|
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 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 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
|
IP
|
$4,755.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,329.95 |
| Max. Negotiated Rate |
$4,374.60 |
| Rate for Payer: Aetna Commercial |
$4,279.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.30
|
| 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: Health EOS Commercial |
$4,231.95
|
| Rate for Payer: HFN Commercial |
$4,374.60
|
| 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 |
$2,853.00
|
| Rate for Payer: WEA Trust Commercial |
$2,615.25
|
| Rate for Payer: WPS Commercial |
$3,522.03
|
|
|
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
|
|
|
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 |
$2,548.98 |
| Max. Negotiated Rate |
$4,785.84 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,121.20
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$1,456.56 |
| Max. Negotiated Rate |
$20,808.00 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,381.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,601.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,911.04
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,901.50
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,381.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,121.20
|
| Rate for Payer: The Alliance Commercial |
$20,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$1,332.52 |
| Max. Negotiated Rate |
$19,036.00 |
| Rate for Payer: Aetna Commercial |
$4,283.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,093.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.27
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,378.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,663.14
|
| Rate for Payer: Health EOS Commercial |
$4,235.51
|
| Rate for Payer: HFN Commercial |
$4,378.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,569.25
|
| Rate for Payer: Multiplan Commercial |
$3,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,855.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.91
|
| Rate for Payer: Quartz Commercial |
$3,093.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,855.40
|
| Rate for Payer: The Alliance Commercial |
$19,036.00
|
| Rate for Payer: WEA Trust Commercial |
$2,617.45
|
| Rate for Payer: WPS Commercial |
$3,524.99
|
|
|
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 |
$2,331.91 |
| Max. Negotiated Rate |
$4,378.28 |
| Rate for Payer: Aetna Commercial |
$4,283.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.27
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,378.28
|
| Rate for Payer: Health EOS Commercial |
$4,235.51
|
| Rate for Payer: HFN Commercial |
$4,378.28
|
| Rate for Payer: Multiplan Commercial |
$3,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,855.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.91
|
| Rate for Payer: Quartz Commercial |
$2,855.40
|
| Rate for Payer: WEA Trust Commercial |
$2,617.45
|
| Rate for Payer: WPS Commercial |
$3,524.99
|
|
|
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 |
$2,548.98 |
| Max. Negotiated Rate |
$4,785.84 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,121.20
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$1,456.56 |
| Max. Negotiated Rate |
$20,808.00 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,381.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,601.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,911.04
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,901.50
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,381.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,121.20
|
| Rate for Payer: The Alliance Commercial |
$20,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$1,456.56 |
| Max. Negotiated Rate |
$20,808.00 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,381.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,601.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,911.04
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,901.50
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,381.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,121.20
|
| Rate for Payer: The Alliance Commercial |
$20,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$2,548.98 |
| Max. Negotiated Rate |
$4,785.84 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.06
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cigna Commercial |
$4,785.84
|
| Rate for Payer: Health EOS Commercial |
$4,629.78
|
| Rate for Payer: HFN Commercial |
$4,785.84
|
| Rate for Payer: Multiplan Commercial |
$4,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.98
|
| Rate for Payer: Quartz Commercial |
$3,121.20
|
| Rate for Payer: WEA Trust Commercial |
$2,861.10
|
| Rate for Payer: WPS Commercial |
$3,853.12
|
|
|
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 |
$2,334.85 |
| Max. Negotiated Rate |
$4,383.80 |
| Rate for Payer: Aetna Commercial |
$4,288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,097.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,525.45
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,383.80
|
| Rate for Payer: Health EOS Commercial |
$4,240.85
|
| Rate for Payer: HFN Commercial |
$4,383.80
|
| Rate for Payer: Multiplan Commercial |
$3,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,859.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,383.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,334.85
|
| Rate for Payer: Quartz Commercial |
$2,859.00
|
| Rate for Payer: WEA Trust Commercial |
$2,620.75
|
| Rate for Payer: WPS Commercial |
$3,529.44
|
|
|
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 |
$1,334.20 |
| Max. Negotiated Rate |
$19,060.00 |
| Rate for Payer: Aetna Commercial |
$4,288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,097.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,334.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,097.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,382.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,287.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,525.45
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,383.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,666.49
|
| Rate for Payer: Health EOS Commercial |
$4,240.85
|
| Rate for Payer: HFN Commercial |
$4,383.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,573.75
|
| Rate for Payer: Multiplan Commercial |
$3,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,859.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,383.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,334.85
|
| Rate for Payer: Quartz Commercial |
$3,097.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,859.00
|
| Rate for Payer: The Alliance Commercial |
$19,060.00
|
| Rate for Payer: WEA Trust Commercial |
$2,620.75
|
| Rate for Payer: WPS Commercial |
$3,529.44
|
|
|
SCREW ACUTRAK 24MM AT2M-24
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.20 |
| Max. Negotiated Rate |
$19,060.00 |
| Rate for Payer: Aetna Commercial |
$4,288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,097.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,334.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,097.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,382.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,287.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,525.45
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,383.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,666.49
|
| Rate for Payer: Health EOS Commercial |
$4,240.85
|
| Rate for Payer: HFN Commercial |
$4,383.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,573.75
|
| Rate for Payer: Multiplan Commercial |
$3,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,859.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,383.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,334.85
|
| Rate for Payer: Quartz Commercial |
$3,097.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,859.00
|
| Rate for Payer: The Alliance Commercial |
$19,060.00
|
| Rate for Payer: WEA Trust Commercial |
$2,620.75
|
| Rate for Payer: WPS Commercial |
$3,529.44
|
|
|
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 |
$2,334.85 |
| Max. Negotiated Rate |
$4,383.80 |
| Rate for Payer: Aetna Commercial |
$4,288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,097.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,525.45
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,383.80
|
| Rate for Payer: Health EOS Commercial |
$4,240.85
|
| Rate for Payer: HFN Commercial |
$4,383.80
|
| Rate for Payer: Multiplan Commercial |
$3,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,859.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,383.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,334.85
|
| Rate for Payer: Quartz Commercial |
$2,859.00
|
| Rate for Payer: WEA Trust Commercial |
$2,620.75
|
| Rate for Payer: WPS Commercial |
$3,529.44
|
|
|
SCREW ACUTRAK 26MM MINI AT2-M26-S
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.12 |
| Max. Negotiated Rate |
$19,816.00 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,260.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,220.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,772.26
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,715.50
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,972.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$3,220.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,972.40
|
| Rate for Payer: The Alliance Commercial |
$19,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
SCREW ACUTRAK 26MM MINI AT2-M26-S
|
Facility
|
IP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,427.46 |
| Max. Negotiated Rate |
$4,557.68 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,260.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,972.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$2,972.40
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
SCREW ACUTRAK 30MM MINI AT2-M30
|
Facility
|
IP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,427.46 |
| Max. Negotiated Rate |
$4,557.68 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,260.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,972.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$2,972.40
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
SCREW ACUTRAK 30MM MINI AT2-M30
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.12 |
| Max. Negotiated Rate |
$19,816.00 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,260.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,220.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,772.26
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,715.50
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,972.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$3,220.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,972.40
|
| Rate for Payer: The Alliance Commercial |
$19,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
SCREW ACUTRAK 30MM STD AT2-530-S
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964165
|
|
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
|
|
