer: United Healthcare Managed Medicare	$14.16

SCREW CORTICAL 2.7X14

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046616
Hospital Revenue Code	278
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of IA Commercial	$21.60
Rate for Payer: Aetna of IA Medical Rental Products	$21.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$18.00
Rate for Payer: Medical Associates Commercial	$18.00
Rate for Payer: Midlands Choice Commercial	$16.80
Rate for Payer: United Healthcare Commercial	$21.60

SCREW CORTICAL 2.7X16MM

Facility

$30.00

Service Code	HCPCS C1713
Hospital Charge Code	8046617
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of IA Commercial	$27.00
Rate for Payer: Aetna of IA Medical Rental Products	$27.00
Rate for Payer: Aetna of IA Medicare	$17.10
Rate for Payer: Amerigroup Medicaid	$17.30
Rate for Payer: Amerigroup Medicare	$13.64
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.50
Rate for Payer: Iowa Total Care Managed Medicaid	$17.14
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Medical Associates Managed Medicare	$13.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: Molina Healthcare Managed Medicaid	$17.39
Rate for Payer: Partners Health Alliance Commercial	$15.52
Rate for Payer: United Healthcare Commercial	$27.00
Rate for Payer: United Healthcare Managed Medicare	$17.70

Know your out-of-pocket cost for care.

All Charges