|
SCREW LOCK 5.0 X 30MM XL25 IM NAIL TI 04.045.030S
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.76 |
| Max. Negotiated Rate |
$10,868.00 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.62
|
| Rate for Payer: Aetna Managed Medicare |
$760.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,766.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,358.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,304.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,440.01
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,499.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.43
|
| Rate for Payer: Health EOS Commercial |
$2,418.13
|
| Rate for Payer: HFN Commercial |
$2,499.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,037.75
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,630.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.33
|
| Rate for Payer: Quartz Commercial |
$1,766.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,630.20
|
| Rate for Payer: The Alliance Commercial |
$10,868.00
|
| Rate for Payer: WEA Trust Commercial |
$1,494.35
|
| Rate for Payer: WPS Commercial |
$2,012.48
|
|
|
SCREW-LOCK 5.0 X 30 TFN 458.930
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 30 TFN 458.930
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 32 212.210
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 32 212.210
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 32.5 FULLY THREAD 1896-5032S
|
Facility
|
OP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.96 |
| Max. Negotiated Rate |
$7,828.00 |
| Rate for Payer: Aetna Commercial |
$1,761.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.02
|
| Rate for Payer: Aetna Managed Medicare |
$547.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.21
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,800.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.14
|
| Rate for Payer: Health EOS Commercial |
$1,741.73
|
| Rate for Payer: HFN Commercial |
$1,800.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.75
|
| Rate for Payer: Multiplan Commercial |
$1,565.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.44
|
| Rate for Payer: Quartz Beloit One Network |
$958.93
|
| Rate for Payer: Quartz Commercial |
$1,272.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.20
|
| Rate for Payer: The Alliance Commercial |
$7,828.00
|
| Rate for Payer: WEA Trust Commercial |
$1,076.35
|
| Rate for Payer: WPS Commercial |
$1,449.55
|
|
|
SCREW LOCK 5.0 X 32.5 FULLY THREAD 1896-5032S
|
Facility
|
IP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.93 |
| Max. Negotiated Rate |
$1,800.44 |
| Rate for Payer: Aetna Commercial |
$1,761.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.21
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,800.44
|
| Rate for Payer: Health EOS Commercial |
$1,741.73
|
| Rate for Payer: HFN Commercial |
$1,800.44
|
| Rate for Payer: Multiplan Commercial |
$1,565.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.44
|
| Rate for Payer: Quartz Beloit One Network |
$958.93
|
| Rate for Payer: Quartz Commercial |
$1,174.20
|
| Rate for Payer: WEA Trust Commercial |
$1,076.35
|
| Rate for Payer: WPS Commercial |
$1,449.55
|
|
|
SCREW LOCK 5.0 X 32MM TI 04.005.522S
|
Facility
|
OP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.24 |
| Max. Negotiated Rate |
$12,232.00 |
| Rate for Payer: Aetna Commercial |
$2,752.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,629.88
|
| Rate for Payer: Aetna Managed Medicare |
$856.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,987.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,529.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,620.74
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,813.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,711.26
|
| Rate for Payer: Health EOS Commercial |
$2,721.62
|
| Rate for Payer: HFN Commercial |
$2,813.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,293.50
|
| Rate for Payer: Multiplan Commercial |
$2,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,834.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,498.42
|
| Rate for Payer: Quartz Commercial |
$1,987.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,834.80
|
| Rate for Payer: The Alliance Commercial |
$12,232.00
|
| Rate for Payer: WEA Trust Commercial |
$1,681.90
|
| Rate for Payer: WPS Commercial |
$2,265.06
|
|
|
SCREW LOCK 5.0 X 32MM TI 04.005.522S
|
Facility
|
IP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.42 |
| Max. Negotiated Rate |
$2,813.36 |
| Rate for Payer: Aetna Commercial |
$2,752.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,629.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,620.74
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,813.36
|
| Rate for Payer: Health EOS Commercial |
$2,721.62
|
| Rate for Payer: HFN Commercial |
$2,813.36
|
| Rate for Payer: Multiplan Commercial |
$2,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,834.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,498.42
|
| Rate for Payer: Quartz Commercial |
$1,834.80
|
| Rate for Payer: WEA Trust Commercial |
$1,681.90
|
| Rate for Payer: WPS Commercial |
$2,265.06
|
|
|
SCREW LOCK 5.0 X 32MM XL25 IM NAIL TI 04.045.032S
|
Facility
|
IP
|
$2,332.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.68 |
| Max. Negotiated Rate |
$2,145.44 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,399.20
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
SCREW LOCK 5.0 X 32MM XL25 IM NAIL TI 04.045.032S
|
Facility
|
OP
|
$2,332.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.96 |
| Max. Negotiated Rate |
$9,328.00 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.52
|
| Rate for Payer: Aetna Managed Medicare |
$652.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,515.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.99
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,515.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.20
|
| Rate for Payer: The Alliance Commercial |
$9,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
SCREW-LOCK 5.0 X 32 TFN 458.932
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 32 TFN 458.932
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 32 VA 02.231.232
|
Facility
|
IP
|
$2,648.00
|
|
| Hospital Charge Code |
3072542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.52 |
| Max. Negotiated Rate |
$2,436.16 |
| Rate for Payer: Aetna Commercial |
$2,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.44
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cigna Commercial |
$2,436.16
|
| Rate for Payer: Health EOS Commercial |
$2,356.72
|
| Rate for Payer: HFN Commercial |
$2,436.16
|
| Rate for Payer: Multiplan Commercial |
$2,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,588.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.52
|
| Rate for Payer: Quartz Commercial |
$1,588.80
|
| Rate for Payer: WEA Trust Commercial |
$1,456.40
|
| Rate for Payer: WPS Commercial |
$1,961.37
|
|
|
SCREW LOCK 5.0 X 32 VA 02.231.232
|
Facility
|
OP
|
$2,648.00
|
|
| Hospital Charge Code |
3072542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.44 |
| Max. Negotiated Rate |
$10,592.00 |
| Rate for Payer: Aetna Commercial |
$2,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,277.28
|
| Rate for Payer: Aetna Managed Medicare |
$741.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,721.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,324.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,271.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.44
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cigna Commercial |
$2,436.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,481.82
|
| Rate for Payer: Health EOS Commercial |
$2,356.72
|
| Rate for Payer: HFN Commercial |
$2,436.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,986.00
|
| Rate for Payer: Multiplan Commercial |
$2,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,588.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.52
|
| Rate for Payer: Quartz Commercial |
$1,721.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.80
|
| Rate for Payer: The Alliance Commercial |
$10,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,456.40
|
| Rate for Payer: WPS Commercial |
$1,961.37
|
|
|
SCREW-LOCK 5.0X34 212.211
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW-LOCK 5.0X34 212.211
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 34MM TI 04.005.524S
|
Facility
|
OP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.24 |
| Max. Negotiated Rate |
$12,232.00 |
| Rate for Payer: Aetna Commercial |
$2,752.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,629.88
|
| Rate for Payer: Aetna Managed Medicare |
$856.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,987.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,529.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,620.74
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,813.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,711.26
|
| Rate for Payer: Health EOS Commercial |
$2,721.62
|
| Rate for Payer: HFN Commercial |
$2,813.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,293.50
|
| Rate for Payer: Multiplan Commercial |
$2,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,834.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,498.42
|
| Rate for Payer: Quartz Commercial |
$1,987.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,834.80
|
| Rate for Payer: The Alliance Commercial |
$12,232.00
|
| Rate for Payer: WEA Trust Commercial |
$1,681.90
|
| Rate for Payer: WPS Commercial |
$2,265.06
|
|
|
SCREW LOCK 5.0 X 34MM TI 04.005.524S
|
Facility
|
IP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.42 |
| Max. Negotiated Rate |
$2,813.36 |
| Rate for Payer: Aetna Commercial |
$2,752.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,629.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,620.74
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,813.36
|
| Rate for Payer: Health EOS Commercial |
$2,721.62
|
| Rate for Payer: HFN Commercial |
$2,813.36
|
| Rate for Payer: Multiplan Commercial |
$2,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,834.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,498.42
|
| Rate for Payer: Quartz Commercial |
$1,834.80
|
| Rate for Payer: WEA Trust Commercial |
$1,681.90
|
| Rate for Payer: WPS Commercial |
$2,265.06
|
|
|
SCREW LOCK 5.0 X 34MM XL25 IM NAIL TI 04.045.034S
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.28 |
| Max. Negotiated Rate |
$11,304.00 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Aetna Managed Medicare |
$791.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,836.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,581.43
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,119.50
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,836.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,695.60
|
| Rate for Payer: The Alliance Commercial |
$11,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW LOCK 5.0 X 34MM XL25 IM NAIL TI 04.045.034S
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.74 |
| Max. Negotiated Rate |
$2,599.92 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,695.60
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW-LOCK 5.0 X 34 TFN 458.934
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 34 TFN 458.934
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 34 VA 02.231.234
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.40 |
| Max. Negotiated Rate |
$9,020.00 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Aetna Managed Medicare |
$631.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,465.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,127.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,261.90
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,691.25
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,465.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,353.00
|
| Rate for Payer: The Alliance Commercial |
$9,020.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
|
SCREW LOCK 5.0 X 34 VA 02.231.234
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.95 |
| Max. Negotiated Rate |
$2,074.60 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,353.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
