Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

THP tramadol 50 mg tab [VDMC]

Facility

$11.08

Service Code	HCPCS A9270
Hospital Charge Code	10735637
Hospital Revenue Code	259
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$9.97
Rate for Payer: Aetna of IA Commercial	$9.97
Rate for Payer: Aetna of IA Medical Rental Products	$9.97
Rate for Payer: Aetna of IA Medicare	$6.32
Rate for Payer: Amerigroup Medicaid	$5.59
Rate for Payer: Amerigroup Medicare	$5.60
Rate for Payer: Cash Price	$8.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.31
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$5.54
Rate for Payer: Iowa Total Care Managed Medicaid	$5.54
Rate for Payer: Medical Associates Commercial	$8.31
Rate for Payer: Medical Associates Managed Medicare	$5.54
Rate for Payer: Midlands Choice Commercial	$7.76
Rate for Payer: Molina Healthcare Managed Medicaid	$5.62
Rate for Payer: Molina Healthcare Managed Medicare	$5.62
Rate for Payer: Oscar Health of IA Commercial	$8.31
Rate for Payer: Partners Health Alliance Commercial	$8.31
Rate for Payer: United Healthcare Commercial	$9.97
Rate for Payer: United Healthcare Managed Medicare	$6.54

THP tramadol 50 mg tab [VDMC]

Facility

$11.08

Service Code	HCPCS A9270
Hospital Charge Code	10735637
Hospital Revenue Code	259
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$9.97
Rate for Payer: Aetna of IA Commercial	$9.97
Rate for Payer: Aetna of IA Medical Rental Products	$9.97
Rate for Payer: Cash Price	$8.86
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$8.31
Rate for Payer: Medical Associates Commercial	$8.31
Rate for Payer: Midlands Choice Commercial	$7.76
Rate for Payer: United Healthcare Commercial	$9.97

THROAT CULTURE

Facility

$105.00

Service Code	CPT 87070
Hospital Charge Code	633905
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of IA Commercial	$94.50
Rate for Payer: Aetna of IA Medical Rental Products	$94.50
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.75
Rate for Payer: Medical Associates Commercial	$78.75
Rate for Payer: Midlands Choice Commercial	$73.50
Rate for Payer: United Healthcare Commercial	$94.50

THROAT CULTURE

Facility

$105.00

Service Code	CPT 87070
Hospital Charge Code	633905
Hospital Revenue Code	306
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of IA Commercial	$94.50
Rate for Payer: Aetna of IA Medical Rental Products	$94.50
Rate for Payer: Aetna of IA Medicare	$59.85
Rate for Payer: Amerigroup Medicaid	$52.99
Rate for Payer: Amerigroup Medicare	$53.02
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$78.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$52.50
Rate for Payer: Iowa Total Care Managed Medicaid	$52.48
Rate for Payer: Medical Associates Commercial	$78.75
Rate for Payer: Medical Associates Managed Medicare	$52.50
Rate for Payer: Midlands Choice Commercial	$73.50
Rate for Payer: Molina Healthcare Managed Medicaid	$53.29
Rate for Payer: Molina Healthcare Managed Medicare	$53.26
Rate for Payer: Oscar Health of IA Commercial	$78.75
Rate for Payer: Partners Health Alliance Commercial	$78.75
Rate for Payer: United Healthcare Commercial	$94.50
Rate for Payer: United Healthcare Managed Medicare	$61.95
Rate for Payer: Wellmark IA HMO	$31.00
Rate for Payer: Wellmark IA PPO	$34.10

THROMBIN TIME

Facility

$55.00

Service Code	CPT 85670
Hospital Charge Code	8093945
Hospital Revenue Code	305
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Aetna of IA Medicare	$31.35
Rate for Payer: Amerigroup Medicaid	$27.76
Rate for Payer: Amerigroup Medicare	$27.78
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.50
Rate for Payer: Iowa Total Care Managed Medicaid	$27.49
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Medical Associates Managed Medicare	$27.50
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: Molina Healthcare Managed Medicaid	$27.91
Rate for Payer: Molina Healthcare Managed Medicare	$27.90
Rate for Payer: Oscar Health of IA Commercial	$41.25
Rate for Payer: Partners Health Alliance Commercial	$41.25
Rate for Payer: United Healthcare Commercial	$49.50
Rate for Payer: United Healthcare Managed Medicare	$32.45
Rate for Payer: Wellmark IA HMO	$24.18
Rate for Payer: Wellmark IA PPO	$26.60

THROMBIN TIME

Facility

$55.00

Service Code	CPT 85670
Hospital Charge Code	8093945
Hospital Revenue Code	305
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

thrombin topical bovine 5000 intl units Pow [VDMC]

Facility

$179.00

Service Code	NDC 60793-0215-05
Hospital Charge Code	10432413
Hospital Revenue Code	259
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of IA Commercial	$161.10
Rate for Payer: Aetna of IA Medical Rental Products	$161.10
Rate for Payer: Aetna of IA Medicare	$102.03
Rate for Payer: Amerigroup Medicaid	$90.34
Rate for Payer: Amerigroup Medicare	$90.40
Rate for Payer: Cash Price	$143.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$134.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$89.50
Rate for Payer: Iowa Total Care Managed Medicaid	$89.46
Rate for Payer: Medical Associates Commercial	$134.25
Rate for Payer: Medical Associates Managed Medicare	$89.50
Rate for Payer: Midlands Choice Commercial	$125.30
Rate for Payer: Molina Healthcare Managed Medicaid	$90.84
Rate for Payer: Molina Healthcare Managed Medicare	$90.79
Rate for Payer: Oscar Health of IA Commercial	$134.25
Rate for Payer: Partners Health Alliance Commercial	$134.25
Rate for Payer: United Healthcare Commercial	$161.10
Rate for Payer: United Healthcare Managed Medicare	$105.61

thrombin topical bovine 5000 intl units Pow [VDMC]

Facility

$179.00

Service Code	NDC 60793-0215-05
Hospital Charge Code	10432413
Hospital Revenue Code	259
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of IA Commercial	$161.10
Rate for Payer: Aetna of IA Medical Rental Products	$161.10
Rate for Payer: Cash Price	$143.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$134.25
Rate for Payer: Medical Associates Commercial	$134.25
Rate for Payer: Midlands Choice Commercial	$125.30
Rate for Payer: United Healthcare Commercial	$161.10

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: United Healthcare Commercial	$117.00

Thyroglobulin Antibody DMCL

Facility

$130.00

Service Code	CPT 86800
Hospital Charge Code	8037812
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of IA Commercial	$117.00
Rate for Payer: Aetna of IA Medical Rental Products	$117.00
Rate for Payer: Aetna of IA Medicare	$74.10
Rate for Payer: Amerigroup Medicaid	$65.61
Rate for Payer: Amerigroup Medicare	$65.65
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$97.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$65.00
Rate for Payer: Iowa Total Care Managed Medicaid	$64.97
Rate for Payer: Medical Associates Commercial	$97.50
Rate for Payer: Medical Associates Managed Medicare	$65.00
Rate for Payer: Midlands Choice Commercial	$91.00
Rate for Payer: Molina Healthcare Managed Medicaid	$65.98
Rate for Payer: Molina Healthcare Managed Medicare	$65.94
Rate for Payer: Oscar Health of IA Commercial	$97.50
Rate for Payer: Partners Health Alliance Commercial	$97.50
Rate for Payer: United Healthcare Commercial	$117.00
Rate for Payer: United Healthcare Managed Medicare	$76.70
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.15

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna of IA Commercial	$2.84
Rate for Payer: Aetna of IA Medical Rental Products	$2.84
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.36
Rate for Payer: Medical Associates Commercial	$2.36
Rate for Payer: Midlands Choice Commercial	$2.20
Rate for Payer: United Healthcare Commercial	$2.84

thyroid desiccated 30 mg Tab PORK [VDMC]

Facility

$3.15

Service Code	HCPCS A9270
Hospital Charge Code	10425087
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna of IA Commercial	$2.84
Rate for Payer: Aetna of IA Medical Rental Products	$2.84
Rate for Payer: Aetna of IA Medicare	$1.80
Rate for Payer: Amerigroup Medicaid	$1.59
Rate for Payer: Amerigroup Medicare	$1.59
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$2.36
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$1.58
Rate for Payer: Iowa Total Care Managed Medicaid	$1.57
Rate for Payer: Medical Associates Commercial	$2.36
Rate for Payer: Medical Associates Managed Medicare	$1.58
Rate for Payer: Midlands Choice Commercial	$2.20
Rate for Payer: Molina Healthcare Managed Medicaid	$1.60
Rate for Payer: Molina Healthcare Managed Medicare	$1.60
Rate for Payer: Oscar Health of IA Commercial	$2.36
Rate for Payer: Partners Health Alliance Commercial	$2.36
Rate for Payer: United Healthcare Commercial	$2.84
Rate for Payer: United Healthcare Managed Medicare	$1.86

Thyroid, Parathyroid and Thyroglossal Procedures With CC

Facility

$16,186.84

Service Code	MS-DRG 626
Hospital Charge Code	418
Min. Negotiated Rate	$15,952.25
Max. Negotiated Rate	$16,186.84
Rate for Payer: Amerigroup Medicaid	$16,108.64
Rate for Payer: Iowa Total Care Managed Medicaid	$15,952.25
Rate for Payer: Molina Healthcare Managed Medicaid	$16,186.84

Thyroid, Parathyroid and Thyroglossal Procedures With MCC

Facility

$27,971.16

Service Code	MS-DRG 625
Hospital Charge Code	417
Min. Negotiated Rate	$27,565.79
Max. Negotiated Rate	$27,971.16
Rate for Payer: Amerigroup Medicaid	$27,836.04
Rate for Payer: Iowa Total Care Managed Medicaid	$27,565.79
Rate for Payer: Molina Healthcare Managed Medicaid	$27,971.16

Thyroid, Parathyroid and Thyroglossal Procedures Without CC/MCC

Facility

$8,078.65

Service Code	MS-DRG 627
Hospital Charge Code	419
Min. Negotiated Rate	$7,961.57
Max. Negotiated Rate	$8,078.65
Rate for Payer: Amerigroup Medicaid	$8,039.62
Rate for Payer: Iowa Total Care Managed Medicaid	$7,961.57
Rate for Payer: Molina Healthcare Managed Medicaid	$8,078.65

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: United Healthcare Commercial	$125.10

Thyroid Peroxidase Antibody DMCL

Facility

$139.00

Service Code	CPT 86376
Hospital Charge Code	8037813
Hospital Revenue Code	302
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Molina Healthcare Managed Medicare	$70.50
Rate for Payer: Oscar Health of IA Commercial	$104.25
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: United Healthcare Commercial	$123.30

Thyroid Stimulating Hormone DMCL

Facility

$137.00

Service Code	CPT 84443
Hospital Charge Code	8037814
Hospital Revenue Code	301
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of IA Commercial	$123.30
Rate for Payer: Aetna of IA Medical Rental Products	$123.30
Rate for Payer: Aetna of IA Medicare	$78.09
Rate for Payer: Amerigroup Medicaid	$69.14
Rate for Payer: Amerigroup Medicare	$69.18
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$102.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$68.50
Rate for Payer: Iowa Total Care Managed Medicaid	$68.47
Rate for Payer: Medical Associates Commercial	$102.75
Rate for Payer: Medical Associates Managed Medicare	$68.50
Rate for Payer: Midlands Choice Commercial	$95.90
Rate for Payer: Molina Healthcare Managed Medicaid	$69.53
Rate for Payer: Molina Healthcare Managed Medicare	$69.49
Rate for Payer: Oscar Health of IA Commercial	$102.75
Rate for Payer: Partners Health Alliance Commercial	$102.75
Rate for Payer: United Healthcare Commercial	$123.30
Rate for Payer: United Healthcare Managed Medicare	$80.83
Rate for Payer: Wellmark IA HMO	$47.12
Rate for Payer: Wellmark IA PPO	$51.83

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Aetna of IA Medicare	$144.21
Rate for Payer: Amerigroup Medicaid	$127.69
Rate for Payer: Amerigroup Medicare	$127.76
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$126.50
Rate for Payer: Iowa Total Care Managed Medicaid	$126.45
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Medical Associates Managed Medicare	$126.50
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: Molina Healthcare Managed Medicaid	$128.40
Rate for Payer: Molina Healthcare Managed Medicare	$128.32
Rate for Payer: Oscar Health of IA Commercial	$189.75
Rate for Payer: Partners Health Alliance Commercial	$189.75
Rate for Payer: United Healthcare Commercial	$227.70
Rate for Payer: United Healthcare Managed Medicare	$149.27
Rate for Payer: Wellmark IA HMO	$85.56
Rate for Payer: Wellmark IA PPO	$94.12

Thyroid Stimulating Immunoglobulin

Facility

$253.00

Service Code	CPT 84445
Hospital Charge Code	8398200
Hospital Revenue Code	301
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of IA Commercial	$227.70
Rate for Payer: Aetna of IA Medical Rental Products	$227.70
Rate for Payer: Cash Price	$202.40
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$189.75
Rate for Payer: Medical Associates Commercial	$189.75
Rate for Payer: Midlands Choice Commercial	$177.10
Rate for Payer: United Healthcare Commercial	$227.70

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Aetna of IA Medicare	$16.26
Rate for Payer: Amerigroup Medicaid	$14.40
Rate for Payer: Amerigroup Medicare	$14.41
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.26
Rate for Payer: Iowa Total Care Managed Medicaid	$14.26
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Medical Associates Managed Medicare	$14.26
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: Molina Healthcare Managed Medicaid	$14.48
Rate for Payer: Molina Healthcare Managed Medicare	$14.47
Rate for Payer: Oscar Health of IA Commercial	$21.40
Rate for Payer: Partners Health Alliance Commercial	$21.40
Rate for Payer: United Healthcare Commercial	$25.68
Rate for Payer: United Healthcare Managed Medicare	$16.83

Ticagrelor 90 mg Tab [VDMC]

Facility

$28.53

Service Code	HCPCS A9270
Hospital Charge Code	11224921
Hospital Revenue Code	259
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna of IA Commercial	$25.68
Rate for Payer: Aetna of IA Medical Rental Products	$25.68
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$21.40
Rate for Payer: Medical Associates Commercial	$21.40
Rate for Payer: Midlands Choice Commercial	$19.97
Rate for Payer: United Healthcare Commercial	$25.68

TIGER CANNULATED SCREW 2.0MMX10MM

Facility

$315.00

Service Code	CPT C1713
Hospital Charge Code	8788807
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: United Healthcare Commercial	$283.50

TIGER CANNULATED SCREW 2.0MMX10MM

Facility

$315.00

Service Code	CPT C1713
Hospital Charge Code	8788807
Hospital Revenue Code	278
Min. Negotiated Rate	$157.44
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of IA Commercial	$283.50
Rate for Payer: Aetna of IA Medical Rental Products	$283.50
Rate for Payer: Aetna of IA Medicare	$179.55
Rate for Payer: Amerigroup Medicaid	$158.98
Rate for Payer: Amerigroup Medicare	$159.08
Rate for Payer: Cash Price	$252.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$236.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$157.50
Rate for Payer: Iowa Total Care Managed Medicaid	$157.44
Rate for Payer: Medical Associates Commercial	$236.25
Rate for Payer: Medical Associates Managed Medicare	$157.50
Rate for Payer: Midlands Choice Commercial	$220.50
Rate for Payer: Molina Healthcare Managed Medicaid	$159.86
Rate for Payer: Molina Healthcare Managed Medicare	$159.77
Rate for Payer: Oscar Health of IA Commercial	$236.25
Rate for Payer: Partners Health Alliance Commercial	$236.25
Rate for Payer: United Healthcare Commercial	$283.50
Rate for Payer: United Healthcare Managed Medicare	$185.85

Know your out-of-pocket cost for care.

All Charges