|
GLENOID AUGMENTED UNIVERS VAULTLOCK LARGE 15L AR-9107-03-15L
|
Facility
|
IP
|
$15,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,706.17 |
| Max. Negotiated Rate |
$14,468.73 |
| Rate for Payer: Aetna Commercial |
$14,154.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,525.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,335.25
|
| Rate for Payer: Cash Price |
$4,536.60
|
| Rate for Payer: Cigna Commercial |
$14,468.73
|
| Rate for Payer: Health EOS Commercial |
$13,996.92
|
| Rate for Payer: HFN Commercial |
$14,468.73
|
| Rate for Payer: Multiplan Commercial |
$12,581.50
|
| Rate for Payer: Preferred Network Access Commercial |
$14,468.73
|
| Rate for Payer: Quartz Beloit One Network |
$7,706.17
|
| Rate for Payer: Quartz Commercial |
$9,436.13
|
| Rate for Payer: WEA Trust Commercial |
$8,649.78
|
| Rate for Payer: WPS Commercial |
$11,648.48
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK LARGE 15L AR-9107-03-15L
|
Facility
|
OP
|
$15,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,403.53 |
| Max. Negotiated Rate |
$14,468.73 |
| Rate for Payer: Aetna Commercial |
$14,154.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,525.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,403.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,222.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,863.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,548.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,335.25
|
| Rate for Payer: Cash Price |
$4,536.60
|
| Rate for Payer: Cigna Commercial |
$14,468.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,801.00
|
| Rate for Payer: Health EOS Commercial |
$13,996.92
|
| Rate for Payer: HFN Commercial |
$14,468.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,795.16
|
| Rate for Payer: Multiplan Commercial |
$12,581.50
|
| Rate for Payer: NAPHCARE Commercial |
$9,436.13
|
| Rate for Payer: Preferred Network Access Commercial |
$14,468.73
|
| Rate for Payer: Quartz Beloit One Network |
$7,706.17
|
| Rate for Payer: Quartz Commercial |
$10,222.47
|
| Rate for Payer: Quartz Medicare Advantage |
$9,436.13
|
| Rate for Payer: The Alliance Commercial |
$7,863.44
|
| Rate for Payer: WEA Trust Commercial |
$8,649.78
|
| Rate for Payer: WPS Commercial |
$11,648.48
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK MEDIUM 15R AR-9107-02-15R
|
Facility
|
OP
|
$15,727.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,579.70 |
| Max. Negotiated Rate |
$15,047.59 |
| Rate for Payer: Aetna Commercial |
$14,720.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,066.23
|
| Rate for Payer: Aetna Managed Medicare |
$4,579.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,631.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,178.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,850.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,668.72
|
| Rate for Payer: Cash Price |
$4,718.10
|
| Rate for Payer: Cigna Commercial |
$15,047.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,153.11
|
| Rate for Payer: Health EOS Commercial |
$14,556.91
|
| Rate for Payer: HFN Commercial |
$15,047.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,267.06
|
| Rate for Payer: Multiplan Commercial |
$13,084.86
|
| Rate for Payer: NAPHCARE Commercial |
$9,813.65
|
| Rate for Payer: Preferred Network Access Commercial |
$15,047.59
|
| Rate for Payer: Quartz Beloit One Network |
$8,014.48
|
| Rate for Payer: Quartz Commercial |
$10,631.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,813.65
|
| Rate for Payer: The Alliance Commercial |
$8,178.04
|
| Rate for Payer: WEA Trust Commercial |
$8,995.84
|
| Rate for Payer: WPS Commercial |
$12,114.51
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK MEDIUM 15R AR-9107-02-15R
|
Facility
|
IP
|
$15,727.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,014.48 |
| Max. Negotiated Rate |
$15,047.59 |
| Rate for Payer: Aetna Commercial |
$14,720.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,066.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,668.72
|
| Rate for Payer: Cash Price |
$4,718.10
|
| Rate for Payer: Cigna Commercial |
$15,047.59
|
| Rate for Payer: Health EOS Commercial |
$14,556.91
|
| Rate for Payer: HFN Commercial |
$15,047.59
|
| Rate for Payer: Multiplan Commercial |
$13,084.86
|
| Rate for Payer: Preferred Network Access Commercial |
$15,047.59
|
| Rate for Payer: Quartz Beloit One Network |
$8,014.48
|
| Rate for Payer: Quartz Commercial |
$9,813.65
|
| Rate for Payer: WEA Trust Commercial |
$8,995.84
|
| Rate for Payer: WPS Commercial |
$12,114.51
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK SMALL 15R AR-9107-01-15R
|
Facility
|
IP
|
$14,540.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,409.58 |
| Max. Negotiated Rate |
$13,911.87 |
| Rate for Payer: Aetna Commercial |
$13,609.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,004.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,014.45
|
| Rate for Payer: Cash Price |
$4,362.00
|
| Rate for Payer: Cigna Commercial |
$13,911.87
|
| Rate for Payer: Health EOS Commercial |
$13,458.22
|
| Rate for Payer: HFN Commercial |
$13,911.87
|
| Rate for Payer: Multiplan Commercial |
$12,097.28
|
| Rate for Payer: Preferred Network Access Commercial |
$13,911.87
|
| Rate for Payer: Quartz Beloit One Network |
$7,409.58
|
| Rate for Payer: Quartz Commercial |
$9,072.96
|
| Rate for Payer: WEA Trust Commercial |
$8,316.88
|
| Rate for Payer: WPS Commercial |
$11,200.16
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK SMALL 15R AR-9107-01-15R
|
Facility
|
OP
|
$14,540.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,234.05 |
| Max. Negotiated Rate |
$13,911.87 |
| Rate for Payer: Aetna Commercial |
$13,609.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,004.58
|
| Rate for Payer: Aetna Managed Medicare |
$4,234.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,829.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,560.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,258.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,014.45
|
| Rate for Payer: Cash Price |
$4,362.00
|
| Rate for Payer: Cigna Commercial |
$13,911.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,462.28
|
| Rate for Payer: Health EOS Commercial |
$13,458.22
|
| Rate for Payer: HFN Commercial |
$13,911.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,341.20
|
| Rate for Payer: Multiplan Commercial |
$12,097.28
|
| Rate for Payer: NAPHCARE Commercial |
$9,072.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,911.87
|
| Rate for Payer: Quartz Beloit One Network |
$7,409.58
|
| Rate for Payer: Quartz Commercial |
$9,829.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,072.96
|
| Rate for Payer: The Alliance Commercial |
$7,560.80
|
| Rate for Payer: WEA Trust Commercial |
$8,316.88
|
| Rate for Payer: WPS Commercial |
$11,200.16
|
|
|
GLENOID PLATE SUPERIOR AUGMENT 10 DEG EQUINOXE REVERSE SHOULDER 320-15-02
|
Facility
|
IP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,576.04 |
| Max. Negotiated Rate |
$8,591.75 |
| Rate for Payer: Aetna Commercial |
$8,404.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,031.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.59
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,591.75
|
| Rate for Payer: Health EOS Commercial |
$8,311.58
|
| Rate for Payer: HFN Commercial |
$8,591.75
|
| Rate for Payer: Multiplan Commercial |
$7,471.09
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,576.04
|
| Rate for Payer: Quartz Commercial |
$5,603.31
|
| Rate for Payer: WEA Trust Commercial |
$5,136.37
|
| Rate for Payer: WPS Commercial |
$6,917.04
|
|
|
GLENOID PLATE SUPERIOR AUGMENT 10 DEG EQUINOXE REVERSE SHOULDER 320-15-02
|
Facility
|
OP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.88 |
| Max. Negotiated Rate |
$8,591.75 |
| Rate for Payer: Aetna Commercial |
$8,404.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,031.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,070.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,669.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,482.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.59
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,591.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,226.17
|
| Rate for Payer: Health EOS Commercial |
$8,311.58
|
| Rate for Payer: HFN Commercial |
$8,591.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,004.14
|
| Rate for Payer: Multiplan Commercial |
$7,471.09
|
| Rate for Payer: NAPHCARE Commercial |
$5,603.31
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,576.04
|
| Rate for Payer: Quartz Commercial |
$6,070.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5,603.31
|
| Rate for Payer: The Alliance Commercial |
$4,669.43
|
| Rate for Payer: WEA Trust Commercial |
$5,136.37
|
| Rate for Payer: WPS Commercial |
$6,917.04
|
|
|
GLENOID PLATE SUPERIOR/POSTERIOR AUGMENT SMALL RT EQUINOXE REVERSE SHOULDER 320-35-08
|
Facility
|
OP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.88 |
| Max. Negotiated Rate |
$8,591.75 |
| Rate for Payer: Aetna Commercial |
$8,404.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,031.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,070.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,669.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,482.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.59
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,591.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,226.17
|
| Rate for Payer: Health EOS Commercial |
$8,311.58
|
| Rate for Payer: HFN Commercial |
$8,591.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,004.14
|
| Rate for Payer: Multiplan Commercial |
$7,471.09
|
| Rate for Payer: NAPHCARE Commercial |
$5,603.31
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,576.04
|
| Rate for Payer: Quartz Commercial |
$6,070.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5,603.31
|
| Rate for Payer: The Alliance Commercial |
$4,669.43
|
| Rate for Payer: WEA Trust Commercial |
$5,136.37
|
| Rate for Payer: WPS Commercial |
$6,917.04
|
|
|
GLENOID PLATE SUPERIOR/POSTERIOR AUGMENT SMALL RT EQUINOXE REVERSE SHOULDER 320-35-08
|
Facility
|
IP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,576.04 |
| Max. Negotiated Rate |
$8,591.75 |
| Rate for Payer: Aetna Commercial |
$8,404.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,031.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.59
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,591.75
|
| Rate for Payer: Health EOS Commercial |
$8,311.58
|
| Rate for Payer: HFN Commercial |
$8,591.75
|
| Rate for Payer: Multiplan Commercial |
$7,471.09
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,576.04
|
| Rate for Payer: Quartz Commercial |
$5,603.31
|
| Rate for Payer: WEA Trust Commercial |
$5,136.37
|
| Rate for Payer: WPS Commercial |
$6,917.04
|
|
|
GLENOID REVERSE UNIVERSAL SZ 42 AR-9504L
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID REVERSE UNIVERSAL SZ 42 AR-9504L
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 36 +4 LATERAL AR-9504S-04
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 36 +4 LATERAL AR-9504S-04
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 36 AR-9504S
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 36 AR-9504S
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 +2.5 AR-9504-02
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 +2.5 AR-9504-02
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 +4 LATERAL AR-9504M-04
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 +4 LATERAL AR-9504M-04
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 AR-9504M
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5571657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERSAL REVERSE 39 AR-9504M
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5571657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
GLENOID UNIVERS VALULTLOCK LARGE AR-9106-03
|
Facility
|
OP
|
$8,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,439.38 |
| Max. Negotiated Rate |
$8,015.11 |
| Rate for Payer: Aetna Commercial |
$7,840.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,492.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,439.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,662.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,356.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,617.40
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$8,015.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,875.41
|
| Rate for Payer: Health EOS Commercial |
$7,753.75
|
| Rate for Payer: HFN Commercial |
$8,015.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,534.06
|
| Rate for Payer: Multiplan Commercial |
$6,969.66
|
| Rate for Payer: NAPHCARE Commercial |
$5,227.25
|
| Rate for Payer: Preferred Network Access Commercial |
$8,015.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,268.92
|
| Rate for Payer: Quartz Commercial |
$5,662.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,227.25
|
| Rate for Payer: The Alliance Commercial |
$4,356.04
|
| Rate for Payer: WEA Trust Commercial |
$4,791.64
|
| Rate for Payer: WPS Commercial |
$6,452.80
|
|
|
GLENOID UNIVERS VALULTLOCK LARGE AR-9106-03
|
Facility
|
IP
|
$8,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,268.92 |
| Max. Negotiated Rate |
$8,015.11 |
| Rate for Payer: Aetna Commercial |
$7,840.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,617.40
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$8,015.11
|
| Rate for Payer: Health EOS Commercial |
$7,753.75
|
| Rate for Payer: HFN Commercial |
$8,015.11
|
| Rate for Payer: Multiplan Commercial |
$6,969.66
|
| Rate for Payer: Preferred Network Access Commercial |
$8,015.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,268.92
|
| Rate for Payer: Quartz Commercial |
$5,227.25
|
| Rate for Payer: WEA Trust Commercial |
$4,791.64
|
| Rate for Payer: WPS Commercial |
$6,452.80
|
|
|
GLENOID UNIVERS VALULTLOCK MEDIUM AR-9106-02
|
Facility
|
IP
|
$8,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,268.92 |
| Max. Negotiated Rate |
$8,015.11 |
| Rate for Payer: Aetna Commercial |
$7,840.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,617.40
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$8,015.11
|
| Rate for Payer: Health EOS Commercial |
$7,753.75
|
| Rate for Payer: HFN Commercial |
$8,015.11
|
| Rate for Payer: Multiplan Commercial |
$6,969.66
|
| Rate for Payer: Preferred Network Access Commercial |
$8,015.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,268.92
|
| Rate for Payer: Quartz Commercial |
$5,227.25
|
| Rate for Payer: WEA Trust Commercial |
$4,791.64
|
| Rate for Payer: WPS Commercial |
$6,452.80
|
|
