|
SCREW BIOMET LOCK CANC 2.7 X 12MM MAGENTA 73-2712
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415900
|
|
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 2.7 X 14MM MAGENTA 73-2714
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415901
|
|
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 2.7 X 14MM MAGENTA 73-2714
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415901
|
|
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 2.7 X 16MM MAGENTA 73-2716
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415902
|
|
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 2.7 X 16MM MAGENTA 73-2716
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415902
|
|
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 2.7 X 18MM MAGENTA 73-2718
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415903
|
|
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 2.7 X 18MM MAGENTA 73-2718
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415903
|
|
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 2.7 X 20MM MAGENTA 73-2720
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415904
|
|
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 20MM MAGENTA 73-2720
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415904
|
|
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 8MM MAGENTA 73-2708
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415898
|
|
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 8MM MAGENTA 73-2708
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415898
|
|
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 RESCUE LOCK 2.7 X 10MM PURPLE 76-2710
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583274
|
|
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 RESCUE LOCK 2.7 X 10MM PURPLE 76-2710
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583274
|
|
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 RESCUE LOCK 2.7 X 12MM PURPLE 76-2712
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583275
|
|
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 RESCUE LOCK 2.7 X 12MM PURPLE 76-2712
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583275
|
|
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 RESCUE LOCK 2.7 X 16MM PURPLE 76-2716
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583277
|
|
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 RESCUE LOCK 2.7 X 16MM PURPLE 76-2716
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583277
|
|
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 RESCUE LOCK 2.7 X 8MM PURPLE 76-2708
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583273
|
|
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 RESCUE LOCK 2.7 X 8MM PURPLE 76-2708
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583273
|
|
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 BIO-TRANSFIX 5 X 40mm
|
Facility
|
OP
|
$2,183.00
|
|
| Hospital Charge Code |
2964717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.24 |
| Max. Negotiated Rate |
$8,732.00 |
| Rate for Payer: Aetna Commercial |
$1,964.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,877.38
|
| Rate for Payer: Aetna Managed Medicare |
$611.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,091.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.99
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,008.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.61
|
| Rate for Payer: Health EOS Commercial |
$1,942.87
|
| Rate for Payer: HFN Commercial |
$2,008.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,637.25
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,008.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.67
|
| Rate for Payer: Quartz Commercial |
$1,418.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.80
|
| Rate for Payer: The Alliance Commercial |
$8,732.00
|
| Rate for Payer: WEA Trust Commercial |
$1,200.65
|
| Rate for Payer: WPS Commercial |
$1,616.95
|
|
|
SCREW BIO-TRANSFIX 5 X 40mm
|
Facility
|
IP
|
$2,183.00
|
|
| Hospital Charge Code |
2964717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.67 |
| Max. Negotiated Rate |
$2,008.36 |
| Rate for Payer: Aetna Commercial |
$1,964.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,877.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.99
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,008.36
|
| Rate for Payer: Health EOS Commercial |
$1,942.87
|
| Rate for Payer: HFN Commercial |
$2,008.36
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,008.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.67
|
| Rate for Payer: Quartz Commercial |
$1,309.80
|
| Rate for Payer: WEA Trust Commercial |
$1,200.65
|
| Rate for Payer: WPS Commercial |
$1,616.95
|
|
|
SCREW BIO-TRANSFIX AR-1351LB
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
2964698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,925.21 |
| Max. Negotiated Rate |
$3,614.68 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,357.40
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW BIO-TRANSFIX AR-1351LB
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
2964698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.12 |
| Max. Negotiated Rate |
$15,716.00 |
| Rate for Payer: Aetna Commercial |
$3,536.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,100.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,553.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,885.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,082.37
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,614.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,198.67
|
| Rate for Payer: Health EOS Commercial |
$3,496.81
|
| Rate for Payer: HFN Commercial |
$3,614.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,946.75
|
| Rate for Payer: Multiplan Commercial |
$3,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,357.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,614.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,925.21
|
| Rate for Payer: Quartz Commercial |
$2,553.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,357.40
|
| Rate for Payer: The Alliance Commercial |
$15,716.00
|
| Rate for Payer: WEA Trust Commercial |
$2,160.95
|
| Rate for Payer: WPS Commercial |
$2,910.21
|
|
|
SCREW CAGE LARGE 40MM AR-9301-03
|
Facility
|
IP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,649.97 |
| Max. Negotiated Rate |
$16,240.76 |
| Rate for Payer: Aetna Commercial |
$15,887.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,181.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,356.09
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,240.76
|
| Rate for Payer: Health EOS Commercial |
$15,711.17
|
| Rate for Payer: HFN Commercial |
$16,240.76
|
| Rate for Payer: Multiplan Commercial |
$14,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,240.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,649.97
|
| Rate for Payer: Quartz Commercial |
$10,591.80
|
| Rate for Payer: WEA Trust Commercial |
$9,709.15
|
| Rate for Payer: WPS Commercial |
$13,075.58
|
|
|
SCREW CAGE LARGE 40MM AR-9301-03
|
Facility
|
OP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,942.84 |
| Max. Negotiated Rate |
$70,612.00 |
| Rate for Payer: Aetna Commercial |
$15,887.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,181.58
|
| Rate for Payer: Aetna Managed Medicare |
$4,942.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,474.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,826.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,473.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,356.09
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,240.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,878.62
|
| Rate for Payer: Health EOS Commercial |
$15,711.17
|
| Rate for Payer: HFN Commercial |
$16,240.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,239.75
|
| Rate for Payer: Multiplan Commercial |
$14,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,240.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,649.97
|
| Rate for Payer: Quartz Commercial |
$11,474.45
|
| Rate for Payer: Quartz Medicare Advantage |
$10,591.80
|
| Rate for Payer: The Alliance Commercial |
$70,612.00
|
| Rate for Payer: WEA Trust Commercial |
$9,709.15
|
| Rate for Payer: WPS Commercial |
$13,075.58
|
|
