Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL 3.5X14MM SELF CUTTING

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046478
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Aetna of IA Medicare	$19.95
Rate for Payer: Amerigroup Medicaid	$20.19
Rate for Payer: Amerigroup Medicare	$15.91
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.75
Rate for Payer: Iowa Total Care Managed Medicaid	$19.99
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Medical Associates Managed Medicare	$15.75
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: Molina Healthcare Managed Medicaid	$20.29
Rate for Payer: Partners Health Alliance Commercial	$18.11
Rate for Payer: United Healthcare Commercial	$31.50
Rate for Payer: United Healthcare Managed Medicare	$20.65

SCREW CORTICAL 3.5X14MM SELF CUTTING

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	8046478
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of IA Commercial	$31.50
Rate for Payer: Aetna of IA Medical Rental Products	$31.50
Rate for Payer: Cash Price	$28.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$26.25
Rate for Payer: Medical Associates Commercial	$26.25
Rate for Payer: Midlands Choice Commercial	$24.50
Rate for Payer: United Healthcare Commercial	$31.50

SCREW CORTICAL 3.5X 16 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047097
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 CORTICAL 3.5X 16 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047097
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 CORTICAL 3.5X16MM SELF CUTTING

Facility

$26.00

Service Code	HCPCS C1713
Hospital Charge Code	8046479
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

SCREW CORTICAL 3.5X16MM SELF CUTTING

Facility

$26.00

Service Code	HCPCS C1713
Hospital Charge Code	8046479
Hospital Revenue Code	278
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$15.00
Rate for Payer: Amerigroup Medicare	$11.82
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.70
Rate for Payer: Iowa Total Care Managed Medicaid	$14.85
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$11.70
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$15.07
Rate for Payer: Partners Health Alliance Commercial	$13.46
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34

SCREW CORTICAL 3.5X18 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047098
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 CORTICAL 3.5X18 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047098
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 CORTICAL 3.5X18MM SELF CUTTING

Facility

$29.00

Service Code	HCPCS C1713
Hospital Charge Code	8046480
Hospital Revenue Code	278
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of IA Commercial	$26.10
Rate for Payer: Aetna of IA Medical Rental Products	$26.10
Rate for Payer: Aetna of IA Medicare	$16.53
Rate for Payer: Amerigroup Medicaid	$16.73
Rate for Payer: Amerigroup Medicare	$13.18
Rate for Payer: Cash Price	$23.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$13.05
Rate for Payer: Iowa Total Care Managed Medicaid	$16.56
Rate for Payer: Medical Associates Commercial	$21.75
Rate for Payer: Medical Associates Managed Medicare	$13.05
Rate for Payer: Midlands Choice Commercial	$20.30
Rate for Payer: Molina Healthcare Managed Medicaid	$16.81
Rate for Payer: Partners Health Alliance Commercial	$15.01
Rate for Payer: United Healthcare Commercial	$26.10
Rate for Payer: United Healthcare Managed Medicare	$17.11

SCREW CORTICAL 3.5X18MM SELF CUTTING

Facility

$29.00

Service Code	HCPCS C1713
Hospital Charge Code	8046480
Hospital Revenue Code	278
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of IA Commercial	$26.10
Rate for Payer: Aetna of IA Medical Rental Products	$26.10
Rate for Payer: Cash Price	$23.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.75
Rate for Payer: Medical Associates Commercial	$21.75
Rate for Payer: Midlands Choice Commercial	$20.30
Rate for Payer: United Healthcare Commercial	$26.10

SCREW CORTICAL 3.5X20 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047099
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 CORTICAL 3.5X20 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047099
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 CORTICAL 3.5X20MM SELF CUTTING

Facility

$30.00

Service Code	HCPCS C1713
Hospital Charge Code	8046481
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
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: Cash Price	$24.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.50
Rate for Payer: Medical Associates Commercial	$22.50
Rate for Payer: Midlands Choice Commercial	$21.00
Rate for Payer: United Healthcare Commercial	$27.00

SCREW CORTICAL 3.5X20MM SELF CUTTING

Facility

$30.00

Service Code	HCPCS C1713
Hospital Charge Code	8046481
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

SCREW CORTICAL 3.5X22 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047100
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 CORTICAL 3.5X22 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047100
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 CORTICAL 3.5X22MM SELF CUTTING

Facility

$26.00

Service Code	HCPCS C1713
Hospital Charge Code	8046482
Hospital Revenue Code	278
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Aetna of IA Medicare	$14.82
Rate for Payer: Amerigroup Medicaid	$15.00
Rate for Payer: Amerigroup Medicare	$11.82
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.70
Rate for Payer: Iowa Total Care Managed Medicaid	$14.85
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Medical Associates Managed Medicare	$11.70
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: Molina Healthcare Managed Medicaid	$15.07
Rate for Payer: Partners Health Alliance Commercial	$13.46
Rate for Payer: United Healthcare Commercial	$23.40
Rate for Payer: United Healthcare Managed Medicare	$15.34

SCREW CORTICAL 3.5X22MM SELF CUTTING

Facility

$26.00

Service Code	HCPCS C1713
Hospital Charge Code	8046482
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of IA Commercial	$23.40
Rate for Payer: Aetna of IA Medical Rental Products	$23.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.50
Rate for Payer: Medical Associates Commercial	$19.50
Rate for Payer: Midlands Choice Commercial	$18.20
Rate for Payer: United Healthcare Commercial	$23.40

SCREW CORTICAL 3.5X24 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047101
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 CORTICAL 3.5X24 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047101
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 CORTICAL 3.5X24MM SELF CUTTING

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046483
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 3.5X24MM SELF CUTTING

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	8046483
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 CORTICAL 3.5X26 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047102
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 CORTICAL 3.5X26 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047102
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 CORTICAL 3.5X26MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046484
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

Know your out-of-pocket cost for care.

All Charges