|
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 |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$723.73 |
| Max. Negotiated Rate |
$1,358.84 |
| Rate for Payer: Aetna Commercial |
$1,329.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,270.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$782.81
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: Cigna Commercial |
$1,358.84
|
| Rate for Payer: Health EOS Commercial |
$1,314.53
|
| Rate for Payer: HFN Commercial |
$1,358.84
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$886.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,358.84
|
| Rate for Payer: Quartz Beloit One Network |
$723.73
|
| Rate for Payer: Quartz Commercial |
$886.20
|
| Rate for Payer: WEA Trust Commercial |
$812.35
|
| Rate for Payer: WPS Commercial |
$1,094.01
|
|
|
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 |
$413.56 |
| Max. Negotiated Rate |
$5,908.00 |
| Rate for Payer: Aetna Commercial |
$1,329.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,270.22
|
| Rate for Payer: Aetna Managed Medicare |
$413.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$960.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$738.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$708.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$782.81
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: Cigna Commercial |
$1,358.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$826.53
|
| Rate for Payer: Health EOS Commercial |
$1,314.53
|
| Rate for Payer: HFN Commercial |
$1,358.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,107.75
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$886.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,358.84
|
| Rate for Payer: Quartz Beloit One Network |
$723.73
|
| Rate for Payer: Quartz Commercial |
$960.05
|
| Rate for Payer: Quartz Medicare Advantage |
$886.20
|
| Rate for Payer: The Alliance Commercial |
$5,908.00
|
| Rate for Payer: WEA Trust Commercial |
$812.35
|
| Rate for Payer: WPS Commercial |
$1,094.01
|
|
|
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 |
$382.33 |
| Max. Negotiated Rate |
$5,461.84 |
| Rate for Payer: Aetna Commercial |
$1,228.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,174.30
|
| Rate for Payer: Aetna Managed Medicare |
$382.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$887.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$682.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$723.69
|
| Rate for Payer: Cash Price |
$409.64
|
| Rate for Payer: Cigna Commercial |
$1,256.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$764.11
|
| Rate for Payer: Health EOS Commercial |
$1,215.26
|
| Rate for Payer: HFN Commercial |
$1,256.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,024.10
|
| Rate for Payer: Multiplan Commercial |
$1,092.37
|
| Rate for Payer: NAPHCARE Commercial |
$819.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,256.22
|
| Rate for Payer: Quartz Beloit One Network |
$669.08
|
| Rate for Payer: Quartz Commercial |
$887.55
|
| Rate for Payer: Quartz Medicare Advantage |
$819.28
|
| Rate for Payer: The Alliance Commercial |
$5,461.84
|
| Rate for Payer: WEA Trust Commercial |
$751.00
|
| Rate for Payer: WPS Commercial |
$1,011.40
|
|
|
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 |
$669.08 |
| Max. Negotiated Rate |
$1,256.22 |
| Rate for Payer: Aetna Commercial |
$1,228.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,174.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$723.69
|
| Rate for Payer: Cash Price |
$409.64
|
| Rate for Payer: Cigna Commercial |
$1,256.22
|
| Rate for Payer: Health EOS Commercial |
$1,215.26
|
| Rate for Payer: HFN Commercial |
$1,256.22
|
| Rate for Payer: Multiplan Commercial |
$1,092.37
|
| Rate for Payer: NAPHCARE Commercial |
$819.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,256.22
|
| Rate for Payer: Quartz Beloit One Network |
$669.08
|
| Rate for Payer: Quartz Commercial |
$819.28
|
| Rate for Payer: WEA Trust Commercial |
$751.00
|
| Rate for Payer: WPS Commercial |
$1,011.40
|
|
|
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 |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
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 |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
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 |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
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 |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
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 |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X32MM AR-9562-32NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X36MM AR-9562-36NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X36MM AR-9562-36NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X40MM AR-9562-40NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X40MM AR-9562-40NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X44MM AR-9562-44NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
