|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$4,104.73 |
| Max. Negotiated Rate |
$7,706.84 |
| Rate for Payer: Aetna Commercial |
$7,539.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.81
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$7,706.84
|
| Rate for Payer: Health EOS Commercial |
$7,455.53
|
| Rate for Payer: HFN Commercial |
$7,706.84
|
| Rate for Payer: Multiplan Commercial |
$6,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,026.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,706.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.73
|
| Rate for Payer: Quartz Commercial |
$5,026.20
|
| Rate for Payer: WEA Trust Commercial |
$4,607.35
|
| Rate for Payer: WPS Commercial |
$6,204.84
|
|
|
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 |
$2,345.56 |
| Max. Negotiated Rate |
$33,508.00 |
| Rate for Payer: Aetna Commercial |
$7,539.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,345.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,445.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,188.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,020.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.81
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$7,706.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,687.77
|
| Rate for Payer: Health EOS Commercial |
$7,455.53
|
| Rate for Payer: HFN Commercial |
$7,706.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,282.75
|
| Rate for Payer: Multiplan Commercial |
$6,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,026.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,706.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.73
|
| Rate for Payer: Quartz Commercial |
$5,445.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,026.20
|
| Rate for Payer: The Alliance Commercial |
$33,508.00
|
| Rate for Payer: WEA Trust Commercial |
$4,607.35
|
| Rate for Payer: WPS Commercial |
$6,204.84
|
|
|
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 |
$2,345.56 |
| Max. Negotiated Rate |
$33,508.00 |
| Rate for Payer: Aetna Commercial |
$7,539.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,345.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,445.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,188.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,020.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.81
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$7,706.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,687.77
|
| Rate for Payer: Health EOS Commercial |
$7,455.53
|
| Rate for Payer: HFN Commercial |
$7,706.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,282.75
|
| Rate for Payer: Multiplan Commercial |
$6,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,026.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,706.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.73
|
| Rate for Payer: Quartz Commercial |
$5,445.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,026.20
|
| Rate for Payer: The Alliance Commercial |
$33,508.00
|
| Rate for Payer: WEA Trust Commercial |
$4,607.35
|
| Rate for Payer: WPS Commercial |
$6,204.84
|
|
|
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 |
$4,104.73 |
| Max. Negotiated Rate |
$7,706.84 |
| Rate for Payer: Aetna Commercial |
$7,539.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,439.81
|
| Rate for Payer: Cash Price |
$2,513.10
|
| Rate for Payer: Cigna Commercial |
$7,706.84
|
| Rate for Payer: Health EOS Commercial |
$7,455.53
|
| Rate for Payer: HFN Commercial |
$7,706.84
|
| Rate for Payer: Multiplan Commercial |
$6,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,026.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,706.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,104.73
|
| Rate for Payer: Quartz Commercial |
$5,026.20
|
| Rate for Payer: WEA Trust Commercial |
$4,607.35
|
| Rate for Payer: WPS Commercial |
$6,204.84
|
|
|
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 |
$3,946.95 |
| Max. Negotiated Rate |
$7,410.60 |
| Rate for Payer: Aetna Commercial |
$7,249.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,927.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,269.15
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cigna Commercial |
$7,410.60
|
| Rate for Payer: Health EOS Commercial |
$7,168.95
|
| Rate for Payer: HFN Commercial |
$7,410.60
|
| Rate for Payer: Multiplan Commercial |
$6,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,833.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,410.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.95
|
| Rate for Payer: Quartz Commercial |
$4,833.00
|
| Rate for Payer: WEA Trust Commercial |
$4,430.25
|
| Rate for Payer: WPS Commercial |
$5,966.34
|
|
|
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 |
$2,255.40 |
| Max. Negotiated Rate |
$32,220.00 |
| Rate for Payer: Aetna Commercial |
$7,249.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,927.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,255.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,235.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,027.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,269.15
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cigna Commercial |
$7,410.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,507.58
|
| Rate for Payer: Health EOS Commercial |
$7,168.95
|
| Rate for Payer: HFN Commercial |
$7,410.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,041.25
|
| Rate for Payer: Multiplan Commercial |
$6,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,833.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,410.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.95
|
| Rate for Payer: Quartz Commercial |
$5,235.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,833.00
|
| Rate for Payer: The Alliance Commercial |
$32,220.00
|
| Rate for Payer: WEA Trust Commercial |
$4,430.25
|
| Rate for Payer: WPS Commercial |
$5,966.34
|
|
|
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 |
$5,994.66 |
| Max. Negotiated Rate |
$11,255.28 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,340.40
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
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 |
$3,425.52 |
| Max. Negotiated Rate |
$48,936.00 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,425.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,952.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,846.15
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,952.10
|
| Rate for Payer: Quartz Medicare Advantage |
$7,340.40
|
| Rate for Payer: The Alliance Commercial |
$48,936.00
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
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 |
$3,007.62 |
| Max. Negotiated Rate |
$5,646.96 |
| Rate for Payer: Aetna Commercial |
$5,524.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,278.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.14
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,646.96
|
| Rate for Payer: Health EOS Commercial |
$5,462.82
|
| Rate for Payer: HFN Commercial |
$5,646.96
|
| Rate for Payer: Multiplan Commercial |
$4,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.62
|
| Rate for Payer: Quartz Commercial |
$3,682.80
|
| Rate for Payer: WEA Trust Commercial |
$3,375.90
|
| Rate for Payer: WPS Commercial |
$4,546.42
|
|
|
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 |
$1,718.64 |
| Max. Negotiated Rate |
$24,552.00 |
| Rate for Payer: Aetna Commercial |
$5,524.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,278.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,989.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,069.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,946.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.14
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,646.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,434.82
|
| Rate for Payer: Health EOS Commercial |
$5,462.82
|
| Rate for Payer: HFN Commercial |
$5,646.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,603.50
|
| Rate for Payer: Multiplan Commercial |
$4,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.62
|
| Rate for Payer: Quartz Commercial |
$3,989.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,682.80
|
| Rate for Payer: The Alliance Commercial |
$24,552.00
|
| Rate for Payer: WEA Trust Commercial |
$3,375.90
|
| Rate for Payer: WPS Commercial |
$4,546.42
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$2,771.44 |
| Max. Negotiated Rate |
$5,203.52 |
| Rate for Payer: Aetna Commercial |
$5,090.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,864.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,997.68
|
| Rate for Payer: Cash Price |
$1,696.80
|
| Rate for Payer: Cigna Commercial |
$5,203.52
|
| Rate for Payer: Health EOS Commercial |
$5,033.84
|
| Rate for Payer: HFN Commercial |
$5,203.52
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,203.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.44
|
| Rate for Payer: Quartz Commercial |
$3,393.60
|
| Rate for Payer: WEA Trust Commercial |
$3,110.80
|
| Rate for Payer: WPS Commercial |
$4,189.40
|
|
|
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 |
$1,583.68 |
| Max. Negotiated Rate |
$22,624.00 |
| Rate for Payer: Aetna Commercial |
$5,090.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,864.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,583.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,676.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,828.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,714.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,997.68
|
| Rate for Payer: Cash Price |
$1,696.80
|
| Rate for Payer: Cigna Commercial |
$5,203.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,165.10
|
| Rate for Payer: Health EOS Commercial |
$5,033.84
|
| Rate for Payer: HFN Commercial |
$5,203.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,242.00
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,203.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.44
|
| Rate for Payer: Quartz Commercial |
$3,676.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,393.60
|
| Rate for Payer: The Alliance Commercial |
$22,624.00
|
| Rate for Payer: WEA Trust Commercial |
$3,110.80
|
| Rate for Payer: WPS Commercial |
$4,189.40
|
|
|
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 |
$1,718.64 |
| Max. Negotiated Rate |
$24,552.00 |
| Rate for Payer: Aetna Commercial |
$5,524.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,278.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,989.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,069.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,946.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.14
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,646.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,434.82
|
| Rate for Payer: Health EOS Commercial |
$5,462.82
|
| Rate for Payer: HFN Commercial |
$5,646.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,603.50
|
| Rate for Payer: Multiplan Commercial |
$4,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.62
|
| Rate for Payer: Quartz Commercial |
$3,989.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,682.80
|
| Rate for Payer: The Alliance Commercial |
$24,552.00
|
| Rate for Payer: WEA Trust Commercial |
$3,375.90
|
| Rate for Payer: WPS Commercial |
$4,546.42
|
|
