|
SCREW CANN VAL 5.0 X 85MM OPTILINK TI 42.231.685
|
Facility
|
IP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.02 |
| Max. Negotiated Rate |
$2,279.39 |
| Rate for Payer: Aetna Commercial |
$2,229.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,130.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.13
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,279.39
|
| Rate for Payer: Health EOS Commercial |
$2,205.06
|
| Rate for Payer: HFN Commercial |
$2,279.39
|
| Rate for Payer: Multiplan Commercial |
$1,982.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.02
|
| Rate for Payer: Quartz Commercial |
$1,486.56
|
| Rate for Payer: WEA Trust Commercial |
$1,362.68
|
| Rate for Payer: WPS Commercial |
$1,835.16
|
|
|
SCREW CANN VAL 5.0 X 85MM OPTILINK TI 42.231.685
|
Facility
|
OP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.73 |
| Max. Negotiated Rate |
$9,910.40 |
| Rate for Payer: Aetna Commercial |
$2,229.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,130.74
|
| Rate for Payer: Aetna Managed Medicare |
$693.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,610.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,238.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.13
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,386.46
|
| Rate for Payer: Health EOS Commercial |
$2,205.06
|
| Rate for Payer: HFN Commercial |
$2,279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.20
|
| Rate for Payer: Multiplan Commercial |
$1,982.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.02
|
| Rate for Payer: Quartz Commercial |
$1,610.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,486.56
|
| Rate for Payer: The Alliance Commercial |
$9,910.40
|
| Rate for Payer: WEA Trust Commercial |
$1,362.68
|
| Rate for Payer: WPS Commercial |
$1,835.16
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 38MM 8001-038
|
Facility
|
OP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.24 |
| Max. Negotiated Rate |
$9,932.00 |
| Rate for Payer: Aetna Commercial |
$2,234.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,135.38
|
| Rate for Payer: Aetna Managed Medicare |
$695.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,613.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,241.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,191.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,315.99
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,284.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,389.49
|
| Rate for Payer: Health EOS Commercial |
$2,209.87
|
| Rate for Payer: HFN Commercial |
$2,284.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,862.25
|
| Rate for Payer: Multiplan Commercial |
$1,986.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,489.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,284.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,216.67
|
| Rate for Payer: Quartz Commercial |
$1,613.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,489.80
|
| Rate for Payer: The Alliance Commercial |
$9,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,365.65
|
| Rate for Payer: WPS Commercial |
$1,839.16
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 38MM 8001-038
|
Facility
|
IP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.67 |
| Max. Negotiated Rate |
$2,284.36 |
| Rate for Payer: Aetna Commercial |
$2,234.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,135.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,315.99
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,284.36
|
| Rate for Payer: Health EOS Commercial |
$2,209.87
|
| Rate for Payer: HFN Commercial |
$2,284.36
|
| Rate for Payer: Multiplan Commercial |
$1,986.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,489.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,284.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,216.67
|
| Rate for Payer: Quartz Commercial |
$1,489.80
|
| Rate for Payer: WEA Trust Commercial |
$1,365.65
|
| Rate for Payer: WPS Commercial |
$1,839.16
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 40MM 8001-040
|
Facility
|
OP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.24 |
| Max. Negotiated Rate |
$9,932.00 |
| Rate for Payer: Aetna Commercial |
$2,234.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,135.38
|
| Rate for Payer: Aetna Managed Medicare |
$695.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,613.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,241.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,191.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,315.99
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,284.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,389.49
|
| Rate for Payer: Health EOS Commercial |
$2,209.87
|
| Rate for Payer: HFN Commercial |
$2,284.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,862.25
|
| Rate for Payer: Multiplan Commercial |
$1,986.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,489.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,284.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,216.67
|
| Rate for Payer: Quartz Commercial |
$1,613.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,489.80
|
| Rate for Payer: The Alliance Commercial |
$9,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,365.65
|
| Rate for Payer: WPS Commercial |
$1,839.16
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 40MM 8001-040
|
Facility
|
IP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.67 |
| Max. Negotiated Rate |
$2,284.36 |
| Rate for Payer: Aetna Commercial |
$2,234.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,135.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,315.99
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,284.36
|
| Rate for Payer: Health EOS Commercial |
$2,209.87
|
| Rate for Payer: HFN Commercial |
$2,284.36
|
| Rate for Payer: Multiplan Commercial |
$1,986.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,489.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,284.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,216.67
|
| Rate for Payer: Quartz Commercial |
$1,489.80
|
| Rate for Payer: WEA Trust Commercial |
$1,365.65
|
| Rate for Payer: WPS Commercial |
$1,839.16
|
|
|
SCREW CAPTURE HEADLESS 2.5 X 16MM AH2516
|
Facility
|
IP
|
$2,788.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.12 |
| Max. Negotiated Rate |
$2,564.96 |
| Rate for Payer: Aetna Commercial |
$2,509.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,397.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,477.64
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,564.96
|
| Rate for Payer: Health EOS Commercial |
$2,481.32
|
| Rate for Payer: HFN Commercial |
$2,564.96
|
| Rate for Payer: Multiplan Commercial |
$2,230.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,672.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,564.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.12
|
| Rate for Payer: Quartz Commercial |
$1,672.80
|
| Rate for Payer: WEA Trust Commercial |
$1,533.40
|
| Rate for Payer: WPS Commercial |
$2,065.07
|
|
|
SCREW CAPTURE HEADLESS 2.5 X 16MM AH2516
|
Facility
|
OP
|
$2,788.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.64 |
| Max. Negotiated Rate |
$11,152.00 |
| Rate for Payer: Aetna Commercial |
$2,509.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,397.68
|
| Rate for Payer: Aetna Managed Medicare |
$780.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,812.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,394.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,338.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,477.64
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,564.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,560.16
|
| Rate for Payer: Health EOS Commercial |
$2,481.32
|
| Rate for Payer: HFN Commercial |
$2,564.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,091.00
|
| Rate for Payer: Multiplan Commercial |
$2,230.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,672.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,564.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.12
|
| Rate for Payer: Quartz Commercial |
$1,812.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,672.80
|
| Rate for Payer: The Alliance Commercial |
$11,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,533.40
|
| Rate for Payer: WPS Commercial |
$2,065.07
|
|
|
SCREW CENTRAL COMPREHENSIVE REVERSE SHOULDER 6.5MM X 20MM 115394
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.64 |
| Max. Negotiated Rate |
$4,452.00 |
| Rate for Payer: Aetna Commercial |
$1,001.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.18
|
| Rate for Payer: Aetna Managed Medicare |
$311.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$723.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$556.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.89
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,023.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.83
|
| Rate for Payer: Health EOS Commercial |
$990.57
|
| Rate for Payer: HFN Commercial |
$1,023.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$834.75
|
| Rate for Payer: Multiplan Commercial |
$890.40
|
| Rate for Payer: NAPHCARE Commercial |
$667.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.96
|
| Rate for Payer: Quartz Beloit One Network |
$545.37
|
| Rate for Payer: Quartz Commercial |
$723.45
|
| Rate for Payer: Quartz Medicare Advantage |
$667.80
|
| Rate for Payer: The Alliance Commercial |
$4,452.00
|
| Rate for Payer: WEA Trust Commercial |
$612.15
|
| Rate for Payer: WPS Commercial |
$824.40
|
|
|
SCREW CENTRAL COMPREHENSIVE REVERSE SHOULDER 6.5MM X 20MM 115394
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.37 |
| Max. Negotiated Rate |
$1,023.96 |
| Rate for Payer: Aetna Commercial |
$1,001.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.89
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,023.96
|
| Rate for Payer: Health EOS Commercial |
$990.57
|
| Rate for Payer: HFN Commercial |
$1,023.96
|
| Rate for Payer: Multiplan Commercial |
$890.40
|
| Rate for Payer: NAPHCARE Commercial |
$667.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.96
|
| Rate for Payer: Quartz Beloit One Network |
$545.37
|
| Rate for Payer: Quartz Commercial |
$667.80
|
| Rate for Payer: WEA Trust Commercial |
$612.15
|
| Rate for Payer: WPS Commercial |
$824.40
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4433204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4433204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.87 |
| Max. Negotiated Rate |
$2,081.96 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,357.80
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15NL
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.87 |
| Max. Negotiated Rate |
$2,081.96 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,357.80
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15NL
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 25MM AR-9165-25
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4240353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 25MM AR-9165-25
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4240353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.87 |
| Max. Negotiated Rate |
$2,081.96 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,357.80
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 20MM AR-9561-20S
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 20MM AR-9561-20S
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$30,320.00 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: The Alliance Commercial |
$30,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 25MM AR-9561-25S
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$30,320.00 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: The Alliance Commercial |
$30,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 25MM AR-9561-25S
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 30MM AR-9561-30S
|
Facility
|
IP
|
$7,288.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,571.12 |
| Max. Negotiated Rate |
$6,704.96 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,372.80
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 30MM AR-9561-30S
|
Facility
|
OP
|
$7,288.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.64 |
| Max. Negotiated Rate |
$29,152.00 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.36
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.00
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,737.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 35MM AR-9561-35S
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$30,320.00 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: The Alliance Commercial |
$30,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 35MM AR-9561-35S
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL NON-LOCKING UNIVERSAL GLENOID 25MM AR-9165-25NL
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
