Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SUPPLIES FOR WOUND CARE NON SELECTIVE

Facility

$374.00

Service Code	CPT 99070
Hospital Charge Code	8013710
Hospital Revenue Code	272
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of IA Commercial	$336.60
Rate for Payer: Aetna of IA Medical Rental Products	$336.60
Rate for Payer: Cash Price	$299.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$280.50
Rate for Payer: Medical Associates Commercial	$280.50
Rate for Payer: Midlands Choice Commercial	$261.80
Rate for Payer: United Healthcare Commercial	$336.60

SUPPLIES FOR WOUND CARE NON SELECTIVE

Facility

$374.00

Service Code	CPT 99070
Hospital Charge Code	8013710
Hospital Revenue Code	272
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of IA Commercial	$336.60
Rate for Payer: Aetna of IA Medical Rental Products	$336.60
Rate for Payer: Aetna of IA Medicare	$213.18
Rate for Payer: Amerigroup Medicaid	$215.72
Rate for Payer: Amerigroup Medicare	$169.98
Rate for Payer: Cash Price	$299.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$280.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$168.30
Rate for Payer: Iowa Total Care Managed Medicaid	$213.63
Rate for Payer: Medical Associates Commercial	$280.50
Rate for Payer: Medical Associates Managed Medicare	$168.30
Rate for Payer: Midlands Choice Commercial	$261.80
Rate for Payer: Molina Healthcare Managed Medicaid	$216.77
Rate for Payer: Partners Health Alliance Commercial	$193.54
Rate for Payer: United Healthcare Commercial	$336.60
Rate for Payer: United Healthcare Managed Medicare	$220.66

SURETAPE 2-0

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8767795
Hospital Revenue Code	278
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Aetna of IA Medicare	$59.28
Rate for Payer: Amerigroup Medicaid	$59.99
Rate for Payer: Amerigroup Medicare	$47.27
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$46.80
Rate for Payer: Iowa Total Care Managed Medicaid	$59.40
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Medical Associates Managed Medicare	$46.80
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: Molina Healthcare Managed Medicaid	$60.28
Rate for Payer: Partners Health Alliance Commercial	$53.82
Rate for Payer: United Healthcare Commercial	$93.60
Rate for Payer: United Healthcare Managed Medicare	$61.36

SURETAPE 2-0

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	8767795
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of IA Commercial	$93.60
Rate for Payer: Aetna of IA Medical Rental Products	$93.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.00
Rate for Payer: Medical Associates Commercial	$78.00
Rate for Payer: Midlands Choice Commercial	$72.80
Rate for Payer: United Healthcare Commercial	$93.60

SURGIMESH HERNIA BARRIER MESH VENRAL

Facility

$2,988.00

Service Code	HCPCS C1781
Hospital Charge Code	8046321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.60
Max. Negotiated Rate	$2,689.20
Rate for Payer: Aetna of IA Commercial	$2,689.20
Rate for Payer: Aetna of IA Medical Rental Products	$2,689.20
Rate for Payer: Aetna of IA Medicare	$1,703.16
Rate for Payer: Amerigroup Medicaid	$1,723.48
Rate for Payer: Amerigroup Medicare	$1,358.05
Rate for Payer: Cash Price	$2,390.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,241.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1,344.60
Rate for Payer: Iowa Total Care Managed Medicaid	$1,706.75
Rate for Payer: Medical Associates Commercial	$2,241.00
Rate for Payer: Medical Associates Managed Medicare	$1,344.60
Rate for Payer: Midlands Choice Commercial	$2,091.60
Rate for Payer: Molina Healthcare Managed Medicaid	$1,731.84
Rate for Payer: Partners Health Alliance Commercial	$1,546.29
Rate for Payer: United Healthcare Commercial	$2,689.20
Rate for Payer: United Healthcare Managed Medicare	$1,762.92

SURGIMESH HERNIA BARRIER MESH VENRAL

Facility

$2,988.00

Service Code	HCPCS C1781
Hospital Charge Code	8046321
Hospital Revenue Code	278
Min. Negotiated Rate	$2,091.60
Max. Negotiated Rate	$2,689.20
Rate for Payer: Aetna of IA Commercial	$2,689.20
Rate for Payer: Aetna of IA Medical Rental Products	$2,689.20
Rate for Payer: Cash Price	$2,390.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2,241.00
Rate for Payer: Medical Associates Commercial	$2,241.00
Rate for Payer: Midlands Choice Commercial	$2,091.60
Rate for Payer: United Healthcare Commercial	$2,689.20

SURGIMESH OPEN/LAP INGUINAL 7 CM

Facility

$1,440.00

Service Code	HCPCS C1781
Hospital Charge Code	8026545
Hospital Revenue Code	278
Min. Negotiated Rate	$648.00
Max. Negotiated Rate	$1,296.00
Rate for Payer: Aetna of IA Commercial	$1,296.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,296.00
Rate for Payer: Aetna of IA Medicare	$820.80
Rate for Payer: Amerigroup Medicaid	$830.59
Rate for Payer: Amerigroup Medicare	$654.48
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,080.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$648.00
Rate for Payer: Iowa Total Care Managed Medicaid	$822.53
Rate for Payer: Medical Associates Commercial	$1,080.00
Rate for Payer: Medical Associates Managed Medicare	$648.00
Rate for Payer: Midlands Choice Commercial	$1,008.00
Rate for Payer: Molina Healthcare Managed Medicaid	$834.62
Rate for Payer: Partners Health Alliance Commercial	$745.20
Rate for Payer: United Healthcare Commercial	$1,296.00
Rate for Payer: United Healthcare Managed Medicare	$849.60

SURGIMESH OPEN/LAP INGUINAL 7 CM

Facility

$1,440.00

Service Code	HCPCS C1781
Hospital Charge Code	8026545
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,296.00
Rate for Payer: Aetna of IA Commercial	$1,296.00
Rate for Payer: Aetna of IA Medical Rental Products	$1,296.00
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1,080.00
Rate for Payer: Medical Associates Commercial	$1,080.00
Rate for Payer: Midlands Choice Commercial	$1,008.00
Rate for Payer: United Healthcare Commercial	$1,296.00

SURGITIE LIGATING LOOP

Facility

$1,104.00

Hospital Charge Code	8046978
Hospital Revenue Code	272
Min. Negotiated Rate	$496.80
Max. Negotiated Rate	$993.60
Rate for Payer: Aetna of IA Commercial	$993.60
Rate for Payer: Aetna of IA Medical Rental Products	$993.60
Rate for Payer: Aetna of IA Medicare	$629.28
Rate for Payer: Amerigroup Medicaid	$636.79
Rate for Payer: Amerigroup Medicare	$501.77
Rate for Payer: Cash Price	$883.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$828.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$496.80
Rate for Payer: Iowa Total Care Managed Medicaid	$630.60
Rate for Payer: Medical Associates Commercial	$828.00
Rate for Payer: Medical Associates Managed Medicare	$496.80
Rate for Payer: Midlands Choice Commercial	$772.80
Rate for Payer: Molina Healthcare Managed Medicaid	$639.88
Rate for Payer: Partners Health Alliance Commercial	$571.32
Rate for Payer: United Healthcare Commercial	$993.60
Rate for Payer: United Healthcare Managed Medicare	$651.36

SURGITIE LIGATING LOOP

Facility

$1,104.00

Hospital Charge Code	8046978
Hospital Revenue Code	272
Min. Negotiated Rate	$772.80
Max. Negotiated Rate	$993.60
Rate for Payer: Aetna of IA Commercial	$993.60
Rate for Payer: Aetna of IA Medical Rental Products	$993.60
Rate for Payer: Cash Price	$883.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$828.00
Rate for Payer: Medical Associates Commercial	$828.00
Rate for Payer: Midlands Choice Commercial	$772.80
Rate for Payer: United Healthcare Commercial	$993.60

SURG TX MISSED ABORT; 2ND TRIMESTR

Professional

Both

$1,283.00

Service Code	CPT 59821
Hospital Charge Code	8068908
Hospital Revenue Code	975
Min. Negotiated Rate	$607.06
Max. Negotiated Rate	$962.25
Rate for Payer: Cash Price	$1,026.40
Rate for Payer: Cash Price	$1,026.40
Rate for Payer: Medical Associates Commercial	$962.25
Rate for Payer: Midlands Choice Commercial	$898.10
Rate for Payer: Partners Health Alliance Commercial	$962.25
Rate for Payer: United Healthcare Commercial	$607.06

SUTURE ANCH, BIO-COMPOSITE P-LCK 2.4X11.3

Facility

$1,030.00

Service Code	HCPCS C1713
Hospital Charge Code	8771306
Hospital Revenue Code	278
Min. Negotiated Rate	$463.50
Max. Negotiated Rate	$927.00
Rate for Payer: Aetna of IA Commercial	$927.00
Rate for Payer: Aetna of IA Medical Rental Products	$927.00
Rate for Payer: Aetna of IA Medicare	$587.10
Rate for Payer: Amerigroup Medicaid	$594.10
Rate for Payer: Amerigroup Medicare	$468.13
Rate for Payer: Cash Price	$824.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$772.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$463.50
Rate for Payer: Iowa Total Care Managed Medicaid	$588.34
Rate for Payer: Medical Associates Commercial	$772.50
Rate for Payer: Medical Associates Managed Medicare	$463.50
Rate for Payer: Midlands Choice Commercial	$721.00
Rate for Payer: Molina Healthcare Managed Medicaid	$596.99
Rate for Payer: Partners Health Alliance Commercial	$533.02
Rate for Payer: United Healthcare Commercial	$927.00
Rate for Payer: United Healthcare Managed Medicare	$607.70

SUTURE ANCH, BIO-COMPOSITE P-LCK 2.4X11.3

Facility

$1,030.00

Service Code	HCPCS C1713
Hospital Charge Code	8771306
Hospital Revenue Code	278
Min. Negotiated Rate	$721.00
Max. Negotiated Rate	$927.00
Rate for Payer: Aetna of IA Commercial	$927.00
Rate for Payer: Aetna of IA Medical Rental Products	$927.00
Rate for Payer: Cash Price	$824.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$772.50
Rate for Payer: Medical Associates Commercial	$772.50
Rate for Payer: Midlands Choice Commercial	$721.00
Rate for Payer: United Healthcare Commercial	$927.00

SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 4.75 X 19.1

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	8026420
Hospital Revenue Code	278
Min. Negotiated Rate	$324.00
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of IA Commercial	$648.00
Rate for Payer: Aetna of IA Medical Rental Products	$648.00
Rate for Payer: Aetna of IA Medicare	$410.40
Rate for Payer: Amerigroup Medicaid	$415.30
Rate for Payer: Amerigroup Medicare	$327.24
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$540.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$324.00
Rate for Payer: Iowa Total Care Managed Medicaid	$411.26
Rate for Payer: Medical Associates Commercial	$540.00
Rate for Payer: Medical Associates Managed Medicare	$324.00
Rate for Payer: Midlands Choice Commercial	$504.00
Rate for Payer: Molina Healthcare Managed Medicaid	$417.31
Rate for Payer: Partners Health Alliance Commercial	$372.60
Rate for Payer: United Healthcare Commercial	$648.00
Rate for Payer: United Healthcare Managed Medicare	$424.80

SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 4.75 X 19.1

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	8026420
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of IA Commercial	$648.00
Rate for Payer: Aetna of IA Medical Rental Products	$648.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$540.00
Rate for Payer: Medical Associates Commercial	$540.00
Rate for Payer: Midlands Choice Commercial	$504.00
Rate for Payer: United Healthcare Commercial	$648.00

SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 5.5 X 24.5

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	8025946
Hospital Revenue Code	278
Min. Negotiated Rate	$324.00
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of IA Commercial	$648.00
Rate for Payer: Aetna of IA Medical Rental Products	$648.00
Rate for Payer: Aetna of IA Medicare	$410.40
Rate for Payer: Amerigroup Medicaid	$415.30
Rate for Payer: Amerigroup Medicare	$327.24
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$540.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$324.00
Rate for Payer: Iowa Total Care Managed Medicaid	$411.26
Rate for Payer: Medical Associates Commercial	$540.00
Rate for Payer: Medical Associates Managed Medicare	$324.00
Rate for Payer: Midlands Choice Commercial	$504.00
Rate for Payer: Molina Healthcare Managed Medicaid	$417.31
Rate for Payer: Partners Health Alliance Commercial	$372.60
Rate for Payer: United Healthcare Commercial	$648.00
Rate for Payer: United Healthcare Managed Medicare	$424.80

SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 5.5 X 24.5

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	8025946
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of IA Commercial	$648.00
Rate for Payer: Aetna of IA Medical Rental Products	$648.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$540.00
Rate for Payer: Medical Associates Commercial	$540.00
Rate for Payer: Midlands Choice Commercial	$504.00
Rate for Payer: United Healthcare Commercial	$648.00

SUTURE ANCHOR MINIBIO SUTURETAK 2.4X8.5M

Facility

$585.00

Service Code	HCPCS C1713
Hospital Charge Code	8026400
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$526.50
Rate for Payer: Aetna of IA Commercial	$526.50
Rate for Payer: Aetna of IA Medical Rental Products	$526.50
Rate for Payer: Aetna of IA Medicare	$333.45
Rate for Payer: Amerigroup Medicaid	$337.43
Rate for Payer: Amerigroup Medicare	$265.88
Rate for Payer: Cash Price	$468.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$438.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$263.25
Rate for Payer: Iowa Total Care Managed Medicaid	$334.15
Rate for Payer: Medical Associates Commercial	$438.75
Rate for Payer: Medical Associates Managed Medicare	$263.25
Rate for Payer: Midlands Choice Commercial	$409.50
Rate for Payer: Molina Healthcare Managed Medicaid	$339.07
Rate for Payer: Partners Health Alliance Commercial	$302.74
Rate for Payer: United Healthcare Commercial	$526.50
Rate for Payer: United Healthcare Managed Medicare	$345.15

SUTURE ANCHOR MINIBIO SUTURETAK 2.4X8.5M

Facility

$585.00

Service Code	HCPCS C1713
Hospital Charge Code	8026400
Hospital Revenue Code	278
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$526.50
Rate for Payer: Aetna of IA Commercial	$526.50
Rate for Payer: Aetna of IA Medical Rental Products	$526.50
Rate for Payer: Cash Price	$468.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$438.75
Rate for Payer: Medical Associates Commercial	$438.75
Rate for Payer: Midlands Choice Commercial	$409.50
Rate for Payer: United Healthcare Commercial	$526.50

SUTUREETAPE TIGERLINK 1.3MM WH/BLK

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	8760623
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Aetna of IA Medicare	$125.40
Rate for Payer: Amerigroup Medicaid	$126.90
Rate for Payer: Amerigroup Medicare	$99.99
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$99.00
Rate for Payer: Iowa Total Care Managed Medicaid	$125.66
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Medical Associates Managed Medicare	$99.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: Molina Healthcare Managed Medicaid	$127.51
Rate for Payer: Partners Health Alliance Commercial	$113.85
Rate for Payer: United Healthcare Commercial	$198.00
Rate for Payer: United Healthcare Managed Medicare	$129.80

SUTUREETAPE TIGERLINK 1.3MM WH/BLK

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	8760623
Hospital Revenue Code	278
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna of IA Commercial	$198.00
Rate for Payer: Aetna of IA Medical Rental Products	$198.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$165.00
Rate for Payer: Medical Associates Commercial	$165.00
Rate for Payer: Midlands Choice Commercial	$154.00
Rate for Payer: United Healthcare Commercial	$198.00

SUTURE FIBERWIRE/NEEDLE

Facility

$34.00

Hospital Charge Code	8026439
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	$17.59
Rate for Payer: United Healthcare Commercial	$30.60
Rate for Payer: United Healthcare Managed Medicare	$20.06

SUTURE FIBERWIRE/NEEDLE

Facility

$34.00

Hospital Charge Code	8026439
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

SUTURE RW

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	8773299
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Aetna of IA Medicare	$25.65
Rate for Payer: Amerigroup Medicaid	$25.96
Rate for Payer: Amerigroup Medicare	$20.45
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$20.25
Rate for Payer: Iowa Total Care Managed Medicaid	$25.70
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Medical Associates Managed Medicare	$20.25
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: Molina Healthcare Managed Medicaid	$26.08
Rate for Payer: Partners Health Alliance Commercial	$23.29
Rate for Payer: United Healthcare Commercial	$40.50
Rate for Payer: United Healthcare Managed Medicare	$26.55

SUTURE RW

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	8773299
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of IA Commercial	$40.50
Rate for Payer: Aetna of IA Medical Rental Products	$40.50
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$33.75
Rate for Payer: Medical Associates Commercial	$33.75
Rate for Payer: Midlands Choice Commercial	$31.50
Rate for Payer: United Healthcare Commercial	$40.50

Know your out-of-pocket cost for care.

All Charges