|
HUMERAL INSERT CONSTRAINED COMBO 36 +3C / 33 AR-9503-3633-3C
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT CONSTRAINED COMBO 36 +3C / 33 AR-9503-3633-3C
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +3 AR-9503S-03C
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +3 AR-9503S-03C
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +3 TO FIT IN 36 CUP AR-9503S-03
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +3 TO FIT IN 36 CUP AR-9503S-03
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +6 TO FIT 36 CUP AR-9503S-06
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +6 TO FIT 36 CUP AR-9503S-06
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +6 TO FIT 36 CUP CONSTRAINT AR-9503S-06C
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT S/36 +6 TO FIT 36 CUP CONSTRAINT AR-9503S-06C
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +3 CONSTRAINED AR-9503L-03C
|
Facility
|
OP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.48 |
| Max. Negotiated Rate |
$20,764.00 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,374.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,904.88
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,893.25
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,374.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.60
|
| Rate for Payer: The Alliance Commercial |
$20,764.00
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +3 CONSTRAINED AR-9503L-03C
|
Facility
|
IP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.59 |
| Max. Negotiated Rate |
$4,775.72 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,114.60
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +3 TO FIT 42 CUP AR-9503L-03
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +3 TO FIT 42 CUP AR-9503L-03
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +6 CONSTRAINED AR-9503L-06C
|
Facility
|
IP
|
$4,991.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,445.59 |
| Max. Negotiated Rate |
$4,591.72 |
| Rate for Payer: Aetna Commercial |
$4,491.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.23
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,591.72
|
| Rate for Payer: Health EOS Commercial |
$4,441.99
|
| Rate for Payer: HFN Commercial |
$4,591.72
|
| Rate for Payer: Multiplan Commercial |
$3,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.59
|
| Rate for Payer: Quartz Commercial |
$2,994.60
|
| Rate for Payer: WEA Trust Commercial |
$2,745.05
|
| Rate for Payer: WPS Commercial |
$3,696.83
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +6 CONSTRAINED AR-9503L-06C
|
Facility
|
OP
|
$4,991.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.48 |
| Max. Negotiated Rate |
$19,964.00 |
| Rate for Payer: Aetna Commercial |
$4,491.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,397.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,244.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,395.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.23
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,591.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,792.96
|
| Rate for Payer: Health EOS Commercial |
$4,441.99
|
| Rate for Payer: HFN Commercial |
$4,591.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,743.25
|
| Rate for Payer: Multiplan Commercial |
$3,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.59
|
| Rate for Payer: Quartz Commercial |
$3,244.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,994.60
|
| Rate for Payer: The Alliance Commercial |
$19,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,745.05
|
| Rate for Payer: WPS Commercial |
$3,696.83
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +6 TO FIT 42 CUP AR-9503L-06
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL L/42 +6 TO FIT 42 CUP AR-9503L-06
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL M/39 +6 TO FIT 39 CUP AR-9503M-06
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4740611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL M/39 +6 TO FIT 39 CUP AR-9503M-06
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4740611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERSAL M/39 +6 TO FIT 39 CUP CONSTRAINT AR-9503M-06C
|
Facility
|
OP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5617773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.48 |
| Max. Negotiated Rate |
$20,764.00 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,374.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,904.88
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,893.25
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,374.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.60
|
| Rate for Payer: The Alliance Commercial |
$20,764.00
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
|
HUMERAL INSERT UNIVERSAL M/39 +6 TO FIT 39 CUP CONSTRAINT AR-9503M-06C
|
Facility
|
IP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5617773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.59 |
| Max. Negotiated Rate |
$4,775.72 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,114.60
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
|
HUMERAL INSERT UNIVERS REVERS M/39 +3 TO FIT 39 CUP AR-9503M-03
|
Facility
|
IP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.51 |
| Max. Negotiated Rate |
$4,967.08 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,239.40
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERS REVERS M/39 +3 TO FIT 39 CUP AR-9503M-03
|
Facility
|
OP
|
$5,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.72 |
| Max. Negotiated Rate |
$21,596.00 |
| Rate for Payer: Aetna Commercial |
$4,859.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.47
|
| Rate for Payer: Cash Price |
$1,619.70
|
| Rate for Payer: Cigna Commercial |
$4,967.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.28
|
| Rate for Payer: Health EOS Commercial |
$4,805.11
|
| Rate for Payer: HFN Commercial |
$4,967.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.25
|
| Rate for Payer: Multiplan Commercial |
$4,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.51
|
| Rate for Payer: Quartz Commercial |
$3,509.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.40
|
| Rate for Payer: The Alliance Commercial |
$21,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,969.45
|
| Rate for Payer: WPS Commercial |
$3,999.04
|
|
|
HUMERAL INSERT UNIVERS REVERS M/39 +3 TO FIT 39 CUP CONSTRAINT AR-9503M-03C
|
Facility
|
IP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.59 |
| Max. Negotiated Rate |
$4,775.72 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,114.60
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
