|
SCREW PERIPHERAL LOCKING UNIVERS GLENOID 42MM AR-9145-42
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS GLENOID 42MM AR-9145-42
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 16MM AR-9563-16
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 16MM AR-9563-16
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 20MM AR-9563-20
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 20MM AR-9563-20
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 24MM AR-9563-24
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 24MM AR-9563-24
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 28MM AR-9563-28
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 28MM AR-9563-28
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 32MM AR-9563-32
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 32MM AR-9563-32
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 36MM AR-9563-36
|
Facility
|
OP
|
$1,477.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$1,413.19 |
| Rate for Payer: Aetna Commercial |
$1,382.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.03
|
| Rate for Payer: Aetna Managed Medicare |
$430.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.12
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: Cigna Commercial |
$1,413.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.61
|
| Rate for Payer: Health EOS Commercial |
$1,367.11
|
| Rate for Payer: HFN Commercial |
$1,413.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.06
|
| Rate for Payer: Multiplan Commercial |
$1,228.86
|
| Rate for Payer: NAPHCARE Commercial |
$921.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.19
|
| Rate for Payer: Quartz Beloit One Network |
$752.68
|
| Rate for Payer: Quartz Commercial |
$998.45
|
| Rate for Payer: Quartz Medicare Advantage |
$921.65
|
| Rate for Payer: The Alliance Commercial |
$768.04
|
| Rate for Payer: WEA Trust Commercial |
$844.84
|
| Rate for Payer: WPS Commercial |
$1,137.73
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 36MM AR-9563-36
|
Facility
|
IP
|
$1,477.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.68 |
| Max. Negotiated Rate |
$1,413.19 |
| Rate for Payer: Aetna Commercial |
$1,382.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.12
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: Cigna Commercial |
$1,413.19
|
| Rate for Payer: Health EOS Commercial |
$1,367.11
|
| Rate for Payer: HFN Commercial |
$1,413.19
|
| Rate for Payer: Multiplan Commercial |
$1,228.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.19
|
| Rate for Payer: Quartz Beloit One Network |
$752.68
|
| Rate for Payer: Quartz Commercial |
$921.65
|
| Rate for Payer: WEA Trust Commercial |
$844.84
|
| Rate for Payer: WPS Commercial |
$1,137.73
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 44MM AR-9563-44
|
Facility
|
OP
|
$1,365.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.62 |
| Max. Negotiated Rate |
$1,306.47 |
| Rate for Payer: Aetna Commercial |
$1,278.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,221.27
|
| Rate for Payer: Aetna Managed Medicare |
$397.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$923.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$710.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$752.64
|
| Rate for Payer: Cash Price |
$409.64
|
| Rate for Payer: Cigna Commercial |
$1,306.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$794.70
|
| Rate for Payer: Health EOS Commercial |
$1,263.87
|
| Rate for Payer: HFN Commercial |
$1,306.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,065.06
|
| Rate for Payer: Multiplan Commercial |
$1,136.06
|
| Rate for Payer: NAPHCARE Commercial |
$852.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,306.47
|
| Rate for Payer: Quartz Beloit One Network |
$695.84
|
| Rate for Payer: Quartz Commercial |
$923.05
|
| Rate for Payer: Quartz Medicare Advantage |
$852.05
|
| Rate for Payer: The Alliance Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$781.04
|
| Rate for Payer: WPS Commercial |
$1,051.81
|
|
|
SCREW PERIPHERAL LOCKING UNIVERS REVERS GLENOID 5.5 X 44MM AR-9563-44
|
Facility
|
IP
|
$1,365.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.84 |
| Max. Negotiated Rate |
$1,306.47 |
| Rate for Payer: Aetna Commercial |
$1,278.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,221.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$752.64
|
| Rate for Payer: Cash Price |
$409.64
|
| Rate for Payer: Cigna Commercial |
$1,306.47
|
| Rate for Payer: Health EOS Commercial |
$1,263.87
|
| Rate for Payer: HFN Commercial |
$1,306.47
|
| Rate for Payer: Multiplan Commercial |
$1,136.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,306.47
|
| Rate for Payer: Quartz Beloit One Network |
$695.84
|
| Rate for Payer: Quartz Commercial |
$852.05
|
| Rate for Payer: WEA Trust Commercial |
$781.04
|
| Rate for Payer: WPS Commercial |
$1,051.81
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X16MM AR-9562-16NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X16MM AR-9562-16NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X20MM AR-9562-20NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X20MM AR-9562-20NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X24MM AR-9562-24NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X24MM AR-9562-24NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X28MM AR-9562-28NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X28MM AR-9562-28NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X32MM AR-9562-32NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
