|
Bartonella quintana IgM Screen
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Bartonella quintana IgM Screen
|
Professional
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$44.79
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$110.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$680.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Professional
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$44.79
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT +2 LATERAL AR-9580-2420-2
|
Facility
OP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,582.20 |
| Max. Negotiated Rate |
$15,055.80 |
| Rate for Payer: Aetna Commercial |
$14,728.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,073.90
|
| Rate for Payer: Aetna Managed Medicare |
$4,582.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,637.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,182.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,855.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,673.45
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,055.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,157.85
|
| Rate for Payer: Health EOS Commercial |
$14,564.85
|
| Rate for Payer: HFN Commercial |
$15,055.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,273.75
|
| Rate for Payer: Multiplan Commercial |
$13,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,819.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,055.80
|
| Rate for Payer: Quartz Beloit One Network |
$8,018.85
|
| Rate for Payer: Quartz Commercial |
$10,637.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9,819.00
|
| Rate for Payer: WEA Trust Commercial |
$9,000.75
|
| Rate for Payer: WPS Commercial |
$12,121.56
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT +2 LATERAL AR-9580-2420-2
|
Facility
IP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,018.85 |
| Max. Negotiated Rate |
$15,055.80 |
| Rate for Payer: Aetna Commercial |
$14,728.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,673.45
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,055.80
|
| Rate for Payer: Health EOS Commercial |
$14,564.85
|
| Rate for Payer: HFN Commercial |
$15,055.80
|
| Rate for Payer: Multiplan Commercial |
$13,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,819.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,055.80
|
| Rate for Payer: Quartz Beloit One Network |
$8,018.85
|
| Rate for Payer: Quartz Commercial |
$9,819.00
|
| Rate for Payer: WEA Trust Commercial |
$9,000.75
|
| Rate for Payer: WPS Commercial |
$12,121.56
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT AR-9580-2420
|
Facility
IP
|
$15,736.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,710.64 |
| Max. Negotiated Rate |
$14,477.12 |
| Rate for Payer: Aetna Commercial |
$14,162.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.08
|
| Rate for Payer: Cash Price |
$4,720.80
|
| Rate for Payer: Cigna Commercial |
$14,477.12
|
| Rate for Payer: Health EOS Commercial |
$14,005.04
|
| Rate for Payer: HFN Commercial |
$14,477.12
|
| Rate for Payer: Multiplan Commercial |
$12,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.64
|
| Rate for Payer: Quartz Commercial |
$9,441.60
|
| Rate for Payer: WEA Trust Commercial |
$8,654.80
|
| Rate for Payer: WPS Commercial |
$11,655.66
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT AR-9580-2420
|
Facility
OP
|
$15,736.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,406.08 |
| Max. Negotiated Rate |
$14,477.12 |
| Rate for Payer: Aetna Commercial |
$14,162.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,532.96
|
| Rate for Payer: Aetna Managed Medicare |
$4,406.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,228.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,553.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.08
|
| Rate for Payer: Cash Price |
$4,720.80
|
| Rate for Payer: Cigna Commercial |
$14,477.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,805.87
|
| Rate for Payer: Health EOS Commercial |
$14,005.04
|
| Rate for Payer: HFN Commercial |
$14,477.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,802.00
|
| Rate for Payer: Multiplan Commercial |
$12,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.64
|
| Rate for Payer: Quartz Commercial |
$10,228.40
|
| Rate for Payer: Quartz Medicare Advantage |
$9,441.60
|
| Rate for Payer: WEA Trust Commercial |
$8,654.80
|
| Rate for Payer: WPS Commercial |
$11,655.66
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT ST AR-9580-2420S
|
Facility
IP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6204974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,414.19 |
| Max. Negotiated Rate |
$13,920.52 |
| Rate for Payer: Aetna Commercial |
$13,617.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,019.43
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$13,920.52
|
| Rate for Payer: Health EOS Commercial |
$13,466.59
|
| Rate for Payer: HFN Commercial |
$13,920.52
|
| Rate for Payer: Multiplan Commercial |
$12,104.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,078.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,920.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,414.19
|
| Rate for Payer: Quartz Commercial |
$9,078.60
|
| Rate for Payer: WEA Trust Commercial |
$8,322.05
|
| Rate for Payer: WPS Commercial |
$11,207.53
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT ST AR-9580-2420S
|
Facility
OP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6204974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,236.68 |
| Max. Negotiated Rate |
$13,920.52 |
| Rate for Payer: Aetna Commercial |
$13,617.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,012.66
|
| Rate for Payer: Aetna Managed Medicare |
$4,236.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,835.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,565.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,262.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,019.43
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$13,920.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,467.31
|
| Rate for Payer: Health EOS Commercial |
$13,466.59
|
| Rate for Payer: HFN Commercial |
$13,920.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,348.25
|
| Rate for Payer: Multiplan Commercial |
$12,104.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,078.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,920.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,414.19
|
| Rate for Payer: Quartz Commercial |
$9,835.15
|
| Rate for Payer: Quartz Medicare Advantage |
$9,078.60
|
| Rate for Payer: WEA Trust Commercial |
$8,322.05
|
| Rate for Payer: WPS Commercial |
$11,207.53
|
|
|
BASEPLATE GLENOSPHERE MINI COMPREHENSIVE REVERSE SHOULDER 25MM 010000589
|
Facility
OP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.68 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,409.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,593.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,815.92
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,454.50
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,593.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
BASEPLATE GLENOSPHERE MINI COMPREHENSIVE REVERSE SHOULDER 25MM 010000589
|
Facility
IP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,216.94 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM +2 AR-9560-24-2
|
Facility
OP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.56 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,276.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,616.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,548.44
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,776.50
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,606.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM +2 AR-9560-24-2
|
Facility
IP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,733.98 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM +4 AR-9560-24-4
|
Facility
OP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.56 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,276.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,616.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,548.44
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,776.50
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,606.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM +4 AR-9560-24-4
|
Facility
IP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,733.98 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM AR-9560-24
|
Facility
OP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.56 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,276.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,616.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,548.44
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,776.50
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,606.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 24MM AR-9560-24
|
Facility
IP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,733.98 |
| Max. Negotiated Rate |
$10,765.84 |
| Rate for Payer: Aetna Commercial |
$10,531.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.06
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$10,765.84
|
| Rate for Payer: Health EOS Commercial |
$10,414.78
|
| Rate for Payer: HFN Commercial |
$10,765.84
|
| Rate for Payer: Multiplan Commercial |
$9,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,733.98
|
| Rate for Payer: Quartz Commercial |
$7,021.20
|
| Rate for Payer: WEA Trust Commercial |
$6,436.10
|
| Rate for Payer: WPS Commercial |
$8,667.67
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM +2 AR-9560-28-2
|
Facility
IP
|
$11,252.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,513.48 |
| Max. Negotiated Rate |
$10,351.84 |
| Rate for Payer: Aetna Commercial |
$10,126.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,963.56
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,351.84
|
| Rate for Payer: Health EOS Commercial |
$10,014.28
|
| Rate for Payer: HFN Commercial |
$10,351.84
|
| Rate for Payer: Multiplan Commercial |
$9,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,351.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.48
|
| Rate for Payer: Quartz Commercial |
$6,751.20
|
| Rate for Payer: WEA Trust Commercial |
$6,188.60
|
| Rate for Payer: WPS Commercial |
$8,334.36
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM +2 AR-9560-28-2
|
Facility
OP
|
$11,252.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.56 |
| Max. Negotiated Rate |
$10,351.84 |
| Rate for Payer: Aetna Commercial |
$10,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,676.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,313.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,626.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,400.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,963.56
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,351.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,296.62
|
| Rate for Payer: Health EOS Commercial |
$10,014.28
|
| Rate for Payer: HFN Commercial |
$10,351.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,439.00
|
| Rate for Payer: Multiplan Commercial |
$9,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,351.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.48
|
| Rate for Payer: Quartz Commercial |
$7,313.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,751.20
|
| Rate for Payer: WEA Trust Commercial |
$6,188.60
|
| Rate for Payer: WPS Commercial |
$8,334.36
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM +4 AR-9560-28-4
|
Facility
OP
|
$11,252.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.56 |
| Max. Negotiated Rate |
$10,351.84 |
| Rate for Payer: Aetna Commercial |
$10,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,676.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,313.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,626.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,400.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,963.56
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,351.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,296.62
|
| Rate for Payer: Health EOS Commercial |
$10,014.28
|
| Rate for Payer: HFN Commercial |
$10,351.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,439.00
|
| Rate for Payer: Multiplan Commercial |
$9,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,351.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.48
|
| Rate for Payer: Quartz Commercial |
$7,313.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,751.20
|
| Rate for Payer: WEA Trust Commercial |
$6,188.60
|
| Rate for Payer: WPS Commercial |
$8,334.36
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM +4 AR-9560-28-4
|
Facility
IP
|
$11,252.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,513.48 |
| Max. Negotiated Rate |
$10,351.84 |
| Rate for Payer: Aetna Commercial |
$10,126.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,963.56
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,351.84
|
| Rate for Payer: Health EOS Commercial |
$10,014.28
|
| Rate for Payer: HFN Commercial |
$10,351.84
|
| Rate for Payer: Multiplan Commercial |
$9,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,351.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.48
|
| Rate for Payer: Quartz Commercial |
$6,751.20
|
| Rate for Payer: WEA Trust Commercial |
$6,188.60
|
| Rate for Payer: WPS Commercial |
$8,334.36
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM AR-9560-28
|
Facility
OP
|
$10,403.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,912.84 |
| Max. Negotiated Rate |
$9,570.76 |
| Rate for Payer: Aetna Commercial |
$9,362.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,946.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,912.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,761.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,201.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,993.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,513.59
|
| Rate for Payer: Cash Price |
$3,120.90
|
| Rate for Payer: Cigna Commercial |
$9,570.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,821.52
|
| Rate for Payer: Health EOS Commercial |
$9,258.67
|
| Rate for Payer: HFN Commercial |
$9,570.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,802.25
|
| Rate for Payer: Multiplan Commercial |
$8,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,241.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,570.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,097.47
|
| Rate for Payer: Quartz Commercial |
$6,761.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,241.80
|
| Rate for Payer: WEA Trust Commercial |
$5,721.65
|
| Rate for Payer: WPS Commercial |
$7,705.50
|
|
|
BASEPLATE MODULAR UNIVERS REVERS MODULAR GLENOID 28MM AR-9560-28
|
Facility
IP
|
$10,403.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,097.47 |
| Max. Negotiated Rate |
$9,570.76 |
| Rate for Payer: Aetna Commercial |
$9,362.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,513.59
|
| Rate for Payer: Cash Price |
$3,120.90
|
| Rate for Payer: Cigna Commercial |
$9,570.76
|
| Rate for Payer: Health EOS Commercial |
$9,258.67
|
| Rate for Payer: HFN Commercial |
$9,570.76
|
| Rate for Payer: Multiplan Commercial |
$8,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,241.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,570.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,097.47
|
| Rate for Payer: Quartz Commercial |
$6,241.80
|
| Rate for Payer: WEA Trust Commercial |
$5,721.65
|
| Rate for Payer: WPS Commercial |
$7,705.50
|
|
