|
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 |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
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 |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
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 |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
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 |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
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 |
$3,862.77 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$4,729.92
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
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 |
$2,207.30 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,207.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,124.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,941.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,783.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,411.56
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$5,124.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,729.92
|
| Rate for Payer: The Alliance Commercial |
$3,941.60
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
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 |
$3,862.77 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$4,729.92
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
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 |
$2,207.30 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,207.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,124.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,941.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,783.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,411.56
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$5,124.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,729.92
|
| Rate for Payer: The Alliance Commercial |
$3,941.60
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
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 |
$2,122.27 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,926.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,789.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.62
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,684.64
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,547.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,926.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,547.71
|
| Rate for Payer: The Alliance Commercial |
$3,789.76
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
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 |
$3,713.96 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,547.71
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
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 |
$3,862.77 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$4,729.92
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
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 |
$2,207.30 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,207.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,124.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,941.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,783.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,411.56
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$5,124.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,729.92
|
| Rate for Payer: The Alliance Commercial |
$3,941.60
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
SCREW CENTRAL NON-LOCKING UNIVERSAL GLENOID 25MM AR-9165-25NL
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
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 |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CENTRAL UNIVERSAL GLENOID 20MM AR-9165-20
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4220567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CENTRAL UNIVERSAL GLENOID 20MM AR-9165-20
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4220567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CENTRAL UNIVERSAL GLENOID NL 20MM AR-9165-20NL
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CENTRAL UNIVERSAL GLENOID NL 20MM AR-9165-20NL
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CHAMFERED 5.5 X 55MM 56025555
|
Facility
|
IP
|
$7,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,014.63 |
| Max. Negotiated Rate |
$7,537.67 |
| Rate for Payer: Aetna Commercial |
$7,373.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,046.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna Commercial |
$7,537.67
|
| Rate for Payer: Health EOS Commercial |
$7,291.88
|
| Rate for Payer: HFN Commercial |
$7,537.67
|
| Rate for Payer: Multiplan Commercial |
$6,554.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,537.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,014.63
|
| Rate for Payer: Quartz Commercial |
$4,915.87
|
| Rate for Payer: WEA Trust Commercial |
$4,506.22
|
| Rate for Payer: WPS Commercial |
$6,068.42
|
|
|
SCREW CHAMFERED 5.5 X 55MM 56025555
|
Facility
|
OP
|
$7,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.07 |
| Max. Negotiated Rate |
$7,537.67 |
| Rate for Payer: Aetna Commercial |
$7,373.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,046.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,294.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,325.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,096.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,932.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna Commercial |
$7,537.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,585.00
|
| Rate for Payer: Health EOS Commercial |
$7,291.88
|
| Rate for Payer: HFN Commercial |
$7,537.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,144.84
|
| Rate for Payer: Multiplan Commercial |
$6,554.50
|
| Rate for Payer: NAPHCARE Commercial |
$4,915.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,537.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,014.63
|
| Rate for Payer: Quartz Commercial |
$5,325.53
|
| Rate for Payer: Quartz Medicare Advantage |
$4,915.87
|
| Rate for Payer: The Alliance Commercial |
$4,096.56
|
| Rate for Payer: WEA Trust Commercial |
$4,506.22
|
| Rate for Payer: WPS Commercial |
$6,068.42
|
|
|
SCREW COMPRESSION 7.0 XL 50MM FULL-THREAD AR-8770-55H
|
Facility
|
OP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.25 |
| Max. Negotiated Rate |
$4,952.40 |
| Rate for Payer: Aetna Commercial |
$4,844.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,629.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,507.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,498.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,691.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,583.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,853.01
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$4,952.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,012.43
|
| Rate for Payer: Health EOS Commercial |
$4,790.91
|
| Rate for Payer: HFN Commercial |
$4,952.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,037.28
|
| Rate for Payer: Multiplan Commercial |
$4,306.43
|
| Rate for Payer: NAPHCARE Commercial |
$3,229.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,952.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,637.69
|
| Rate for Payer: Quartz Commercial |
$3,498.98
|
| Rate for Payer: Quartz Medicare Advantage |
$3,229.82
|
| Rate for Payer: The Alliance Commercial |
$2,691.52
|
| Rate for Payer: WEA Trust Commercial |
$2,960.67
|
| Rate for Payer: WPS Commercial |
$3,987.07
|
|
|
SCREW COMPRESSION 7.0 XL 50MM FULL-THREAD AR-8770-55H
|
Facility
|
IP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.69 |
| Max. Negotiated Rate |
$4,952.40 |
| Rate for Payer: Aetna Commercial |
$4,844.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,629.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,853.01
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$4,952.40
|
| Rate for Payer: Health EOS Commercial |
$4,790.91
|
| Rate for Payer: HFN Commercial |
$4,952.40
|
| Rate for Payer: Multiplan Commercial |
$4,306.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,952.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,637.69
|
| Rate for Payer: Quartz Commercial |
$3,229.82
|
| Rate for Payer: WEA Trust Commercial |
$2,960.67
|
| Rate for Payer: WPS Commercial |
$3,987.07
|
|
|
SCREW-COMPRESSION AMBI 19.0MM 121116
|
Facility
|
IP
|
$546.00
|
|
| Hospital Charge Code |
2966039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$340.70
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
SCREW-COMPRESSION AMBI 19.0MM 121116
|
Facility
|
OP
|
$546.00
|
|
| Hospital Charge Code |
2966039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.77
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.88
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: NAPHCARE Commercial |
$340.70
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$369.10
|
| Rate for Payer: Quartz Medicare Advantage |
$340.70
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
SCREW-COMPRESSION AMBI 28.5MM 121117
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
2966040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
