|
SCREW ACL BIO-TRANSFIX 9MM AR-5028C-09
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
3072504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.12 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,144.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,656.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,043.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,961.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,286.68
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,064.62
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,451.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,656.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,451.70
|
| Rate for Payer: The Alliance Commercial |
$2,043.08
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
SCREW ACL BIO-TRANSFIX 9MM AR-5028C-09
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
3072504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.22 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,451.70
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
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 |
$897.77 |
| Max. Negotiated Rate |
$2,949.81 |
| Rate for Payer: Aetna Commercial |
$2,885.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,757.44
|
| Rate for Payer: Aetna Managed Medicare |
$897.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,084.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,603.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,539.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,699.35
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,949.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,794.31
|
| Rate for Payer: Health EOS Commercial |
$2,853.62
|
| Rate for Payer: HFN Commercial |
$2,949.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,404.74
|
| Rate for Payer: Multiplan Commercial |
$2,565.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,923.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,949.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.10
|
| Rate for Payer: Quartz Commercial |
$2,084.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,923.79
|
| Rate for Payer: The Alliance Commercial |
$1,603.16
|
| Rate for Payer: WEA Trust Commercial |
$1,763.48
|
| Rate for Payer: WPS Commercial |
$2,374.83
|
|
|
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 |
$1,571.10 |
| Max. Negotiated Rate |
$2,949.81 |
| Rate for Payer: Aetna Commercial |
$2,885.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,757.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,699.35
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,949.81
|
| Rate for Payer: Health EOS Commercial |
$2,853.62
|
| Rate for Payer: HFN Commercial |
$2,949.81
|
| Rate for Payer: Multiplan Commercial |
$2,565.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,949.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.10
|
| Rate for Payer: Quartz Commercial |
$1,923.79
|
| Rate for Payer: WEA Trust Commercial |
$1,763.48
|
| Rate for Payer: WPS Commercial |
$2,374.83
|
|
|
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 |
$2,518.44 |
| Max. Negotiated Rate |
$4,728.51 |
| Rate for Payer: Aetna Commercial |
$4,625.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,420.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,724.03
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$4,728.51
|
| Rate for Payer: Health EOS Commercial |
$4,574.32
|
| Rate for Payer: HFN Commercial |
$4,728.51
|
| Rate for Payer: Multiplan Commercial |
$4,111.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,728.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,518.44
|
| Rate for Payer: Quartz Commercial |
$3,083.81
|
| Rate for Payer: WEA Trust Commercial |
$2,826.82
|
| Rate for Payer: WPS Commercial |
$3,806.82
|
|
|
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 |
$1,439.11 |
| Max. Negotiated Rate |
$4,728.51 |
| Rate for Payer: Aetna Commercial |
$4,625.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,420.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,439.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,340.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,569.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,467.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,724.03
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$4,728.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,876.24
|
| Rate for Payer: Health EOS Commercial |
$4,574.32
|
| Rate for Payer: HFN Commercial |
$4,728.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,854.76
|
| Rate for Payer: Multiplan Commercial |
$4,111.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,083.81
|
| Rate for Payer: Preferred Network Access Commercial |
$4,728.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,518.44
|
| Rate for Payer: Quartz Commercial |
$3,340.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,083.81
|
| Rate for Payer: The Alliance Commercial |
$2,569.84
|
| Rate for Payer: WEA Trust Commercial |
$2,826.82
|
| Rate for Payer: WPS Commercial |
$3,806.82
|
|
|
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 |
$1,816.21 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,223.94
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
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 |
$1,037.84 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.25
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.92
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,409.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.94
|
| Rate for Payer: The Alliance Commercial |
$1,853.28
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
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 |
$1,332.24 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.65
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,568.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$3,092.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.80
|
| Rate for Payer: The Alliance Commercial |
$2,379.00
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
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 |
$2,331.42 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$2,854.80
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
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 |
$1,332.24 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.65
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,568.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$3,092.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.80
|
| Rate for Payer: The Alliance Commercial |
$2,379.00
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
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 |
$2,331.42 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$2,854.80
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
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 |
$1,384.66 |
| Max. Negotiated Rate |
$4,549.58 |
| Rate for Payer: Aetna Commercial |
$4,450.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,252.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,384.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,214.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,472.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,373.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,620.96
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna Commercial |
$4,549.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,767.41
|
| Rate for Payer: Health EOS Commercial |
$4,401.23
|
| Rate for Payer: HFN Commercial |
$4,549.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,708.90
|
| Rate for Payer: Multiplan Commercial |
$3,956.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,967.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,549.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,423.15
|
| Rate for Payer: Quartz Commercial |
$3,214.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,967.12
|
| Rate for Payer: The Alliance Commercial |
$2,472.60
|
| Rate for Payer: WEA Trust Commercial |
$2,719.86
|
| Rate for Payer: WPS Commercial |
$3,662.78
|
|
|
SCREW ACUTRAK 2 20.0MM MICRO AT2-C20
|
Facility
|
IP
|
$4,755.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,423.15 |
| Max. Negotiated Rate |
$4,549.58 |
| Rate for Payer: Aetna Commercial |
$4,450.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,252.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,620.96
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna Commercial |
$4,549.58
|
| Rate for Payer: Health EOS Commercial |
$4,401.23
|
| Rate for Payer: HFN Commercial |
$4,549.58
|
| Rate for Payer: Multiplan Commercial |
$3,956.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,549.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,423.15
|
| Rate for Payer: Quartz Commercial |
$2,967.12
|
| Rate for Payer: WEA Trust Commercial |
$2,719.86
|
| Rate for Payer: WPS Commercial |
$3,662.78
|
|
|
SCREW ACUTRAK 2 22.0MM MICRO AT2-C22
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.94 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,246.05
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 22.0MM MICRO AT2-C22
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.82 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,514.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,516.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,705.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,596.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,027.56
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,057.56
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,246.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,516.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,246.05
|
| Rate for Payer: The Alliance Commercial |
$2,705.04
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 22MM MINI AT2-M22-S
|
Facility
|
OP
|
$4,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.82 |
| Max. Negotiated Rate |
$4,553.41 |
| Rate for Payer: Aetna Commercial |
$4,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,256.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,385.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,217.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,474.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,375.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,623.16
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,553.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,769.74
|
| Rate for Payer: Health EOS Commercial |
$4,404.93
|
| Rate for Payer: HFN Commercial |
$4,553.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,712.02
|
| Rate for Payer: Multiplan Commercial |
$3,959.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,969.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,553.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,425.19
|
| Rate for Payer: Quartz Commercial |
$3,217.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,969.62
|
| Rate for Payer: The Alliance Commercial |
$2,474.68
|
| Rate for Payer: WEA Trust Commercial |
$2,722.15
|
| Rate for Payer: WPS Commercial |
$3,665.86
|
|
|
SCREW ACUTRAK 2 22MM MINI AT2-M22-S
|
Facility
|
IP
|
$4,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,425.19 |
| Max. Negotiated Rate |
$4,553.41 |
| Rate for Payer: Aetna Commercial |
$4,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,256.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,623.16
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,553.41
|
| Rate for Payer: Health EOS Commercial |
$4,404.93
|
| Rate for Payer: HFN Commercial |
$4,553.41
|
| Rate for Payer: Multiplan Commercial |
$3,959.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,553.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,425.19
|
| Rate for Payer: Quartz Commercial |
$2,969.62
|
| Rate for Payer: WEA Trust Commercial |
$2,722.15
|
| Rate for Payer: WPS Commercial |
$3,665.86
|
|
|
SCREW ACUTRAK 2 26.0MM MICRO AT2-C26
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.94 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,246.05
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 26.0MM MICRO AT2-C26
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.82 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,514.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,516.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,705.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,596.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,027.56
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,057.56
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,246.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,516.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,246.05
|
| Rate for Payer: The Alliance Commercial |
$2,705.04
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 28.0MM MICRO AT2-C28
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.94 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,246.05
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 28.0MM MICRO AT2-C28
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.82 |
| Max. Negotiated Rate |
$4,977.27 |
| Rate for Payer: Aetna Commercial |
$4,869.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,514.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,516.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,705.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,596.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.34
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,977.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,027.56
|
| Rate for Payer: Health EOS Commercial |
$4,814.97
|
| Rate for Payer: HFN Commercial |
$4,977.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,057.56
|
| Rate for Payer: Multiplan Commercial |
$4,328.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,246.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.94
|
| Rate for Payer: Quartz Commercial |
$3,516.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,246.05
|
| Rate for Payer: The Alliance Commercial |
$2,705.04
|
| Rate for Payer: WEA Trust Commercial |
$2,975.54
|
| Rate for Payer: WPS Commercial |
$4,007.10
|
|
|
SCREW ACUTRAK 2 28.0MM STD AT2-S28
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.57 |
| Max. Negotiated Rate |
$4,559.15 |
| Rate for Payer: Aetna Commercial |
$4,460.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,261.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,221.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,477.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,378.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,626.47
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,559.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,773.23
|
| Rate for Payer: Health EOS Commercial |
$4,410.48
|
| Rate for Payer: HFN Commercial |
$4,559.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,964.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,973.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,559.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.24
|
| Rate for Payer: Quartz Commercial |
$3,221.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,973.36
|
| Rate for Payer: The Alliance Commercial |
$2,477.80
|
| Rate for Payer: WEA Trust Commercial |
$2,725.58
|
| Rate for Payer: WPS Commercial |
$3,670.48
|
|
|
SCREW ACUTRAK 2 28.0MM STD AT2-S28
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,428.24 |
| Max. Negotiated Rate |
$4,559.15 |
| Rate for Payer: Aetna Commercial |
$4,460.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,626.47
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,559.15
|
| Rate for Payer: Health EOS Commercial |
$4,410.48
|
| Rate for Payer: HFN Commercial |
$4,559.15
|
| Rate for Payer: Multiplan Commercial |
$3,964.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,559.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.24
|
| Rate for Payer: Quartz Commercial |
$2,973.36
|
| Rate for Payer: WEA Trust Commercial |
$2,725.58
|
| Rate for Payer: WPS Commercial |
$3,670.48
|
|
|
SCREW ACUTRAK 24MM AT2M-24
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,428.24 |
| Max. Negotiated Rate |
$4,559.15 |
| Rate for Payer: Aetna Commercial |
$4,460.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,626.47
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,559.15
|
| Rate for Payer: Health EOS Commercial |
$4,410.48
|
| Rate for Payer: HFN Commercial |
$4,559.15
|
| Rate for Payer: Multiplan Commercial |
$3,964.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,559.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.24
|
| Rate for Payer: Quartz Commercial |
$2,973.36
|
| Rate for Payer: WEA Trust Commercial |
$2,725.58
|
| Rate for Payer: WPS Commercial |
$3,670.48
|
|
