|
SCREW QWIX FIXATION 3MM DIA X 34MM L STERILE 111334SND
|
Facility
|
IP
|
$4,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617662
|
|
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 SCHANZ 4.0/3.0 X 20MM 294.30
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$491.09
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
SCREW SCHANZ 4.0/3.0 X 20MM 294.30
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Aetna Managed Medicare |
$229.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$532.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.03
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.86
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: NAPHCARE Commercial |
$491.09
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$532.01
|
| Rate for Payer: Quartz Medicare Advantage |
$491.09
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
SCREW SCHANZ 4.0/3.0 X 80 20MM THREAD SELF-DRILLING SS 294.771
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,178.70 |
| Max. Negotiated Rate |
$2,213.08 |
| Rate for Payer: Aetna Commercial |
$2,164.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,068.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,274.93
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,213.08
|
| Rate for Payer: Health EOS Commercial |
$2,140.91
|
| Rate for Payer: HFN Commercial |
$2,213.08
|
| Rate for Payer: Multiplan Commercial |
$1,924.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,213.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,178.70
|
| Rate for Payer: Quartz Commercial |
$1,443.31
|
| Rate for Payer: WEA Trust Commercial |
$1,323.04
|
| Rate for Payer: WPS Commercial |
$1,781.70
|
|
|
SCREW SCHANZ 4.0/3.0 X 80 20MM THREAD SELF-DRILLING SS 294.771
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.55 |
| Max. Negotiated Rate |
$2,213.08 |
| Rate for Payer: Aetna Commercial |
$2,164.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,068.75
|
| Rate for Payer: Aetna Managed Medicare |
$673.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,563.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,202.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,154.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,274.93
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,213.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,346.17
|
| Rate for Payer: Health EOS Commercial |
$2,140.91
|
| Rate for Payer: HFN Commercial |
$2,213.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,804.14
|
| Rate for Payer: Multiplan Commercial |
$1,924.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,443.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,213.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,178.70
|
| Rate for Payer: Quartz Commercial |
$1,563.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,443.31
|
| Rate for Payer: The Alliance Commercial |
$1,202.76
|
| Rate for Payer: WEA Trust Commercial |
$1,323.04
|
| Rate for Payer: WPS Commercial |
$1,781.70
|
|
|
SCREW SCHANZ 4.0 X 150 40MM THREAD SELF-DRILLING SS 294.778
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.23 |
| Max. Negotiated Rate |
$2,215.95 |
| Rate for Payer: Aetna Commercial |
$2,167.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,071.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,276.58
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: Health EOS Commercial |
$2,143.69
|
| Rate for Payer: HFN Commercial |
$2,215.95
|
| Rate for Payer: Multiplan Commercial |
$1,926.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,215.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.23
|
| Rate for Payer: Quartz Commercial |
$1,445.18
|
| Rate for Payer: WEA Trust Commercial |
$1,324.75
|
| Rate for Payer: WPS Commercial |
$1,784.01
|
|
|
SCREW SCHANZ 4.0 X 150 40MM THREAD SELF-DRILLING SS 294.778
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.42 |
| Max. Negotiated Rate |
$2,215.95 |
| Rate for Payer: Aetna Commercial |
$2,167.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,071.43
|
| Rate for Payer: Aetna Managed Medicare |
$674.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,565.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,204.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,156.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,276.58
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,347.91
|
| Rate for Payer: Health EOS Commercial |
$2,143.69
|
| Rate for Payer: HFN Commercial |
$2,215.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,806.48
|
| Rate for Payer: Multiplan Commercial |
$1,926.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,445.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,215.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.23
|
| Rate for Payer: Quartz Commercial |
$1,565.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,445.18
|
| Rate for Payer: The Alliance Commercial |
$1,204.32
|
| Rate for Payer: WEA Trust Commercial |
$1,324.75
|
| Rate for Payer: WPS Commercial |
$1,784.01
|
|
|
SCREW SCHANZ 4.5 X 175 60MM THREAD SELF-DRILLING SS 294.785
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$1,594.03 |
| Rate for Payer: Aetna Commercial |
$1,559.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.07
|
| Rate for Payer: Aetna Managed Medicare |
$485.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,126.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$866.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$918.30
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,594.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$969.61
|
| Rate for Payer: Health EOS Commercial |
$1,542.05
|
| Rate for Payer: HFN Commercial |
$1,594.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.48
|
| Rate for Payer: Multiplan Commercial |
$1,386.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,039.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,594.03
|
| Rate for Payer: Quartz Beloit One Network |
$848.99
|
| Rate for Payer: Quartz Commercial |
$1,126.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,039.58
|
| Rate for Payer: The Alliance Commercial |
$866.32
|
| Rate for Payer: WEA Trust Commercial |
$952.95
|
| Rate for Payer: WPS Commercial |
$1,283.32
|
|
|
SCREW SCHANZ 4.5 X 175 60MM THREAD SELF-DRILLING SS 294.785
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.99 |
| Max. Negotiated Rate |
$1,594.03 |
| Rate for Payer: Aetna Commercial |
$1,559.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$918.30
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,594.03
|
| Rate for Payer: Health EOS Commercial |
$1,542.05
|
| Rate for Payer: HFN Commercial |
$1,594.03
|
| Rate for Payer: Multiplan Commercial |
$1,386.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,594.03
|
| Rate for Payer: Quartz Beloit One Network |
$848.99
|
| Rate for Payer: Quartz Commercial |
$1,039.58
|
| Rate for Payer: WEA Trust Commercial |
$952.95
|
| Rate for Payer: WPS Commercial |
$1,283.32
|
|
|
SCREW SCHANZ 5.0 X 150 60MM THREAD SELF-DRILLING SS 294.784
|
Facility
|
IP
|
$2,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.72 |
| Max. Negotiated Rate |
$2,414.01 |
| Rate for Payer: Aetna Commercial |
$2,361.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,256.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.68
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna Commercial |
$2,414.01
|
| Rate for Payer: Health EOS Commercial |
$2,335.29
|
| Rate for Payer: HFN Commercial |
$2,414.01
|
| Rate for Payer: Multiplan Commercial |
$2,099.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.72
|
| Rate for Payer: Quartz Commercial |
$1,574.35
|
| Rate for Payer: WEA Trust Commercial |
$1,443.16
|
| Rate for Payer: WPS Commercial |
$1,943.47
|
|
|
SCREW SCHANZ 5.0 X 150 60MM THREAD SELF-DRILLING SS 294.784
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$2,414.01 |
| Rate for Payer: Aetna Commercial |
$2,361.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,256.57
|
| Rate for Payer: Aetna Managed Medicare |
$734.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,705.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.68
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna Commercial |
$2,414.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.39
|
| Rate for Payer: Health EOS Commercial |
$2,335.29
|
| Rate for Payer: HFN Commercial |
$2,414.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,967.94
|
| Rate for Payer: Multiplan Commercial |
$2,099.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.72
|
| Rate for Payer: Quartz Commercial |
$1,705.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.35
|
| Rate for Payer: The Alliance Commercial |
$1,311.96
|
| Rate for Payer: WEA Trust Commercial |
$1,443.16
|
| Rate for Payer: WPS Commercial |
$1,943.47
|
|
|
SCREW SCHANZ 5.0 X 150 BLUNT POINT 294.54
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3523499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.15 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Aetna Managed Medicare |
$349.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$810.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$623.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$598.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$697.82
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.22
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$748.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| Rate for Payer: Quartz Medicare Advantage |
$748.18
|
| Rate for Payer: The Alliance Commercial |
$623.48
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
SCREW SCHANZ 5.0 X 150 BLUNT POINT 294.54
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3523499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
SCREW SCHANZ 5.0 X 170 BLUNT POINT 294.55
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.09 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$623.38
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW SCHANZ 5.0 X 170 BLUNT POINT 294.55
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.91 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$675.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$519.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.22
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$623.38
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$675.32
|
| Rate for Payer: Quartz Medicare Advantage |
$623.38
|
| Rate for Payer: The Alliance Commercial |
$519.48
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW SCHANZ 5.0 X 200 80MM THREAD SELF DRILLING SS 294.786
|
Facility
|
OP
|
$2,621.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.24 |
| Max. Negotiated Rate |
$2,507.77 |
| Rate for Payer: Aetna Commercial |
$2,453.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,344.22
|
| Rate for Payer: Aetna Managed Medicare |
$763.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,771.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,308.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,444.70
|
| Rate for Payer: Cash Price |
$786.30
|
| Rate for Payer: Cigna Commercial |
$2,507.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,525.42
|
| Rate for Payer: Health EOS Commercial |
$2,426.00
|
| Rate for Payer: HFN Commercial |
$2,507.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,044.38
|
| Rate for Payer: Multiplan Commercial |
$2,180.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,635.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,507.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,335.66
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,635.50
|
| Rate for Payer: The Alliance Commercial |
$1,362.92
|
| Rate for Payer: WEA Trust Commercial |
$1,499.21
|
| Rate for Payer: WPS Commercial |
$2,018.96
|
|
|
SCREW SCHANZ 5.0 X 200 80MM THREAD SELF DRILLING SS 294.786
|
Facility
|
IP
|
$2,621.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.66 |
| Max. Negotiated Rate |
$2,507.77 |
| Rate for Payer: Aetna Commercial |
$2,453.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,344.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,444.70
|
| Rate for Payer: Cash Price |
$786.30
|
| Rate for Payer: Cigna Commercial |
$2,507.77
|
| Rate for Payer: Health EOS Commercial |
$2,426.00
|
| Rate for Payer: HFN Commercial |
$2,507.77
|
| Rate for Payer: Multiplan Commercial |
$2,180.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,507.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,335.66
|
| Rate for Payer: Quartz Commercial |
$1,635.50
|
| Rate for Payer: WEA Trust Commercial |
$1,499.21
|
| Rate for Payer: WPS Commercial |
$2,018.96
|
|
|
SCREW SCHANZ 5.0 X 200 BLUNT POINT 294.56
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
SCREW SCHANZ 5.0 X 200 BLUNT POINT 294.56
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Aetna Managed Medicare |
$346.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.58
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.20
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: NAPHCARE Commercial |
$742.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$804.44
|
| Rate for Payer: Quartz Medicare Advantage |
$742.56
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
SCREW SCHANZ 6.0 X 160 294.67
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.02 |
| Max. Negotiated Rate |
$848.68 |
| Rate for Payer: Aetna Commercial |
$830.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.91
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$848.68
|
| Rate for Payer: Health EOS Commercial |
$821.01
|
| Rate for Payer: HFN Commercial |
$848.68
|
| Rate for Payer: Multiplan Commercial |
$737.98
|
| Rate for Payer: Preferred Network Access Commercial |
$848.68
|
| Rate for Payer: Quartz Beloit One Network |
$452.02
|
| Rate for Payer: Quartz Commercial |
$553.49
|
| Rate for Payer: WEA Trust Commercial |
$507.36
|
| Rate for Payer: WPS Commercial |
$683.26
|
|
|
SCREW SCHANZ 6.0 X 160 294.67
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.29 |
| Max. Negotiated Rate |
$848.68 |
| Rate for Payer: Aetna Commercial |
$830.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.33
|
| Rate for Payer: Aetna Managed Medicare |
$258.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.91
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$848.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.23
|
| Rate for Payer: Health EOS Commercial |
$821.01
|
| Rate for Payer: HFN Commercial |
$848.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$691.86
|
| Rate for Payer: Multiplan Commercial |
$737.98
|
| Rate for Payer: NAPHCARE Commercial |
$553.49
|
| Rate for Payer: Preferred Network Access Commercial |
$848.68
|
| Rate for Payer: Quartz Beloit One Network |
$452.02
|
| Rate for Payer: Quartz Commercial |
$599.61
|
| Rate for Payer: Quartz Medicare Advantage |
$553.49
|
| Rate for Payer: The Alliance Commercial |
$461.24
|
| Rate for Payer: WEA Trust Commercial |
$507.36
|
| Rate for Payer: WPS Commercial |
$683.26
|
|
|
SCREW SLEEVE 3.5M LOCK 323.053
|
Facility
|
OP
|
$1,938.00
|
|
| Hospital Charge Code |
2967024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.35 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Aetna Managed Medicare |
$564.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,310.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,007.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$967.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,127.92
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,511.64
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,209.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,310.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,209.31
|
| Rate for Payer: The Alliance Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
SCREW SLEEVE 3.5M LOCK 323.053
|
Facility
|
IP
|
$1,938.00
|
|
| Hospital Charge Code |
2967024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.60 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,209.31
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
SCREW SNAP-OFF 2.0 X 11MM CHARLOTTE F & A 45110001
|
Facility
|
IP
|
$2,532.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$2,422.62 |
| Rate for Payer: Aetna Commercial |
$2,369.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,264.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,395.64
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$2,422.62
|
| Rate for Payer: Health EOS Commercial |
$2,343.62
|
| Rate for Payer: HFN Commercial |
$2,422.62
|
| Rate for Payer: Multiplan Commercial |
$2,106.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,422.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,290.31
|
| Rate for Payer: Quartz Commercial |
$1,579.97
|
| Rate for Payer: WEA Trust Commercial |
$1,448.30
|
| Rate for Payer: WPS Commercial |
$1,950.40
|
|
|
SCREW SNAP-OFF 2.0 X 11MM CHARLOTTE F & A 45110001
|
Facility
|
OP
|
$2,532.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.32 |
| Max. Negotiated Rate |
$2,422.62 |
| Rate for Payer: Aetna Commercial |
$2,369.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,264.62
|
| Rate for Payer: Aetna Managed Medicare |
$737.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,711.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,316.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,263.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,395.64
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$2,422.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,473.62
|
| Rate for Payer: Health EOS Commercial |
$2,343.62
|
| Rate for Payer: HFN Commercial |
$2,422.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,974.96
|
| Rate for Payer: Multiplan Commercial |
$2,106.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,579.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,422.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,290.31
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,579.97
|
| Rate for Payer: The Alliance Commercial |
$1,316.64
|
| Rate for Payer: WEA Trust Commercial |
$1,448.30
|
| Rate for Payer: WPS Commercial |
$1,950.40
|
|
