|
SCREW BIOMET LOCK 2.4 X 14MM ST GREEN 76-2414
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.79 |
| Max. Negotiated Rate |
$1,813.32 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,182.60
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
SCREW BIOMET LOCK 2.4 X 14MM ST GREEN 76-2414
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$7,884.00 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Aetna Managed Medicare |
$551.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$985.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,102.97
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,478.25
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,281.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,182.60
|
| Rate for Payer: The Alliance Commercial |
$7,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
SCREW BIOMET LOCK 2.4 X 16MM ST GREEN 76-2416
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK 2.4 X 16MM ST GREEN 76-2416
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$3,652.00 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$255.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.75
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$547.80
|
| Rate for Payer: The Alliance Commercial |
$3,652.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK 2.4 X 7MM ST GREEN 76-2407
|
Facility
|
IP
|
$2,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.78 |
| Max. Negotiated Rate |
$2,412.24 |
| Rate for Payer: Aetna Commercial |
$2,359.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.66
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$2,412.24
|
| Rate for Payer: Health EOS Commercial |
$2,333.58
|
| Rate for Payer: HFN Commercial |
$2,412.24
|
| Rate for Payer: Multiplan Commercial |
$2,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.78
|
| Rate for Payer: Quartz Commercial |
$1,573.20
|
| Rate for Payer: WEA Trust Commercial |
$1,442.10
|
| Rate for Payer: WPS Commercial |
$1,942.12
|
|
|
SCREW BIOMET LOCK 2.4 X 7MM ST GREEN 76-2407
|
Facility
|
OP
|
$2,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.16 |
| Max. Negotiated Rate |
$10,488.00 |
| Rate for Payer: Aetna Commercial |
$2,359.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.92
|
| Rate for Payer: Aetna Managed Medicare |
$734.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.66
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$2,412.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.27
|
| Rate for Payer: Health EOS Commercial |
$2,333.58
|
| Rate for Payer: HFN Commercial |
$2,412.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,966.50
|
| Rate for Payer: Multiplan Commercial |
$2,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.78
|
| Rate for Payer: Quartz Commercial |
$1,704.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.20
|
| Rate for Payer: The Alliance Commercial |
$10,488.00
|
| Rate for Payer: WEA Trust Commercial |
$1,442.10
|
| Rate for Payer: WPS Commercial |
$1,942.12
|
|
|
SCREW BIOMET LOCK 2.4 X 8MM ST GREEN 76-2408
|
Facility
|
OP
|
$2,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.96 |
| Max. Negotiated Rate |
$8,728.00 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Aetna Managed Medicare |
$610.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.05
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.50
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,418.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.20
|
| Rate for Payer: The Alliance Commercial |
$8,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
SCREW BIOMET LOCK 2.4 X 8MM ST GREEN 76-2408
|
Facility
|
IP
|
$2,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.18 |
| Max. Negotiated Rate |
$2,007.44 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,309.20
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 10MM GOLD 73-2410
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 10MM GOLD 73-2410
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$3,652.00 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$255.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.75
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$547.80
|
| Rate for Payer: The Alliance Commercial |
$3,652.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 12MM GOLD 73-2412
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 12MM GOLD 73-2412
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.50
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.00
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$616.20
|
| Rate for Payer: Quartz Medicare Advantage |
$568.80
|
| Rate for Payer: The Alliance Commercial |
$3,792.00
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 14MM GOLD 73-2414
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 14MM GOLD 73-2414
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.50
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.00
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$616.20
|
| Rate for Payer: Quartz Medicare Advantage |
$568.80
|
| Rate for Payer: The Alliance Commercial |
$3,792.00
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 16MM GOLD 73-2416
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.50
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.00
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$616.20
|
| Rate for Payer: Quartz Medicare Advantage |
$568.80
|
| Rate for Payer: The Alliance Commercial |
$3,792.00
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 16MM GOLD 73-2416
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 18MM GOLD 73-2418
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.50
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.00
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$616.20
|
| Rate for Payer: Quartz Medicare Advantage |
$568.80
|
| Rate for Payer: The Alliance Commercial |
$3,792.00
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 18MM GOLD 73-2418
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 20MM GOLD 73-2420
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$3,652.00 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$255.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.75
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$547.80
|
| Rate for Payer: The Alliance Commercial |
$3,652.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 20MM GOLD 73-2420
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 8MM GOLD 73-2408
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$3,652.00 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$255.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.75
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$547.80
|
| Rate for Payer: The Alliance Commercial |
$3,652.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.4 X 8MM GOLD 73-2408
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.7 X 10MM MAGENTA 73-2710
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.7 X 10MM MAGENTA 73-2710
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$3,652.00 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$255.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.75
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$547.80
|
| Rate for Payer: The Alliance Commercial |
$3,652.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
SCREW BIOMET LOCK CANC 2.7 X 12MM MAGENTA 73-2712
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
