|
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 |
$34,424.00 |
| 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: The Alliance Commercial |
$34,424.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| 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 |
$46,808.00 |
| 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: The Alliance Commercial |
$46,808.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| 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 |
$46,808.00 |
| 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: The Alliance Commercial |
$46,808.00
|
| 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 |
$46,808.00 |
| 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: The Alliance Commercial |
$46,808.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$10,063.72
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$9,676.72
|
| 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 |
$45,008.00 |
| 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: The Alliance Commercial |
$45,008.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$9,676.72
|
| 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 +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 |
$45,008.00 |
| 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: The Alliance Commercial |
$45,008.00
|
| 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 |
$41,612.00 |
| 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: The Alliance Commercial |
$41,612.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$8,946.58
|
| 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
|
|
|
BASEPLATE REVERS GLENOID LARGE AR-9120-03PC
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.88 |
| Max. Negotiated Rate |
$36,484.00 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.11
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.75
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,928.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.60
|
| Rate for Payer: The Alliance Commercial |
$36,484.00
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE REVERS GLENOID LARGE AR-9120-03PC
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,469.29 |
| Max. Negotiated Rate |
$8,391.32 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,472.60
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE UNIVERSAL GLENOID LARGE AR-9120-03
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,469.29 |
| Max. Negotiated Rate |
$8,391.32 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,472.60
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE UNIVERSAL GLENOID LARGE AR-9120-03
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.88 |
| Max. Negotiated Rate |
$36,484.00 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.11
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.75
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,928.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.60
|
| Rate for Payer: The Alliance Commercial |
$36,484.00
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE UNIVERSAL GLENOID MEDIUM AR-9120-02
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,469.29 |
| Max. Negotiated Rate |
$8,391.32 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,472.60
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE UNIVERSAL GLENOID MEDIUM AR-9120-02
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.88 |
| Max. Negotiated Rate |
$36,484.00 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.11
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.75
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,928.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.60
|
| Rate for Payer: The Alliance Commercial |
$36,484.00
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
|
BASEPLATE UNIVERSAL GLENOID MEDIUM POROUS COAT AR-9120-02PC
|
Facility
|
IP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.30 |
| Max. Negotiated Rate |
$8,068.40 |
| Rate for Payer: Aetna Commercial |
$7,893.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,542.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.10
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,068.40
|
| Rate for Payer: Health EOS Commercial |
$7,805.30
|
| Rate for Payer: HFN Commercial |
$8,068.40
|
| Rate for Payer: Multiplan Commercial |
$7,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,068.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.30
|
| Rate for Payer: Quartz Commercial |
$5,262.00
|
| Rate for Payer: WEA Trust Commercial |
$4,823.50
|
| Rate for Payer: WPS Commercial |
$6,495.94
|
|
|
BASEPLATE UNIVERSAL GLENOID MEDIUM POROUS COAT AR-9120-02PC
|
Facility
|
OP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.60 |
| Max. Negotiated Rate |
$35,080.00 |
| Rate for Payer: Aetna Commercial |
$7,893.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,542.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,700.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.10
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,068.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,907.69
|
| Rate for Payer: Health EOS Commercial |
$7,805.30
|
| Rate for Payer: HFN Commercial |
$8,068.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,577.50
|
| Rate for Payer: Multiplan Commercial |
$7,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,068.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.30
|
| Rate for Payer: Quartz Commercial |
$5,700.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.00
|
| Rate for Payer: The Alliance Commercial |
$35,080.00
|
| Rate for Payer: WEA Trust Commercial |
$4,823.50
|
| Rate for Payer: WPS Commercial |
$6,495.94
|
|
|
BASEPLATE UNIVERSAL GLENOID POROUS SMALL AR-9120-01PC
|
Facility
|
IP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.30 |
| Max. Negotiated Rate |
$8,068.40 |
| Rate for Payer: Aetna Commercial |
$7,893.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,542.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.10
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,068.40
|
| Rate for Payer: Health EOS Commercial |
$7,805.30
|
| Rate for Payer: HFN Commercial |
$8,068.40
|
| Rate for Payer: Multiplan Commercial |
$7,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,068.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.30
|
| Rate for Payer: Quartz Commercial |
$5,262.00
|
| Rate for Payer: WEA Trust Commercial |
$4,823.50
|
| Rate for Payer: WPS Commercial |
$6,495.94
|
|
|
BASEPLATE UNIVERSAL GLENOID POROUS SMALL AR-9120-01PC
|
Facility
|
OP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.60 |
| Max. Negotiated Rate |
$35,080.00 |
| Rate for Payer: Aetna Commercial |
$7,893.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,542.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,700.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.10
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,068.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,907.69
|
| Rate for Payer: Health EOS Commercial |
$7,805.30
|
| Rate for Payer: HFN Commercial |
$8,068.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,577.50
|
| Rate for Payer: Multiplan Commercial |
$7,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,068.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.30
|
| Rate for Payer: Quartz Commercial |
$5,700.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.00
|
| Rate for Payer: The Alliance Commercial |
$35,080.00
|
| Rate for Payer: WEA Trust Commercial |
$4,823.50
|
| Rate for Payer: WPS Commercial |
$6,495.94
|
|
|
BASEPLATE UNIVERSAL GLENOID SMALL AR-9120-01
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4240352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.88 |
| Max. Negotiated Rate |
$36,484.00 |
| Rate for Payer: Aetna Commercial |
$8,208.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.13
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,391.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.11
|
| Rate for Payer: Health EOS Commercial |
$8,117.69
|
| Rate for Payer: HFN Commercial |
$8,391.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.75
|
| Rate for Payer: Multiplan Commercial |
$7,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.29
|
| Rate for Payer: Quartz Commercial |
$5,928.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.60
|
| Rate for Payer: The Alliance Commercial |
$36,484.00
|
| Rate for Payer: WEA Trust Commercial |
$5,016.55
|
| Rate for Payer: WPS Commercial |
$6,755.92
|
|
