|
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 |
$1,435.21 |
| Max. Negotiated Rate |
$2,694.68 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,757.40
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
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 |
$1,435.21 |
| Max. Negotiated Rate |
$2,694.68 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,757.40
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
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 |
$820.12 |
| Max. Negotiated Rate |
$11,716.00 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Aetna Managed Medicare |
$820.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.07
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,196.75
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.40
|
| Rate for Payer: The Alliance Commercial |
$11,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
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 |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
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 |
$612.28 |
| Max. Negotiated Rate |
$8,746.80 |
| Rate for Payer: Aetna Commercial |
$1,968.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.56
|
| Rate for Payer: Aetna Managed Medicare |
$612.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,421.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.95
|
| Rate for Payer: Cash Price |
$656.01
|
| Rate for Payer: Cigna Commercial |
$2,011.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.68
|
| Rate for Payer: Health EOS Commercial |
$1,946.16
|
| Rate for Payer: HFN Commercial |
$2,011.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,640.02
|
| Rate for Payer: Multiplan Commercial |
$1,749.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.48
|
| Rate for Payer: Quartz Commercial |
$1,421.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,312.02
|
| Rate for Payer: The Alliance Commercial |
$8,746.80
|
| Rate for Payer: WEA Trust Commercial |
$1,202.68
|
| Rate for Payer: WPS Commercial |
$1,619.69
|
|
|
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 |
$1,071.48 |
| Max. Negotiated Rate |
$2,011.76 |
| Rate for Payer: Aetna Commercial |
$1,968.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.95
|
| Rate for Payer: Cash Price |
$656.01
|
| Rate for Payer: Cigna Commercial |
$2,011.76
|
| Rate for Payer: Health EOS Commercial |
$1,946.16
|
| Rate for Payer: HFN Commercial |
$2,011.76
|
| Rate for Payer: Multiplan Commercial |
$1,749.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.48
|
| Rate for Payer: Quartz Commercial |
$1,312.02
|
| Rate for Payer: WEA Trust Commercial |
$1,202.68
|
| Rate for Payer: WPS Commercial |
$1,619.69
|
|
|
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 |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,435.21 |
| Max. Negotiated Rate |
$2,694.68 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,757.40
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
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 |
$820.12 |
| Max. Negotiated Rate |
$11,716.00 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Aetna Managed Medicare |
$820.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.07
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,196.75
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.40
|
| Rate for Payer: The Alliance Commercial |
$11,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
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 |
$1,854.16 |
| Max. Negotiated Rate |
$3,481.28 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,270.40
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
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 |
$1,059.52 |
| Max. Negotiated Rate |
$15,136.00 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,459.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,892.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,117.53
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,838.00
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,459.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,270.40
|
| Rate for Payer: The Alliance Commercial |
$15,136.00
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
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 |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8835CL-16
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8835CL-16
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8935CL-16
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8935CL-16
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW LAG 10.5 X 80MM GAMMA 3060-0080S
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.16 |
| Max. Negotiated Rate |
$4,585.28 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$2,990.40
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
|
SCREW LAG 10.5 X 80MM GAMMA 3060-0080S
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$19,936.00 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,239.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.05
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.00
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$3,239.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.40
|
| Rate for Payer: The Alliance Commercial |
$19,936.00
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
