|
HUMERAL STEM APEX UNIVERS REVERS SZ 9 AR-9501-09S
|
Facility
|
IP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,780.06 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$9,526.61
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
|
HUMERAL STEM PRESS-FIT PLASMA COATED 6MM EQUINOXE 300-30-06
|
Facility
|
OP
|
$9,548.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.38 |
| Max. Negotiated Rate |
$9,135.54 |
| Rate for Payer: Aetna Commercial |
$8,936.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,539.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,780.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,454.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,964.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,766.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,262.86
|
| Rate for Payer: Cash Price |
$2,864.40
|
| Rate for Payer: Cigna Commercial |
$9,135.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,556.94
|
| Rate for Payer: Health EOS Commercial |
$8,837.64
|
| Rate for Payer: HFN Commercial |
$9,135.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,447.45
|
| Rate for Payer: Multiplan Commercial |
$7,943.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,957.96
|
| Rate for Payer: Preferred Network Access Commercial |
$9,135.54
|
| Rate for Payer: Quartz Beloit One Network |
$4,865.67
|
| Rate for Payer: Quartz Commercial |
$6,454.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,957.96
|
| Rate for Payer: The Alliance Commercial |
$4,964.97
|
| Rate for Payer: WEA Trust Commercial |
$5,461.46
|
| Rate for Payer: WPS Commercial |
$7,354.83
|
|
|
HUMERAL STEM PRESS-FIT PLASMA COATED 6MM EQUINOXE 300-30-06
|
Facility
|
IP
|
$9,548.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.67 |
| Max. Negotiated Rate |
$9,135.54 |
| Rate for Payer: Aetna Commercial |
$8,936.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,539.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,262.86
|
| Rate for Payer: Cash Price |
$2,864.40
|
| Rate for Payer: Cigna Commercial |
$9,135.54
|
| Rate for Payer: Health EOS Commercial |
$8,837.64
|
| Rate for Payer: HFN Commercial |
$9,135.54
|
| Rate for Payer: Multiplan Commercial |
$7,943.94
|
| Rate for Payer: Preferred Network Access Commercial |
$9,135.54
|
| Rate for Payer: Quartz Beloit One Network |
$4,865.67
|
| Rate for Payer: Quartz Commercial |
$5,957.96
|
| Rate for Payer: WEA Trust Commercial |
$5,461.46
|
| Rate for Payer: WPS Commercial |
$7,354.83
|
|
|
HUMERAL STEM PRESS-FIT PRIMARY 11MM EQUINOXE 300-01-11
|
Facility
|
OP
|
$7,820.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.26 |
| Max. Negotiated Rate |
$7,482.43 |
| Rate for Payer: Aetna Commercial |
$7,319.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,994.45
|
| Rate for Payer: Aetna Managed Medicare |
$2,277.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,286.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,066.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,903.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,310.53
|
| Rate for Payer: Cash Price |
$2,346.08
|
| Rate for Payer: Cigna Commercial |
$7,482.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,551.40
|
| Rate for Payer: Health EOS Commercial |
$7,238.44
|
| Rate for Payer: HFN Commercial |
$7,482.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,099.81
|
| Rate for Payer: Multiplan Commercial |
$6,506.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,879.85
|
| Rate for Payer: Preferred Network Access Commercial |
$7,482.43
|
| Rate for Payer: Quartz Beloit One Network |
$3,985.21
|
| Rate for Payer: Quartz Commercial |
$5,286.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,879.85
|
| Rate for Payer: The Alliance Commercial |
$4,066.54
|
| Rate for Payer: WEA Trust Commercial |
$4,473.19
|
| Rate for Payer: WPS Commercial |
$6,023.95
|
|
|
HUMERAL STEM PRESS-FIT PRIMARY 11MM EQUINOXE 300-01-11
|
Facility
|
IP
|
$7,820.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,985.21 |
| Max. Negotiated Rate |
$7,482.43 |
| Rate for Payer: Aetna Commercial |
$7,319.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,994.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,310.53
|
| Rate for Payer: Cash Price |
$2,346.08
|
| Rate for Payer: Cigna Commercial |
$7,482.43
|
| Rate for Payer: Health EOS Commercial |
$7,238.44
|
| Rate for Payer: HFN Commercial |
$7,482.43
|
| Rate for Payer: Multiplan Commercial |
$6,506.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,482.43
|
| Rate for Payer: Quartz Beloit One Network |
$3,985.21
|
| Rate for Payer: Quartz Commercial |
$4,879.85
|
| Rate for Payer: WEA Trust Commercial |
$4,473.19
|
| Rate for Payer: WPS Commercial |
$6,023.95
|
|
|
HUMERAL STEM SZ 12 PRESS-FIT
|
Facility
|
OP
|
$23,098.00
|
|
| Hospital Charge Code |
2966255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,726.14 |
| Max. Negotiated Rate |
$22,100.17 |
| Rate for Payer: Aetna Commercial |
$21,619.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,658.85
|
| Rate for Payer: Aetna Managed Medicare |
$6,726.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,614.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,010.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,530.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,731.62
|
| Rate for Payer: Cash Price |
$6,929.40
|
| Rate for Payer: Cigna Commercial |
$22,100.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,443.04
|
| Rate for Payer: Health EOS Commercial |
$21,379.51
|
| Rate for Payer: HFN Commercial |
$22,100.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,016.44
|
| Rate for Payer: Multiplan Commercial |
$19,217.54
|
| Rate for Payer: NAPHCARE Commercial |
$14,413.15
|
| Rate for Payer: Preferred Network Access Commercial |
$22,100.17
|
| Rate for Payer: Quartz Beloit One Network |
$11,770.74
|
| Rate for Payer: Quartz Commercial |
$15,614.25
|
| Rate for Payer: Quartz Medicare Advantage |
$14,413.15
|
| Rate for Payer: The Alliance Commercial |
$12,010.96
|
| Rate for Payer: WEA Trust Commercial |
$13,212.06
|
| Rate for Payer: WPS Commercial |
$17,792.39
|
|
|
HUMERAL STEM SZ 12 PRESS-FIT
|
Facility
|
IP
|
$23,098.00
|
|
| Hospital Charge Code |
2966255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,770.74 |
| Max. Negotiated Rate |
$22,100.17 |
| Rate for Payer: Aetna Commercial |
$21,619.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,658.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,731.62
|
| Rate for Payer: Cash Price |
$6,929.40
|
| Rate for Payer: Cigna Commercial |
$22,100.17
|
| Rate for Payer: Health EOS Commercial |
$21,379.51
|
| Rate for Payer: HFN Commercial |
$22,100.17
|
| Rate for Payer: Multiplan Commercial |
$19,217.54
|
| Rate for Payer: Preferred Network Access Commercial |
$22,100.17
|
| Rate for Payer: Quartz Beloit One Network |
$11,770.74
|
| Rate for Payer: Quartz Commercial |
$14,413.15
|
| Rate for Payer: WEA Trust Commercial |
$13,212.06
|
| Rate for Payer: WPS Commercial |
$17,792.39
|
|
|
HUMERAL STEM UNIVERS APEX 6MM AR-9100-06S
|
Facility
|
OP
|
$19,742.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,748.87 |
| Max. Negotiated Rate |
$18,889.15 |
| Rate for Payer: Aetna Commercial |
$18,478.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,657.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,748.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,345.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,265.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,855.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,881.79
|
| Rate for Payer: Cash Price |
$5,922.60
|
| Rate for Payer: Cigna Commercial |
$18,889.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,489.84
|
| Rate for Payer: Health EOS Commercial |
$18,273.20
|
| Rate for Payer: HFN Commercial |
$18,889.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,398.76
|
| Rate for Payer: Multiplan Commercial |
$16,425.34
|
| Rate for Payer: NAPHCARE Commercial |
$12,319.01
|
| Rate for Payer: Preferred Network Access Commercial |
$18,889.15
|
| Rate for Payer: Quartz Beloit One Network |
$10,060.52
|
| Rate for Payer: Quartz Commercial |
$13,345.59
|
| Rate for Payer: Quartz Medicare Advantage |
$12,319.01
|
| Rate for Payer: The Alliance Commercial |
$10,265.84
|
| Rate for Payer: WEA Trust Commercial |
$11,292.42
|
| Rate for Payer: WPS Commercial |
$15,207.26
|
|
|
HUMERAL STEM UNIVERS APEX 6MM AR-9100-06S
|
Facility
|
IP
|
$19,742.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,060.52 |
| Max. Negotiated Rate |
$18,889.15 |
| Rate for Payer: Aetna Commercial |
$18,478.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,657.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,881.79
|
| Rate for Payer: Cash Price |
$5,922.60
|
| Rate for Payer: Cigna Commercial |
$18,889.15
|
| Rate for Payer: Health EOS Commercial |
$18,273.20
|
| Rate for Payer: HFN Commercial |
$18,889.15
|
| Rate for Payer: Multiplan Commercial |
$16,425.34
|
| Rate for Payer: Preferred Network Access Commercial |
$18,889.15
|
| Rate for Payer: Quartz Beloit One Network |
$10,060.52
|
| Rate for Payer: Quartz Commercial |
$12,319.01
|
| Rate for Payer: WEA Trust Commercial |
$11,292.42
|
| Rate for Payer: WPS Commercial |
$15,207.26
|
|
|
HUMERAL STEM UNIVERS II 6MM AR-9100-06P
|
Facility
|
IP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,855.32 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$10,843.25
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 6MM AR-9100-06P
|
Facility
|
OP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.18 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,060.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,746.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,036.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,674.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,113.41
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,554.06
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,843.25
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$11,746.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,843.25
|
| Rate for Payer: The Alliance Commercial |
$9,036.04
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 7MM AR-9100-07P
|
Facility
|
IP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,855.32 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$10,843.25
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 7MM AR-9100-07P
|
Facility
|
OP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.18 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,060.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,746.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,036.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,674.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,113.41
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,554.06
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,843.25
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$11,746.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,843.25
|
| Rate for Payer: The Alliance Commercial |
$9,036.04
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 8MM AR-9100-08P
|
Facility
|
OP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4202658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.18 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,060.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,746.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,036.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,674.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,113.41
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,554.06
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,843.25
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$11,746.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,843.25
|
| Rate for Payer: The Alliance Commercial |
$9,036.04
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 8MM AR-9100-08P
|
Facility
|
IP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4202658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,855.32 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$10,843.25
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 9MM AR-9100-09P
|
Facility
|
IP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,855.32 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$10,843.25
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS II 9MM AR-9100-09P
|
Facility
|
OP
|
$17,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.18 |
| Max. Negotiated Rate |
$16,626.31 |
| Rate for Payer: Aetna Commercial |
$16,264.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,060.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,746.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,036.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,674.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,578.20
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$16,626.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,113.41
|
| Rate for Payer: Health EOS Commercial |
$16,084.15
|
| Rate for Payer: HFN Commercial |
$16,626.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,554.06
|
| Rate for Payer: Multiplan Commercial |
$14,457.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,843.25
|
| Rate for Payer: Preferred Network Access Commercial |
$16,626.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,855.32
|
| Rate for Payer: Quartz Commercial |
$11,746.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,843.25
|
| Rate for Payer: The Alliance Commercial |
$9,036.04
|
| Rate for Payer: WEA Trust Commercial |
$9,939.64
|
| Rate for Payer: WPS Commercial |
$13,385.50
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 12 AR-9501-12S
|
Facility
|
OP
|
$14,680.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.82 |
| Max. Negotiated Rate |
$14,045.82 |
| Rate for Payer: Aetna Commercial |
$13,740.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.79
|
| Rate for Payer: Aetna Managed Medicare |
$4,274.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,923.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,633.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,328.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.62
|
| Rate for Payer: Cash Price |
$4,404.00
|
| Rate for Payer: Cigna Commercial |
$14,045.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,543.76
|
| Rate for Payer: Health EOS Commercial |
$13,587.81
|
| Rate for Payer: HFN Commercial |
$14,045.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,450.40
|
| Rate for Payer: Multiplan Commercial |
$12,213.76
|
| Rate for Payer: NAPHCARE Commercial |
$9,160.32
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.82
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.93
|
| Rate for Payer: Quartz Commercial |
$9,923.68
|
| Rate for Payer: Quartz Medicare Advantage |
$9,160.32
|
| Rate for Payer: The Alliance Commercial |
$7,633.60
|
| Rate for Payer: WEA Trust Commercial |
$8,396.96
|
| Rate for Payer: WPS Commercial |
$11,308.00
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 12 AR-9501-12S
|
Facility
|
IP
|
$14,680.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,480.93 |
| Max. Negotiated Rate |
$14,045.82 |
| Rate for Payer: Aetna Commercial |
$13,740.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.62
|
| Rate for Payer: Cash Price |
$4,404.00
|
| Rate for Payer: Cigna Commercial |
$14,045.82
|
| Rate for Payer: Health EOS Commercial |
$13,587.81
|
| Rate for Payer: HFN Commercial |
$14,045.82
|
| Rate for Payer: Multiplan Commercial |
$12,213.76
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.82
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.93
|
| Rate for Payer: Quartz Commercial |
$9,160.32
|
| Rate for Payer: WEA Trust Commercial |
$8,396.96
|
| Rate for Payer: WPS Commercial |
$11,308.00
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 13 AR-9501-13S
|
Facility
|
OP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,110.29 |
| Max. Negotiated Rate |
$13,505.23 |
| Rate for Payer: Aetna Commercial |
$13,211.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,110.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,541.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,339.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,046.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.19
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$13,505.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,214.93
|
| Rate for Payer: Health EOS Commercial |
$13,064.84
|
| Rate for Payer: HFN Commercial |
$13,505.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,009.70
|
| Rate for Payer: Multiplan Commercial |
$11,743.68
|
| Rate for Payer: NAPHCARE Commercial |
$8,807.76
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.00
|
| Rate for Payer: Quartz Commercial |
$9,541.74
|
| Rate for Payer: Quartz Medicare Advantage |
$8,807.76
|
| Rate for Payer: The Alliance Commercial |
$7,339.80
|
| Rate for Payer: WEA Trust Commercial |
$8,073.78
|
| Rate for Payer: WPS Commercial |
$10,872.78
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 13 AR-9501-13S
|
Facility
|
IP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,193.00 |
| Max. Negotiated Rate |
$13,505.23 |
| Rate for Payer: Aetna Commercial |
$13,211.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.19
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$13,505.23
|
| Rate for Payer: Health EOS Commercial |
$13,064.84
|
| Rate for Payer: HFN Commercial |
$13,505.23
|
| Rate for Payer: Multiplan Commercial |
$11,743.68
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.00
|
| Rate for Payer: Quartz Commercial |
$8,807.76
|
| Rate for Payer: WEA Trust Commercial |
$8,073.78
|
| Rate for Payer: WPS Commercial |
$10,872.78
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 6 AR-9501-06S
|
Facility
|
OP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6212988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,110.29 |
| Max. Negotiated Rate |
$13,505.23 |
| Rate for Payer: Aetna Commercial |
$13,211.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,110.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,541.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,339.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,046.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.19
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$13,505.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,214.93
|
| Rate for Payer: Health EOS Commercial |
$13,064.84
|
| Rate for Payer: HFN Commercial |
$13,505.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,009.70
|
| Rate for Payer: Multiplan Commercial |
$11,743.68
|
| Rate for Payer: NAPHCARE Commercial |
$8,807.76
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.00
|
| Rate for Payer: Quartz Commercial |
$9,541.74
|
| Rate for Payer: Quartz Medicare Advantage |
$8,807.76
|
| Rate for Payer: The Alliance Commercial |
$7,339.80
|
| Rate for Payer: WEA Trust Commercial |
$8,073.78
|
| Rate for Payer: WPS Commercial |
$10,872.78
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 6 AR-9501-06S
|
Facility
|
IP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6212988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,193.00 |
| Max. Negotiated Rate |
$13,505.23 |
| Rate for Payer: Aetna Commercial |
$13,211.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.19
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$13,505.23
|
| Rate for Payer: Health EOS Commercial |
$13,064.84
|
| Rate for Payer: HFN Commercial |
$13,505.23
|
| Rate for Payer: Multiplan Commercial |
$11,743.68
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.00
|
| Rate for Payer: Quartz Commercial |
$8,807.76
|
| Rate for Payer: WEA Trust Commercial |
$8,073.78
|
| Rate for Payer: WPS Commercial |
$10,872.78
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 8 AR-9501-08S
|
Facility
|
IP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,780.06 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$9,526.61
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 8 AR-9501-08S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,445.75 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,445.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,320.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,938.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,621.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,885.39
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,908.26
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,526.61
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$10,320.49
|
| Rate for Payer: Quartz Medicare Advantage |
$9,526.61
|
| Rate for Payer: The Alliance Commercial |
$7,938.84
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
