Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL 3.5X44MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046493
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 3.5X44MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046493
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 3.5X45 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047107
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 3.5X45 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047107
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 3.5X46MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046494
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 3.5X46MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046494
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 3.5X48MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046495
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 3.5X48MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046495
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 3.5X50 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047108
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 3.5X50 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047108
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 3.5X50MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046496
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 3.5X50MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046496
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 3.5X55 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047109
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 3.5X55 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047109
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 3.5X55MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046497
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 3.5X55MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046497
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 3.5X60 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047110
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 3.5X60 MM, LPS, SS

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	8047110
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 3.5X60MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046498
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 3.5X60MM SELF CUTTING

Facility

$24.00

Service Code	HCPCS C1713
Hospital Charge Code	8046498
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 BONE 3.5X14 MM, LPS, SS

Facility

$63.00

Service Code	HCPCS C1713
Hospital Charge Code	8047096
Hospital Revenue Code	278
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of IA Commercial	$56.70
Rate for Payer: Aetna of IA Medical Rental Products	$56.70
Rate for Payer: Aetna of IA Medicare	$35.91
Rate for Payer: Amerigroup Medicaid	$36.34
Rate for Payer: Amerigroup Medicare	$28.63
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$28.35
Rate for Payer: Iowa Total Care Managed Medicaid	$35.99
Rate for Payer: Medical Associates Commercial	$47.25
Rate for Payer: Medical Associates Managed Medicare	$28.35
Rate for Payer: Midlands Choice Commercial	$44.10
Rate for Payer: Molina Healthcare Managed Medicaid	$36.51
Rate for Payer: Partners Health Alliance Commercial	$32.60
Rate for Payer: United Healthcare Commercial	$56.70
Rate for Payer: United Healthcare Managed Medicare	$37.17

SCREW CORTICAL BONE 3.5X14 MM, LPS, SS

Facility

$63.00

Service Code	HCPCS C1713
Hospital Charge Code	8047096
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of IA Commercial	$56.70
Rate for Payer: Aetna of IA Medical Rental Products	$56.70
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$47.25
Rate for Payer: Medical Associates Commercial	$47.25
Rate for Payer: Midlands Choice Commercial	$44.10
Rate for Payer: United Healthcare Commercial	$56.70

SCREW CORTICAL SELF TAP

Facility

$28.00

Service Code	HCPCS C1713
Hospital Charge Code	8046504
Hospital Revenue Code	278
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of IA Commercial	$25.20
Rate for Payer: Aetna of IA Medical Rental Products	$25.20
Rate for Payer: Aetna of IA Medicare	$15.96
Rate for Payer: Amerigroup Medicaid	$16.15
Rate for Payer: Amerigroup Medicare	$12.73
Rate for Payer: Cash Price	$22.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.60
Rate for Payer: Iowa Total Care Managed Medicaid	$15.99
Rate for Payer: Medical Associates Commercial	$21.00
Rate for Payer: Medical Associates Managed Medicare	$12.60
Rate for Payer: Midlands Choice Commercial	$19.60
Rate for Payer: Molina Healthcare Managed Medicaid	$16.23
Rate for Payer: Partners Health Alliance Commercial	$14.49
Rate for Payer: United Healthcare Commercial	$25.20
Rate for Payer: United Healthcare Managed Medicare	$16.52

SCREW CORTICAL SELF TAP

Facility

$28.00

Service Code	HCPCS C1713
Hospital Charge Code	8046504
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of IA Commercial	$25.20
Rate for Payer: Aetna of IA Medical Rental Products	$25.20
Rate for Payer: Cash Price	$22.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.00
Rate for Payer: Medical Associates Commercial	$21.00
Rate for Payer: Midlands Choice Commercial	$19.60
Rate for Payer: United Healthcare Commercial	$25.20

SCREW CORTICAL SELF TAP-1

Facility

$28.00

Service Code	HCPCS C1713
Hospital Charge Code	8046517
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of IA Commercial	$25.20
Rate for Payer: Aetna of IA Medical Rental Products	$25.20
Rate for Payer: Cash Price	$22.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.00
Rate for Payer: Medical Associates Commercial	$21.00
Rate for Payer: Midlands Choice Commercial	$19.60
Rate for Payer: United Healthcare Commercial	$25.20

Know your out-of-pocket cost for care.

All Charges