|
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 |
$4,582.32 |
| Max. Negotiated Rate |
$15,056.20 |
| Rate for Payer: Aetna Commercial |
$14,728.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,074.28
|
| Rate for Payer: Aetna Managed Medicare |
$4,582.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,637.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,182.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,855.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,673.68
|
| Rate for Payer: Cash Price |
$4,720.80
|
| Rate for Payer: Cigna Commercial |
$15,056.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,158.35
|
| Rate for Payer: Health EOS Commercial |
$14,565.24
|
| Rate for Payer: HFN Commercial |
$15,056.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,274.08
|
| Rate for Payer: Multiplan Commercial |
$13,092.35
|
| Rate for Payer: NAPHCARE Commercial |
$9,819.26
|
| Rate for Payer: Preferred Network Access Commercial |
$15,056.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,019.07
|
| Rate for Payer: Quartz Commercial |
$10,637.54
|
| Rate for Payer: Quartz Medicare Advantage |
$9,819.26
|
| Rate for Payer: The Alliance Commercial |
$8,182.72
|
| Rate for Payer: WEA Trust Commercial |
$9,000.99
|
| Rate for Payer: WPS Commercial |
$12,121.44
|
|
|
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 |
$4,406.15 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Aetna Managed Medicare |
$4,406.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,228.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,868.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,553.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,806.24
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,802.18
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,441.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$10,228.56
|
| Rate for Payer: Quartz Medicare Advantage |
$9,441.74
|
| Rate for Payer: The Alliance Commercial |
$7,868.12
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
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 |
$7,710.76 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$9,441.74
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
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 |
$2,506.07 |
| Max. Negotiated Rate |
$8,234.22 |
| Rate for Payer: Aetna Commercial |
$8,055.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.21
|
| Rate for Payer: Aetna Managed Medicare |
$2,506.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,817.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,475.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,296.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,743.63
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$8,234.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,008.69
|
| Rate for Payer: Health EOS Commercial |
$7,965.71
|
| Rate for Payer: HFN Commercial |
$8,234.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,712.68
|
| Rate for Payer: Multiplan Commercial |
$7,160.19
|
| Rate for Payer: NAPHCARE Commercial |
$5,370.14
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.62
|
| Rate for Payer: Quartz Commercial |
$5,817.66
|
| Rate for Payer: Quartz Medicare Advantage |
$5,370.14
|
| Rate for Payer: The Alliance Commercial |
$4,475.12
|
| Rate for Payer: WEA Trust Commercial |
$4,922.63
|
| Rate for Payer: WPS Commercial |
$6,629.20
|
|
|
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 |
$4,385.62 |
| Max. Negotiated Rate |
$8,234.22 |
| Rate for Payer: Aetna Commercial |
$8,055.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,743.63
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$8,234.22
|
| Rate for Payer: Health EOS Commercial |
$7,965.71
|
| Rate for Payer: HFN Commercial |
$8,234.22
|
| Rate for Payer: Multiplan Commercial |
$7,160.19
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.62
|
| Rate for Payer: Quartz Commercial |
$5,370.14
|
| Rate for Payer: WEA Trust Commercial |
$4,922.63
|
| Rate for Payer: WPS Commercial |
$6,629.20
|
|
|
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 |
$5,963.34 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,302.05
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$3,407.62 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Aetna Managed Medicare |
$3,407.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,910.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,085.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,841.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,810.56
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,127.56
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,302.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,910.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,302.05
|
| Rate for Payer: The Alliance Commercial |
$6,085.04
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$5,963.34 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,302.05
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$3,407.62 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Aetna Managed Medicare |
$3,407.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,910.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,085.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,841.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,810.56
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,127.56
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,302.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,910.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,302.05
|
| Rate for Payer: The Alliance Commercial |
$6,085.04
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$5,963.34 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,302.05
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$3,407.62 |
| Max. Negotiated Rate |
$11,196.47 |
| Rate for Payer: Aetna Commercial |
$10,953.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,466.27
|
| Rate for Payer: Aetna Managed Medicare |
$3,407.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,910.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,085.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,841.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,450.14
|
| Rate for Payer: Cash Price |
$3,510.60
|
| Rate for Payer: Cigna Commercial |
$11,196.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,810.56
|
| Rate for Payer: Health EOS Commercial |
$10,831.37
|
| Rate for Payer: HFN Commercial |
$11,196.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,127.56
|
| Rate for Payer: Multiplan Commercial |
$9,736.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,302.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,196.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,963.34
|
| Rate for Payer: Quartz Commercial |
$7,910.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,302.05
|
| Rate for Payer: The Alliance Commercial |
$6,085.04
|
| Rate for Payer: WEA Trust Commercial |
$6,693.54
|
| Rate for Payer: WPS Commercial |
$9,014.05
|
|
|
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 |
$5,734.02 |
| Max. Negotiated Rate |
$10,765.91 |
| Rate for Payer: Aetna Commercial |
$10,531.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.10
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,765.91
|
| Rate for Payer: Health EOS Commercial |
$10,414.85
|
| Rate for Payer: HFN Commercial |
$10,765.91
|
| Rate for Payer: Multiplan Commercial |
$9,361.66
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.02
|
| Rate for Payer: Quartz Commercial |
$7,021.25
|
| Rate for Payer: WEA Trust Commercial |
$6,436.14
|
| Rate for Payer: WPS Commercial |
$8,667.42
|
|
|
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 |
$3,276.58 |
| Max. Negotiated Rate |
$10,765.91 |
| Rate for Payer: Aetna Commercial |
$10,531.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.79
|
| Rate for Payer: Aetna Managed Medicare |
$3,276.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,617.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.10
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,765.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,548.66
|
| Rate for Payer: Health EOS Commercial |
$10,414.85
|
| Rate for Payer: HFN Commercial |
$10,765.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,776.56
|
| Rate for Payer: Multiplan Commercial |
$9,361.66
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.25
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.02
|
| Rate for Payer: Quartz Commercial |
$7,606.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,021.25
|
| Rate for Payer: The Alliance Commercial |
$5,851.04
|
| Rate for Payer: WEA Trust Commercial |
$6,436.14
|
| Rate for Payer: WPS Commercial |
$8,667.42
|
|
|
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 |
$5,734.02 |
| Max. Negotiated Rate |
$10,765.91 |
| Rate for Payer: Aetna Commercial |
$10,531.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.10
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,765.91
|
| Rate for Payer: Health EOS Commercial |
$10,414.85
|
| Rate for Payer: HFN Commercial |
$10,765.91
|
| Rate for Payer: Multiplan Commercial |
$9,361.66
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.02
|
| Rate for Payer: Quartz Commercial |
$7,021.25
|
| Rate for Payer: WEA Trust Commercial |
$6,436.14
|
| Rate for Payer: WPS Commercial |
$8,667.42
|
|
|
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 |
$3,276.58 |
| Max. Negotiated Rate |
$10,765.91 |
| Rate for Payer: Aetna Commercial |
$10,531.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,063.79
|
| Rate for Payer: Aetna Managed Medicare |
$3,276.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,617.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.10
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cigna Commercial |
$10,765.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,548.66
|
| Rate for Payer: Health EOS Commercial |
$10,414.85
|
| Rate for Payer: HFN Commercial |
$10,765.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,776.56
|
| Rate for Payer: Multiplan Commercial |
$9,361.66
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.25
|
| Rate for Payer: Preferred Network Access Commercial |
$10,765.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.02
|
| Rate for Payer: Quartz Commercial |
$7,606.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,021.25
|
| Rate for Payer: The Alliance Commercial |
$5,851.04
|
| Rate for Payer: WEA Trust Commercial |
$6,436.14
|
| Rate for Payer: WPS Commercial |
$8,667.42
|
|
|
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 |
$3,029.35 |
| Max. Negotiated Rate |
$9,953.59 |
| Rate for Payer: Aetna Commercial |
$9,737.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,304.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,029.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,032.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,409.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,193.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,734.13
|
| Rate for Payer: Cash Price |
$3,120.90
|
| Rate for Payer: Cigna Commercial |
$9,953.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,054.55
|
| Rate for Payer: Health EOS Commercial |
$9,629.02
|
| Rate for Payer: HFN Commercial |
$9,953.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,114.34
|
| Rate for Payer: Multiplan Commercial |
$8,655.30
|
| Rate for Payer: NAPHCARE Commercial |
$6,491.47
|
| Rate for Payer: Preferred Network Access Commercial |
$9,953.59
|
| Rate for Payer: Quartz Beloit One Network |
$5,301.37
|
| Rate for Payer: Quartz Commercial |
$7,032.43
|
| Rate for Payer: Quartz Medicare Advantage |
$6,491.47
|
| Rate for Payer: The Alliance Commercial |
$5,409.56
|
| Rate for Payer: WEA Trust Commercial |
$5,950.52
|
| Rate for Payer: WPS Commercial |
$8,013.43
|
|
|
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 |
$5,301.37 |
| Max. Negotiated Rate |
$9,953.59 |
| Rate for Payer: Aetna Commercial |
$9,737.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,304.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,734.13
|
| Rate for Payer: Cash Price |
$3,120.90
|
| Rate for Payer: Cigna Commercial |
$9,953.59
|
| Rate for Payer: Health EOS Commercial |
$9,629.02
|
| Rate for Payer: HFN Commercial |
$9,953.59
|
| Rate for Payer: Multiplan Commercial |
$8,655.30
|
| Rate for Payer: Preferred Network Access Commercial |
$9,953.59
|
| Rate for Payer: Quartz Beloit One Network |
$5,301.37
|
| Rate for Payer: Quartz Commercial |
$6,491.47
|
| Rate for Payer: WEA Trust Commercial |
$5,950.52
|
| Rate for Payer: WPS Commercial |
$8,013.43
|
|
|
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 |
$2,656.04 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,656.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,165.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,742.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,308.42
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,114.38
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,691.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$6,165.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,691.50
|
| Rate for Payer: The Alliance Commercial |
$4,742.92
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$4,648.06 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$5,691.50
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$4,648.06 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$5,691.50
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$2,656.04 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,656.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,165.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,742.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,308.42
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,114.38
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,691.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$6,165.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,691.50
|
| Rate for Payer: The Alliance Commercial |
$4,742.92
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$2,656.04 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,656.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,165.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,742.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,308.42
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,114.38
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,691.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$6,165.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,691.50
|
| Rate for Payer: The Alliance Commercial |
$4,742.92
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$4,648.06 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$5,691.50
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
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 |
$2,553.82 |
| Max. Negotiated Rate |
$8,391.14 |
| Rate for Payer: Aetna Commercial |
$8,208.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,843.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,377.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.02
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,391.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.14
|
| Rate for Payer: Health EOS Commercial |
$8,117.51
|
| Rate for Payer: HFN Commercial |
$8,391.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.60
|
| Rate for Payer: Multiplan Commercial |
$7,296.64
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.48
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.19
|
| Rate for Payer: Quartz Commercial |
$5,928.52
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.48
|
| Rate for Payer: The Alliance Commercial |
$4,560.40
|
| Rate for Payer: WEA Trust Commercial |
$5,016.44
|
| Rate for Payer: WPS Commercial |
$6,755.53
|
|
|
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 |
$4,469.19 |
| Max. Negotiated Rate |
$8,391.14 |
| Rate for Payer: Aetna Commercial |
$8,208.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,843.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.02
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,391.14
|
| Rate for Payer: Health EOS Commercial |
$8,117.51
|
| Rate for Payer: HFN Commercial |
$8,391.14
|
| Rate for Payer: Multiplan Commercial |
$7,296.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.19
|
| Rate for Payer: Quartz Commercial |
$5,472.48
|
| Rate for Payer: WEA Trust Commercial |
$5,016.44
|
| Rate for Payer: WPS Commercial |
$6,755.53
|
|
