|
SCREW PINNACLE CANC 6.5 X 20 1217-20-500
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.05 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Aetna Managed Medicare |
$435.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.51
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: NAPHCARE Commercial |
$932.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$1,009.94
|
| Rate for Payer: Quartz Medicare Advantage |
$932.26
|
| Rate for Payer: The Alliance Commercial |
$776.88
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
SCREW PINNACLE CANC 6.5 X 20 1217-20-500
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.34 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$932.26
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
SCREW PINNACLE CANC 6.5 X 25 1217-25-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 25 1217-25-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 30 1217-30-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 30 1217-30-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 35 1217-35-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 35 1217-35-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 40 1217-40-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5497052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW PINNACLE CANC 6.5 X 40 1217-40-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5497052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCREW QUICKFIX CANN 2.0 X 26MM PT TI AR-8720-26PT
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW QUICKFIX CANN 2.0 X 26MM PT TI AR-8720-26PT
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW QUICKFIX CANN 3.0 X 24MM PT TI AR-8730-24PT
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.97 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Aetna Managed Medicare |
$665.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.03
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.86
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,546.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.09
|
| Rate for Payer: The Alliance Commercial |
$1,189.24
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
SCREW QUICKFIX CANN 3.0 X 24MM PT TI AR-8730-24PT
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.46 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,427.09
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
SCREW QUICKFIX SNAP-OFF 2.0 X 12MM AR-8930-12
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.01 |
| Max. Negotiated Rate |
$2,442.71 |
| Rate for Payer: Aetna Commercial |
$2,389.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,283.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,407.21
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,442.71
|
| Rate for Payer: Health EOS Commercial |
$2,363.06
|
| Rate for Payer: HFN Commercial |
$2,442.71
|
| Rate for Payer: Multiplan Commercial |
$2,124.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,442.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.01
|
| Rate for Payer: Quartz Commercial |
$1,593.07
|
| Rate for Payer: WEA Trust Commercial |
$1,460.32
|
| Rate for Payer: WPS Commercial |
$1,966.58
|
|
|
SCREW QUICKFIX SNAP-OFF 2.0 X 12MM AR-8930-12
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$743.43 |
| Max. Negotiated Rate |
$2,442.71 |
| Rate for Payer: Aetna Commercial |
$2,389.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,283.40
|
| Rate for Payer: Aetna Managed Medicare |
$743.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,725.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,327.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,274.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,407.21
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,442.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,485.85
|
| Rate for Payer: Health EOS Commercial |
$2,363.06
|
| Rate for Payer: HFN Commercial |
$2,442.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,991.34
|
| Rate for Payer: Multiplan Commercial |
$2,124.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,593.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,442.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.01
|
| Rate for Payer: Quartz Commercial |
$1,725.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,593.07
|
| Rate for Payer: The Alliance Commercial |
$1,327.56
|
| Rate for Payer: WEA Trust Commercial |
$1,460.32
|
| Rate for Payer: WPS Commercial |
$1,966.58
|
|
|
SCREW QUICKFIX SNAP-OFF 2.0 X 13MM AR-8930-13
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$743.43 |
| Max. Negotiated Rate |
$2,442.71 |
| Rate for Payer: Aetna Commercial |
$2,389.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,283.40
|
| Rate for Payer: Aetna Managed Medicare |
$743.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,725.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,327.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,274.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,407.21
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,442.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,485.85
|
| Rate for Payer: Health EOS Commercial |
$2,363.06
|
| Rate for Payer: HFN Commercial |
$2,442.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,991.34
|
| Rate for Payer: Multiplan Commercial |
$2,124.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,593.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,442.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.01
|
| Rate for Payer: Quartz Commercial |
$1,725.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,593.07
|
| Rate for Payer: The Alliance Commercial |
$1,327.56
|
| Rate for Payer: WEA Trust Commercial |
$1,460.32
|
| Rate for Payer: WPS Commercial |
$1,966.58
|
|
|
SCREW QUICKFIX SNAP-OFF 2.0 X 13MM AR-8930-13
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.01 |
| Max. Negotiated Rate |
$2,442.71 |
| Rate for Payer: Aetna Commercial |
$2,389.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,283.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,407.21
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,442.71
|
| Rate for Payer: Health EOS Commercial |
$2,363.06
|
| Rate for Payer: HFN Commercial |
$2,442.71
|
| Rate for Payer: Multiplan Commercial |
$2,124.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,442.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.01
|
| Rate for Payer: Quartz Commercial |
$1,593.07
|
| Rate for Payer: WEA Trust Commercial |
$1,460.32
|
| Rate for Payer: WPS Commercial |
$1,966.58
|
|
|
SCREW QUIX HEADLESS 3.0 X 16MM 111316SND
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.14 |
| Max. Negotiated Rate |
$3,302.87 |
| Rate for Payer: Aetna Commercial |
$3,231.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,087.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,902.74
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$3,302.87
|
| Rate for Payer: Health EOS Commercial |
$3,195.17
|
| Rate for Payer: HFN Commercial |
$3,302.87
|
| Rate for Payer: Multiplan Commercial |
$2,872.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,302.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.14
|
| Rate for Payer: Quartz Commercial |
$2,154.05
|
| Rate for Payer: WEA Trust Commercial |
$1,974.54
|
| Rate for Payer: WPS Commercial |
$2,659.08
|
|
|
SCREW QUIX HEADLESS 3.0 X 16MM 111316SND
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.22 |
| Max. Negotiated Rate |
$3,302.87 |
| Rate for Payer: Aetna Commercial |
$3,231.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,087.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,005.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,333.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,795.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,723.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,902.74
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$3,302.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,009.06
|
| Rate for Payer: Health EOS Commercial |
$3,195.17
|
| Rate for Payer: HFN Commercial |
$3,302.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,692.56
|
| Rate for Payer: Multiplan Commercial |
$2,872.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,154.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,302.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.14
|
| Rate for Payer: Quartz Commercial |
$2,333.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,154.05
|
| Rate for Payer: The Alliance Commercial |
$1,795.04
|
| Rate for Payer: WEA Trust Commercial |
$1,974.54
|
| Rate for Payer: WPS Commercial |
$2,659.08
|
|
|
SCREW QWIX FIXATION 3MM DIA X 14MM LG STERILE 111314SND
|
Facility
|
IP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.29 |
| Max. Negotiated Rate |
$3,866.43 |
| Rate for Payer: Aetna Commercial |
$3,782.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,614.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,227.40
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,866.43
|
| Rate for Payer: Health EOS Commercial |
$3,740.35
|
| Rate for Payer: HFN Commercial |
$3,866.43
|
| Rate for Payer: Multiplan Commercial |
$3,362.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,866.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.29
|
| Rate for Payer: Quartz Commercial |
$2,521.58
|
| Rate for Payer: WEA Trust Commercial |
$2,311.45
|
| Rate for Payer: WPS Commercial |
$3,112.78
|
|
|
SCREW QWIX FIXATION 3MM DIA X 14MM LG STERILE 111314SND
|
Facility
|
OP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.74 |
| Max. Negotiated Rate |
$3,866.43 |
| Rate for Payer: Aetna Commercial |
$3,782.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,614.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,176.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,731.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,101.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,017.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,227.40
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,866.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,351.86
|
| Rate for Payer: Health EOS Commercial |
$3,740.35
|
| Rate for Payer: HFN Commercial |
$3,866.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,151.98
|
| Rate for Payer: Multiplan Commercial |
$3,362.11
|
| Rate for Payer: NAPHCARE Commercial |
$2,521.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,866.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.29
|
| Rate for Payer: Quartz Commercial |
$2,731.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,521.58
|
| Rate for Payer: The Alliance Commercial |
$2,101.32
|
| Rate for Payer: WEA Trust Commercial |
$2,311.45
|
| Rate for Payer: WPS Commercial |
$3,112.78
|
|
|
SCREW QWIX FIXATION 3MM DIA X 18MM LG STERILE 111318SND
|
Facility
|
OP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.74 |
| Max. Negotiated Rate |
$3,866.43 |
| Rate for Payer: Aetna Commercial |
$3,782.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,614.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,176.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,731.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,101.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,017.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,227.40
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,866.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,351.86
|
| Rate for Payer: Health EOS Commercial |
$3,740.35
|
| Rate for Payer: HFN Commercial |
$3,866.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,151.98
|
| Rate for Payer: Multiplan Commercial |
$3,362.11
|
| Rate for Payer: NAPHCARE Commercial |
$2,521.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,866.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.29
|
| Rate for Payer: Quartz Commercial |
$2,731.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,521.58
|
| Rate for Payer: The Alliance Commercial |
$2,101.32
|
| Rate for Payer: WEA Trust Commercial |
$2,311.45
|
| Rate for Payer: WPS Commercial |
$3,112.78
|
|
|
SCREW QWIX FIXATION 3MM DIA X 18MM LG STERILE 111318SND
|
Facility
|
IP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.29 |
| Max. Negotiated Rate |
$3,866.43 |
| Rate for Payer: Aetna Commercial |
$3,782.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,614.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,227.40
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,866.43
|
| Rate for Payer: Health EOS Commercial |
$3,740.35
|
| Rate for Payer: HFN Commercial |
$3,866.43
|
| Rate for Payer: Multiplan Commercial |
$3,362.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,866.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.29
|
| Rate for Payer: Quartz Commercial |
$2,521.58
|
| Rate for Payer: WEA Trust Commercial |
$2,311.45
|
| Rate for Payer: WPS Commercial |
$3,112.78
|
|
|
SCREW QWIX FIXATION 3MM DIA X 34MM L STERILE 111334SND
|
Facility
|
OP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.74 |
| Max. Negotiated Rate |
$3,866.43 |
| Rate for Payer: Aetna Commercial |
$3,782.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,614.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,176.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,731.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,101.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,017.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,227.40
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,866.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,351.86
|
| Rate for Payer: Health EOS Commercial |
$3,740.35
|
| Rate for Payer: HFN Commercial |
$3,866.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,151.98
|
| Rate for Payer: Multiplan Commercial |
$3,362.11
|
| Rate for Payer: NAPHCARE Commercial |
$2,521.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,866.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.29
|
| Rate for Payer: Quartz Commercial |
$2,731.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,521.58
|
| Rate for Payer: The Alliance Commercial |
$2,101.32
|
| Rate for Payer: WEA Trust Commercial |
$2,311.45
|
| Rate for Payer: WPS Commercial |
$3,112.78
|
|
