|
GLENOID UNIVERS VALULTLOCK MEDIUM AR-9106-02
|
Facility
|
OP
|
$8,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459486
|
|
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 SMALL AR-9106-01
|
Facility
|
OP
|
$8,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5885659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.62 |
| Max. Negotiated Rate |
$7,707.02 |
| Rate for Payer: Aetna Commercial |
$7,539.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,345.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,445.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,188.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,021.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.92
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cigna Commercial |
$7,707.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,688.01
|
| Rate for Payer: Health EOS Commercial |
$7,455.71
|
| Rate for Payer: HFN Commercial |
$7,707.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,282.90
|
| Rate for Payer: Multiplan Commercial |
$6,701.76
|
| Rate for Payer: NAPHCARE Commercial |
$5,026.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,707.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.83
|
| Rate for Payer: Quartz Commercial |
$5,445.18
|
| Rate for Payer: Quartz Medicare Advantage |
$5,026.32
|
| Rate for Payer: The Alliance Commercial |
$4,188.60
|
| Rate for Payer: WEA Trust Commercial |
$4,607.46
|
| Rate for Payer: WPS Commercial |
$6,204.77
|
|
|
GLENOID UNIVERS VALULTLOCK SMALL AR-9106-01
|
Facility
|
IP
|
$8,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5885659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,104.83 |
| Max. Negotiated Rate |
$7,707.02 |
| Rate for Payer: Aetna Commercial |
$7,539.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.92
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cigna Commercial |
$7,707.02
|
| Rate for Payer: Health EOS Commercial |
$7,455.71
|
| Rate for Payer: HFN Commercial |
$7,707.02
|
| Rate for Payer: Multiplan Commercial |
$6,701.76
|
| Rate for Payer: Preferred Network Access Commercial |
$7,707.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.83
|
| Rate for Payer: Quartz Commercial |
$5,026.32
|
| Rate for Payer: WEA Trust Commercial |
$4,607.46
|
| Rate for Payer: WPS Commercial |
$6,204.77
|
|
|
GLENOSHPERE MODULAR UNIVERS REVERS MODULAR 36/24MM AR-9564-2436
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,234.45 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$7,634.02
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSHPERE MODULAR UNIVERS REVERS MODULAR 36/24MM AR-9564-2436
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.54 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,562.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,270.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,361.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,120.19
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,542.52
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,634.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$8,270.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,634.02
|
| Rate for Payer: The Alliance Commercial |
$6,361.68
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE 36MM SMALL EQUINOXE REVERSE SHOULDER 320-31-36
|
Facility
|
IP
|
$6,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,127.92 |
| Max. Negotiated Rate |
$5,872.84 |
| Rate for Payer: Aetna Commercial |
$5,745.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,489.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,383.27
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,872.84
|
| Rate for Payer: Health EOS Commercial |
$5,681.33
|
| Rate for Payer: HFN Commercial |
$5,872.84
|
| Rate for Payer: Multiplan Commercial |
$5,106.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,872.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.92
|
| Rate for Payer: Quartz Commercial |
$3,830.11
|
| Rate for Payer: WEA Trust Commercial |
$3,510.94
|
| Rate for Payer: WPS Commercial |
$4,728.10
|
|
|
GLENOSPHERE 36MM SMALL EQUINOXE REVERSE SHOULDER 320-31-36
|
Facility
|
OP
|
$6,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.39 |
| Max. Negotiated Rate |
$5,872.84 |
| Rate for Payer: Aetna Commercial |
$5,745.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,489.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,787.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,149.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,191.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,064.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,383.27
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,872.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,572.32
|
| Rate for Payer: Health EOS Commercial |
$5,681.33
|
| Rate for Payer: HFN Commercial |
$5,872.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,787.64
|
| Rate for Payer: Multiplan Commercial |
$5,106.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,830.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,872.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.92
|
| Rate for Payer: Quartz Commercial |
$4,149.29
|
| Rate for Payer: Quartz Medicare Advantage |
$3,830.11
|
| Rate for Payer: The Alliance Commercial |
$3,191.76
|
| Rate for Payer: WEA Trust Commercial |
$3,510.94
|
| Rate for Payer: WPS Commercial |
$4,728.10
|
|
|
GLENOSPHERE ARTHREX UNIVERS REVERS 42 +4 LATERAL AR-9504L-04
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190739
|
|
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
|
|
|
GLENOSPHERE ARTHREX UNIVERS REVERS 42 +4 LATERAL AR-9504L-04
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190739
|
|
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
|
|
|
GLENOSPHERE COMPREHENSIVE REVERSE SHOULDER 36MM +6MM OFFSET 115316
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,882.30 |
| Max. Negotiated Rate |
$5,411.66 |
| Rate for Payer: Aetna Commercial |
$5,294.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,058.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,117.59
|
| Rate for Payer: Cash Price |
$1,696.80
|
| Rate for Payer: Cigna Commercial |
$5,411.66
|
| Rate for Payer: Health EOS Commercial |
$5,235.19
|
| Rate for Payer: HFN Commercial |
$5,411.66
|
| Rate for Payer: Multiplan Commercial |
$4,705.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,411.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.30
|
| Rate for Payer: Quartz Commercial |
$3,529.34
|
| Rate for Payer: WEA Trust Commercial |
$3,235.23
|
| Rate for Payer: WPS Commercial |
$4,356.82
|
|
|
GLENOSPHERE COMPREHENSIVE REVERSE SHOULDER 36MM +6MM OFFSET 115316
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,647.03 |
| Max. Negotiated Rate |
$5,411.66 |
| Rate for Payer: Aetna Commercial |
$5,294.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,058.73
|
| Rate for Payer: Aetna Managed Medicare |
$1,647.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,823.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,941.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,823.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,117.59
|
| Rate for Payer: Cash Price |
$1,696.80
|
| Rate for Payer: Cigna Commercial |
$5,411.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,291.79
|
| Rate for Payer: Health EOS Commercial |
$5,235.19
|
| Rate for Payer: HFN Commercial |
$5,411.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,411.68
|
| Rate for Payer: Multiplan Commercial |
$4,705.79
|
| Rate for Payer: NAPHCARE Commercial |
$3,529.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,411.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.30
|
| Rate for Payer: Quartz Commercial |
$3,823.46
|
| Rate for Payer: Quartz Medicare Advantage |
$3,529.34
|
| Rate for Payer: The Alliance Commercial |
$2,941.12
|
| Rate for Payer: WEA Trust Commercial |
$3,235.23
|
| Rate for Payer: WPS Commercial |
$4,356.82
|
|
|
GLENOSPHERE & LOCKING CAPS (2) EQUINOXE REVERSE SHOULDER 320-06-42
|
Facility
|
OP
|
$6,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.39 |
| Max. Negotiated Rate |
$5,872.84 |
| Rate for Payer: Aetna Commercial |
$5,745.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,489.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,787.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,149.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,191.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,064.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,383.27
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,872.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,572.32
|
| Rate for Payer: Health EOS Commercial |
$5,681.33
|
| Rate for Payer: HFN Commercial |
$5,872.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,787.64
|
| Rate for Payer: Multiplan Commercial |
$5,106.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,830.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,872.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.92
|
| Rate for Payer: Quartz Commercial |
$4,149.29
|
| Rate for Payer: Quartz Medicare Advantage |
$3,830.11
|
| Rate for Payer: The Alliance Commercial |
$3,191.76
|
| Rate for Payer: WEA Trust Commercial |
$3,510.94
|
| Rate for Payer: WPS Commercial |
$4,728.10
|
|
|
GLENOSPHERE & LOCKING CAPS (2) EQUINOXE REVERSE SHOULDER 320-06-42
|
Facility
|
IP
|
$6,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,127.92 |
| Max. Negotiated Rate |
$5,872.84 |
| Rate for Payer: Aetna Commercial |
$5,745.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,489.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,383.27
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,872.84
|
| Rate for Payer: Health EOS Commercial |
$5,681.33
|
| Rate for Payer: HFN Commercial |
$5,872.84
|
| Rate for Payer: Multiplan Commercial |
$5,106.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,872.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.92
|
| Rate for Payer: Quartz Commercial |
$3,830.11
|
| Rate for Payer: WEA Trust Commercial |
$3,510.94
|
| Rate for Payer: WPS Commercial |
$4,728.10
|
|
|
GLENOSPHERE REVERS UNI 36 +2.5 AR-9504S-INF
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240358
|
|
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
|
|
|
GLENOSPHERE REVERS UNI 36 +2.5 AR-9504S-INF
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240358
|
|
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
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 / 24 AR-9564-2433
|
Facility
|
OP
|
$10,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6214986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,165.05 |
| Max. Negotiated Rate |
$10,399.46 |
| Rate for Payer: Aetna Commercial |
$10,173.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,721.23
|
| Rate for Payer: Aetna Managed Medicare |
$3,165.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,347.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,651.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,425.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,990.99
|
| Rate for Payer: Cash Price |
$3,260.70
|
| Rate for Payer: Cigna Commercial |
$10,399.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,325.76
|
| Rate for Payer: Health EOS Commercial |
$10,060.35
|
| Rate for Payer: HFN Commercial |
$10,399.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,477.82
|
| Rate for Payer: Multiplan Commercial |
$9,043.01
|
| Rate for Payer: NAPHCARE Commercial |
$6,782.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,399.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,538.84
|
| Rate for Payer: Quartz Commercial |
$7,347.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6,782.26
|
| Rate for Payer: The Alliance Commercial |
$5,651.88
|
| Rate for Payer: WEA Trust Commercial |
$6,217.07
|
| Rate for Payer: WPS Commercial |
$8,372.39
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 / 24 AR-9564-2433
|
Facility
|
IP
|
$10,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6214986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.84 |
| Max. Negotiated Rate |
$10,399.46 |
| Rate for Payer: Aetna Commercial |
$10,173.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,721.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,990.99
|
| Rate for Payer: Cash Price |
$3,260.70
|
| Rate for Payer: Cigna Commercial |
$10,399.46
|
| Rate for Payer: Health EOS Commercial |
$10,060.35
|
| Rate for Payer: HFN Commercial |
$10,399.46
|
| Rate for Payer: Multiplan Commercial |
$9,043.01
|
| Rate for Payer: Preferred Network Access Commercial |
$10,399.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,538.84
|
| Rate for Payer: Quartz Commercial |
$6,782.26
|
| Rate for Payer: WEA Trust Commercial |
$6,217.07
|
| Rate for Payer: WPS Commercial |
$8,372.39
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 +4 LAT / 24 AR-9564-2433-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.54 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,562.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,270.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,361.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,120.19
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,542.52
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,634.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$8,270.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,634.02
|
| Rate for Payer: The Alliance Commercial |
$6,361.68
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 +4 LAT / 24 AR-9564-2433-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,234.45 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$7,634.02
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 36 +4 LAT / 24 AR-9564-2436-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.54 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,562.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,270.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,361.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,120.19
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,542.52
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,634.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$8,270.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,634.02
|
| Rate for Payer: The Alliance Commercial |
$6,361.68
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 36 +4 LAT / 24 AR-9564-2436-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,234.45 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$7,634.02
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 24 AR-9564-2439-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,234.45 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$7,634.02
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 24 AR-9564-2439-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.54 |
| Max. Negotiated Rate |
$11,705.49 |
| Rate for Payer: Aetna Commercial |
$11,451.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,942.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,562.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,270.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,361.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,743.38
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,705.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,120.19
|
| Rate for Payer: Health EOS Commercial |
$11,323.79
|
| Rate for Payer: HFN Commercial |
$11,705.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,542.52
|
| Rate for Payer: Multiplan Commercial |
$10,178.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,634.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,705.49
|
| Rate for Payer: Quartz Beloit One Network |
$6,234.45
|
| Rate for Payer: Quartz Commercial |
$8,270.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,634.02
|
| Rate for Payer: The Alliance Commercial |
$6,361.68
|
| Rate for Payer: WEA Trust Commercial |
$6,997.85
|
| Rate for Payer: WPS Commercial |
$9,423.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 28 AR-9564-2839-LAT
|
Facility
|
IP
|
$11,763.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,994.42 |
| Max. Negotiated Rate |
$11,254.84 |
| Rate for Payer: Aetna Commercial |
$11,010.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,520.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,483.77
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cigna Commercial |
$11,254.84
|
| Rate for Payer: Health EOS Commercial |
$10,887.83
|
| Rate for Payer: HFN Commercial |
$11,254.84
|
| Rate for Payer: Multiplan Commercial |
$9,786.82
|
| Rate for Payer: Preferred Network Access Commercial |
$11,254.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.42
|
| Rate for Payer: Quartz Commercial |
$7,340.11
|
| Rate for Payer: WEA Trust Commercial |
$6,728.44
|
| Rate for Payer: WPS Commercial |
$9,061.04
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 28 AR-9564-2839-LAT
|
Facility
|
OP
|
$11,763.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,425.39 |
| Max. Negotiated Rate |
$11,254.84 |
| Rate for Payer: Aetna Commercial |
$11,010.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,520.83
|
| Rate for Payer: Aetna Managed Medicare |
$3,425.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,951.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,116.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,872.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,483.77
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cigna Commercial |
$11,254.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,846.07
|
| Rate for Payer: Health EOS Commercial |
$10,887.83
|
| Rate for Payer: HFN Commercial |
$11,254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,175.14
|
| Rate for Payer: Multiplan Commercial |
$9,786.82
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.11
|
| Rate for Payer: Preferred Network Access Commercial |
$11,254.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.42
|
| Rate for Payer: Quartz Commercial |
$7,951.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,340.11
|
| Rate for Payer: The Alliance Commercial |
$6,116.76
|
| Rate for Payer: WEA Trust Commercial |
$6,728.44
|
| Rate for Payer: WPS Commercial |
$9,061.04
|
|
