|
SCREW KREULOCK COMPRESSION 2.4 X 18MM VAL AR-8724VCL-18
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 20MM VAL AR-8724VCL-20
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 20MM VAL AR-8724VCL-20
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 22MM VAL AR-8724VCL-22
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 22MM VAL AR-8724VCL-22
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 24MM VAL AR-8724VCL-24
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.62 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,827.70
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 24MM VAL AR-8724VCL-24
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Aetna Managed Medicare |
$852.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.68
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.62
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,980.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.70
|
| Rate for Payer: The Alliance Commercial |
$1,523.08
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 26MM VAL AR-8724VCL-26
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Aetna Managed Medicare |
$852.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.68
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.62
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,980.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.70
|
| Rate for Payer: The Alliance Commercial |
$1,523.08
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 26MM VAL AR-8724VCL-26
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.62 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,827.70
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 12MM SS AR-8827CL-12
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6065648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 12MM SS AR-8827CL-12
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6065648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 14MM SS AR-8827CL-14
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6065649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 14MM SS AR-8827CL-14
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6065649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 16MM SS AR-8827CL-16
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 16MM SS AR-8827CL-16
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 18MM SS AR-8827CL-18
|
Facility
|
IP
|
$2,186.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.34 |
| Max. Negotiated Rate |
$2,092.23 |
| Rate for Payer: Aetna Commercial |
$2,046.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,205.31
|
| Rate for Payer: Cash Price |
$656.01
|
| Rate for Payer: Cigna Commercial |
$2,092.23
|
| Rate for Payer: Health EOS Commercial |
$2,024.01
|
| Rate for Payer: HFN Commercial |
$2,092.23
|
| Rate for Payer: Multiplan Commercial |
$1,819.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,092.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,114.34
|
| Rate for Payer: Quartz Commercial |
$1,364.50
|
| Rate for Payer: WEA Trust Commercial |
$1,250.79
|
| Rate for Payer: WPS Commercial |
$1,684.42
|
|
|
SCREW KREULOCK COMPRESSION 2.7 X 18MM SS AR-8827CL-18
|
Facility
|
OP
|
$2,186.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.77 |
| Max. Negotiated Rate |
$2,092.23 |
| Rate for Payer: Aetna Commercial |
$2,046.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.78
|
| Rate for Payer: Aetna Managed Medicare |
$636.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,478.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,205.31
|
| Rate for Payer: Cash Price |
$656.01
|
| Rate for Payer: Cigna Commercial |
$2,092.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,272.66
|
| Rate for Payer: Health EOS Commercial |
$2,024.01
|
| Rate for Payer: HFN Commercial |
$2,092.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,705.63
|
| Rate for Payer: Multiplan Commercial |
$1,819.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,364.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,092.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,114.34
|
| Rate for Payer: Quartz Commercial |
$1,478.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,364.50
|
| Rate for Payer: The Alliance Commercial |
$1,137.08
|
| Rate for Payer: WEA Trust Commercial |
$1,250.79
|
| Rate for Payer: WPS Commercial |
$1,684.42
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 12MM SS AR-8835CL-12
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 12MM SS AR-8835CL-12
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 12MM SS AR-8935CL-12
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.62 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,827.70
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 12MM SS AR-8935CL-12
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Aetna Managed Medicare |
$852.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.68
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.62
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,980.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.70
|
| Rate for Payer: The Alliance Commercial |
$1,523.08
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 14MM SS AR-8835CL-14
|
Facility
|
IP
|
$3,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,928.33 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,361.22
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 14MM SS AR-8835CL-14
|
Facility
|
OP
|
$3,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.90 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.29
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.52
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,557.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.22
|
| Rate for Payer: The Alliance Commercial |
$1,967.68
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 14MM SS AR-8935CL-14
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 14MM SS AR-8935CL-14
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
