|
SCREW 7.3X85 CANNULATED
|
Facility
|
OP
|
$3,336.00
|
|
| Hospital Charge Code |
2966541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.08 |
| Max. Negotiated Rate |
$13,344.00 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Aetna Managed Medicare |
$934.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,168.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,668.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,601.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,866.83
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,502.00
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,168.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,001.60
|
| Rate for Payer: The Alliance Commercial |
$13,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
SCREW 7.3X85 CANNULATED
|
Facility
|
IP
|
$3,336.00
|
|
| Hospital Charge Code |
2966541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.64 |
| Max. Negotiated Rate |
$3,069.12 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,001.60
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
SCREW 7.3X95 CANNULATED
|
Facility
|
OP
|
$3,336.00
|
|
| Hospital Charge Code |
2969387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.08 |
| Max. Negotiated Rate |
$13,344.00 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Aetna Managed Medicare |
$934.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,168.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,668.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,601.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,866.83
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,502.00
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,168.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,001.60
|
| Rate for Payer: The Alliance Commercial |
$13,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
SCREW 7.3X95 CANNULATED
|
Facility
|
IP
|
$3,336.00
|
|
| Hospital Charge Code |
2969387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.64 |
| Max. Negotiated Rate |
$3,069.12 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,001.60
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
SCREW 8X28 BIO COMPOSITE AR-1380TC
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
2964696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,925.21 |
| Max. Negotiated Rate |
$3,614.68 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,357.40
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW 8X28 BIO COMPOSITE AR-1380TC
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
2964696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.12 |
| Max. Negotiated Rate |
$15,716.00 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,100.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,553.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,885.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,198.67
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,946.75
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,553.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,357.40
|
| Rate for Payer: The Alliance Commercial |
$15,716.00
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW 9 X 23MM PEEK INTERFERANCE AR-1390P
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
4520292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW 9 X 23MM PEEK INTERFERANCE AR-1390P
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
4520292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW 9 X 28 TRANSFIX FULLTHREAD AR-1390TC
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
2964697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,925.21 |
| Max. Negotiated Rate |
$3,614.68 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,357.40
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW 9 X 28 TRANSFIX FULLTHREAD AR-1390TC
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
2964697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.12 |
| Max. Negotiated Rate |
$15,716.00 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,100.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,553.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,885.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,198.67
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,946.75
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,553.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,357.40
|
| Rate for Payer: The Alliance Commercial |
$15,716.00
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW ACETABULAR G7 6.5MM X 25MM 010000998
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$543.72 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$354.60
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
SCREW ACETABULAR G7 6.5MM X 25MM 010000998
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Aetna Managed Medicare |
$165.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$384.15
|
| Rate for Payer: Quartz Medicare Advantage |
$354.60
|
| Rate for Payer: The Alliance Commercial |
$2,364.00
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
SCREW ACL BIO-TRANSFIX 9MM AR-5028C-09
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
3072504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,925.21 |
| Max. Negotiated Rate |
$3,614.68 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,357.40
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW ACL BIO-TRANSFIX 9MM AR-5028C-09
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
3072504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.12 |
| Max. Negotiated Rate |
$15,716.00 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,100.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,553.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,885.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,198.67
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,946.75
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,553.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,357.40
|
| Rate for Payer: The Alliance Commercial |
$15,716.00
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW ACULOC 2 VDR EXTENTION LINK 30-0100
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.24 |
| Max. Negotiated Rate |
$12,332.00 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.38
|
| Rate for Payer: Aetna Managed Medicare |
$863.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,541.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,479.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,633.99
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,836.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,725.25
|
| Rate for Payer: Health EOS Commercial |
$2,743.87
|
| Rate for Payer: HFN Commercial |
$2,836.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,312.25
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,849.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.67
|
| Rate for Payer: Quartz Commercial |
$2,003.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,849.80
|
| Rate for Payer: The Alliance Commercial |
$12,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,695.65
|
| Rate for Payer: WPS Commercial |
$2,283.58
|
|
|
SCREW ACULOC 2 VDR EXTENTION LINK 30-0100
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.67 |
| Max. Negotiated Rate |
$2,836.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,633.99
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,836.36
|
| Rate for Payer: Health EOS Commercial |
$2,743.87
|
| Rate for Payer: HFN Commercial |
$2,836.36
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,849.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.67
|
| Rate for Payer: Quartz Commercial |
$1,849.80
|
| Rate for Payer: WEA Trust Commercial |
$1,695.65
|
| Rate for Payer: WPS Commercial |
$2,283.58
|
|
|
SCREW ACUTRAK 20.0 MINI AT2-M20-S
|
Facility
|
IP
|
$4,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.58 |
| Max. Negotiated Rate |
$4,546.64 |
| Rate for Payer: Aetna Commercial |
$4,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,250.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,619.26
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$4,546.64
|
| Rate for Payer: Health EOS Commercial |
$4,398.38
|
| Rate for Payer: HFN Commercial |
$4,546.64
|
| Rate for Payer: Multiplan Commercial |
$3,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,965.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,546.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,421.58
|
| Rate for Payer: Quartz Commercial |
$2,965.20
|
| Rate for Payer: WEA Trust Commercial |
$2,718.10
|
| Rate for Payer: WPS Commercial |
$3,660.54
|
|
|
SCREW ACUTRAK 20.0 MINI AT2-M20-S
|
Facility
|
OP
|
$4,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.76 |
| Max. Negotiated Rate |
$19,768.00 |
| Rate for Payer: Aetna Commercial |
$4,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,250.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,383.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,212.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,471.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,372.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,619.26
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$4,546.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,765.54
|
| Rate for Payer: Health EOS Commercial |
$4,398.38
|
| Rate for Payer: HFN Commercial |
$4,546.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,706.50
|
| Rate for Payer: Multiplan Commercial |
$3,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,965.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,546.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,421.58
|
| Rate for Payer: Quartz Commercial |
$3,212.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,965.20
|
| Rate for Payer: The Alliance Commercial |
$19,768.00
|
| Rate for Payer: WEA Trust Commercial |
$2,718.10
|
| Rate for Payer: WPS Commercial |
$3,660.54
|
|
|
SCREW ACUTRAK 2.0MM FUSION ATF-200-S
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,746.36 |
| Max. Negotiated Rate |
$3,278.88 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,138.40
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$2,639.85
|
|
|
SCREW ACUTRAK 2.0MM FUSION ATF-200-S
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.92 |
| Max. Negotiated Rate |
$14,256.00 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Aetna Managed Medicare |
$997.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,316.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,782.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,994.41
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,673.00
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,316.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,138.40
|
| Rate for Payer: The Alliance Commercial |
$14,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$2,639.85
|
|
|
SCREW ACUTRAK 20MM STD AT2-520-S
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,241.75 |
| Max. Negotiated Rate |
$4,209.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,745.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
SCREW ACUTRAK 20MM STD AT2-520-S
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$18,300.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,281.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,973.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,560.17
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,431.25
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,973.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,745.00
|
| Rate for Payer: The Alliance Commercial |
$18,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
SCREW ACUTRAK 2 16.0MM MICRO AT2-C16
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$18,300.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,281.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,973.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,560.17
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,431.25
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,973.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,745.00
|
| Rate for Payer: The Alliance Commercial |
$18,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
SCREW ACUTRAK 2 16.0MM MICRO AT2-C16
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,241.75 |
| Max. Negotiated Rate |
$4,209.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,745.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
SCREW ACUTRAK 2 20.0MM MICRO AT2-C20
|
Facility
|
OP
|
$4,755.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.40 |
| Max. Negotiated Rate |
$19,020.00 |
| Rate for Payer: Aetna Commercial |
$4,279.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,090.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,377.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,282.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.15
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna Commercial |
$4,374.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.90
|
| Rate for Payer: Health EOS Commercial |
$4,231.95
|
| Rate for Payer: HFN Commercial |
$4,374.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,566.25
|
| Rate for Payer: Multiplan Commercial |
$3,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,853.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.95
|
| Rate for Payer: Quartz Commercial |
$3,090.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,853.00
|
| Rate for Payer: The Alliance Commercial |
$19,020.00
|
| Rate for Payer: WEA Trust Commercial |
$2,615.25
|
| Rate for Payer: WPS Commercial |
$3,522.03
|
|
