|
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 |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
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 |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
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 |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
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 |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
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 |
$501.76 |
| Max. Negotiated Rate |
$7,168.00 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Aetna Managed Medicare |
$501.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.20
|
| Rate for Payer: The Alliance Commercial |
$7,168.00
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
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 |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
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 |
$1,120.63 |
| Max. Negotiated Rate |
$2,104.04 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,372.20
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
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 |
$640.36 |
| Max. Negotiated Rate |
$9,148.00 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| Rate for Payer: Aetna Managed Medicare |
$640.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,486.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.81
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,715.25
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,486.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.20
|
| Rate for Payer: The Alliance Commercial |
$9,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
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 |
$714.84 |
| Max. Negotiated Rate |
$10,212.00 |
| Rate for Payer: Aetna Commercial |
$2,297.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.58
|
| Rate for Payer: Aetna Managed Medicare |
$714.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,659.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,225.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.09
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,348.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,428.66
|
| Rate for Payer: Health EOS Commercial |
$2,272.17
|
| Rate for Payer: HFN Commercial |
$2,348.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,914.75
|
| Rate for Payer: Multiplan Commercial |
$2,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,531.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,250.97
|
| Rate for Payer: Quartz Commercial |
$1,659.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,531.80
|
| Rate for Payer: The Alliance Commercial |
$10,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,404.15
|
| Rate for Payer: WPS Commercial |
$1,891.01
|
|
|
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 |
$1,250.97 |
| Max. Negotiated Rate |
$2,348.76 |
| Rate for Payer: Aetna Commercial |
$2,297.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.09
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,348.76
|
| Rate for Payer: Health EOS Commercial |
$2,272.17
|
| Rate for Payer: HFN Commercial |
$2,348.76
|
| Rate for Payer: Multiplan Commercial |
$2,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,531.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,250.97
|
| Rate for Payer: Quartz Commercial |
$1,531.80
|
| Rate for Payer: WEA Trust Commercial |
$1,404.15
|
| Rate for Payer: WPS Commercial |
$1,891.01
|
|
|
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 |
$1,250.97 |
| Max. Negotiated Rate |
$2,348.76 |
| Rate for Payer: Aetna Commercial |
$2,297.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.09
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,348.76
|
| Rate for Payer: Health EOS Commercial |
$2,272.17
|
| Rate for Payer: HFN Commercial |
$2,348.76
|
| Rate for Payer: Multiplan Commercial |
$2,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,531.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,250.97
|
| Rate for Payer: Quartz Commercial |
$1,531.80
|
| Rate for Payer: WEA Trust Commercial |
$1,404.15
|
| Rate for Payer: WPS Commercial |
$1,891.01
|
|
|
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 |
$714.84 |
| Max. Negotiated Rate |
$10,212.00 |
| Rate for Payer: Aetna Commercial |
$2,297.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.58
|
| Rate for Payer: Aetna Managed Medicare |
$714.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,659.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,225.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.09
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna Commercial |
$2,348.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,428.66
|
| Rate for Payer: Health EOS Commercial |
$2,272.17
|
| Rate for Payer: HFN Commercial |
$2,348.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,914.75
|
| Rate for Payer: Multiplan Commercial |
$2,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,531.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,250.97
|
| Rate for Payer: Quartz Commercial |
$1,659.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,531.80
|
| Rate for Payer: The Alliance Commercial |
$10,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,404.15
|
| Rate for Payer: WPS Commercial |
$1,891.01
|
|
|
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 |
$1,691.48 |
| Max. Negotiated Rate |
$3,175.84 |
| Rate for Payer: Aetna Commercial |
$3,106.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,968.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,829.56
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$3,175.84
|
| Rate for Payer: Health EOS Commercial |
$3,072.28
|
| Rate for Payer: HFN Commercial |
$3,175.84
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,071.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,175.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.48
|
| Rate for Payer: Quartz Commercial |
$2,071.20
|
| Rate for Payer: WEA Trust Commercial |
$1,898.60
|
| Rate for Payer: WPS Commercial |
$2,556.90
|
|
|
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 |
$966.56 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Aetna Commercial |
$3,106.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,968.72
|
| Rate for Payer: Aetna Managed Medicare |
$966.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,243.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,726.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,656.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,829.56
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$3,175.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,931.74
|
| Rate for Payer: Health EOS Commercial |
$3,072.28
|
| Rate for Payer: HFN Commercial |
$3,175.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,589.00
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,071.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,175.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.48
|
| Rate for Payer: Quartz Commercial |
$2,243.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,071.20
|
| Rate for Payer: The Alliance Commercial |
$13,808.00
|
| Rate for Payer: WEA Trust Commercial |
$1,898.60
|
| Rate for Payer: WPS Commercial |
$2,556.90
|
|
|
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 |
$1,131.48 |
| Max. Negotiated Rate |
$16,164.00 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,131.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,626.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,939.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,261.34
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,030.75
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,626.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,424.60
|
| Rate for Payer: The Alliance Commercial |
$16,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$1,980.09 |
| Max. Negotiated Rate |
$3,717.72 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,424.60
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$1,131.48 |
| Max. Negotiated Rate |
$16,164.00 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,131.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,626.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,939.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,261.34
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,030.75
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,626.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,424.60
|
| Rate for Payer: The Alliance Commercial |
$16,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$1,980.09 |
| Max. Negotiated Rate |
$3,717.72 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,424.60
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$1,131.48 |
| Max. Negotiated Rate |
$16,164.00 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,131.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,626.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,939.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,261.34
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,030.75
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,626.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,424.60
|
| Rate for Payer: The Alliance Commercial |
$16,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$1,980.09 |
| Max. Negotiated Rate |
$3,717.72 |
| Rate for Payer: Aetna Commercial |
$3,636.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.73
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cigna Commercial |
$3,717.72
|
| Rate for Payer: Health EOS Commercial |
$3,596.49
|
| Rate for Payer: HFN Commercial |
$3,717.72
|
| Rate for Payer: Multiplan Commercial |
$3,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,980.09
|
| Rate for Payer: Quartz Commercial |
$2,424.60
|
| Rate for Payer: WEA Trust Commercial |
$2,222.55
|
| Rate for Payer: WPS Commercial |
$2,993.17
|
|
|
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 |
$220.36 |
| Max. Negotiated Rate |
$3,148.00 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Aetna Managed Medicare |
$220.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$511.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.41
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$590.25
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$472.20
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$511.55
|
| Rate for Payer: Quartz Medicare Advantage |
$472.20
|
| Rate for Payer: The Alliance Commercial |
$3,148.00
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
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 |
$385.63 |
| Max. Negotiated Rate |
$724.04 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$472.20
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$472.20
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
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 |
$1,133.37 |
| Max. Negotiated Rate |
$2,127.96 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,989.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,225.89
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,127.96
|
| Rate for Payer: Health EOS Commercial |
$2,058.57
|
| Rate for Payer: HFN Commercial |
$2,127.96
|
| Rate for Payer: Multiplan Commercial |
$1,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,127.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.37
|
| Rate for Payer: Quartz Commercial |
$1,387.80
|
| Rate for Payer: WEA Trust Commercial |
$1,272.15
|
| Rate for Payer: WPS Commercial |
$1,713.24
|
|
|
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 |
$647.64 |
| Max. Negotiated Rate |
$9,252.00 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,989.18
|
| Rate for Payer: Aetna Managed Medicare |
$647.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,503.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,156.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,225.89
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,127.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,294.35
|
| Rate for Payer: Health EOS Commercial |
$2,058.57
|
| Rate for Payer: HFN Commercial |
$2,127.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,734.75
|
| Rate for Payer: Multiplan Commercial |
$1,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,127.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.37
|
| Rate for Payer: Quartz Commercial |
$1,503.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,387.80
|
| Rate for Payer: The Alliance Commercial |
$9,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,272.15
|
| Rate for Payer: WPS Commercial |
$1,713.24
|
|
|
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 |
$648.48 |
| Max. Negotiated Rate |
$9,264.00 |
| Rate for Payer: Aetna Commercial |
$2,084.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.76
|
| Rate for Payer: Aetna Managed Medicare |
$648.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,505.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,158.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,111.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.48
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna Commercial |
$2,130.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,296.03
|
| Rate for Payer: Health EOS Commercial |
$2,061.24
|
| Rate for Payer: HFN Commercial |
$2,130.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,737.00
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.84
|
| Rate for Payer: Quartz Commercial |
$1,505.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,389.60
|
| Rate for Payer: The Alliance Commercial |
$9,264.00
|
| Rate for Payer: WEA Trust Commercial |
$1,273.80
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
