|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 10 AR-9501-10CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 10 AR-9501-10CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 11 AR-9501-11CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5179404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 11 AR-9501-11CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5179404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 12 AR-9501-12CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 12 AR-9501-12CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 8 AR-9501-08CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 8 AR-9501-08CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 9 AR-9501-09CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS CAP COATED SZ 9 AR-9501-09CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS COATED SZ 5 AR-9501-05-155CPC
|
Facility
|
OP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4433205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.09 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,692.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,213.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,164.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,757.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,376.35
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,246.66
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: NAPHCARE Commercial |
$12,197.33
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$13,213.77
|
| Rate for Payer: Quartz Medicare Advantage |
$12,197.33
|
| Rate for Payer: The Alliance Commercial |
$10,164.44
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS COATED SZ 5 AR-9501-05-155CPC
|
Facility
|
IP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4433205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,961.15 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$12,197.33
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 10 AR-9501-10P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5415062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 10 AR-9501-10P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5415062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 11 AR-9501-11P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5416050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 11 AR-9501-11P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5416050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 11 AR-9501-11S
|
Facility
|
OP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6196978
|
|
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 SZ 11 AR-9501-11S
|
Facility
|
IP
|
$14,115.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6196978
|
|
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 SZ 12 AR-9501-12P
|
Facility
|
OP
|
$12,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,697.95 |
| Max. Negotiated Rate |
$12,150.40 |
| Rate for Payer: Aetna Commercial |
$11,886.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,357.99
|
| Rate for Payer: Aetna Managed Medicare |
$3,697.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,584.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,603.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,339.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,999.69
|
| Rate for Payer: Cash Price |
$3,809.70
|
| Rate for Payer: Cigna Commercial |
$12,150.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,390.82
|
| Rate for Payer: Health EOS Commercial |
$11,754.19
|
| Rate for Payer: HFN Commercial |
$12,150.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,905.22
|
| Rate for Payer: Multiplan Commercial |
$10,565.57
|
| Rate for Payer: NAPHCARE Commercial |
$7,924.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,150.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,471.41
|
| Rate for Payer: Quartz Commercial |
$8,584.52
|
| Rate for Payer: Quartz Medicare Advantage |
$7,924.18
|
| Rate for Payer: The Alliance Commercial |
$6,603.48
|
| Rate for Payer: WEA Trust Commercial |
$7,263.83
|
| Rate for Payer: WPS Commercial |
$9,782.04
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 12 AR-9501-12P
|
Facility
|
IP
|
$12,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,471.41 |
| Max. Negotiated Rate |
$12,150.40 |
| Rate for Payer: Aetna Commercial |
$11,886.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,357.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,999.69
|
| Rate for Payer: Cash Price |
$3,809.70
|
| Rate for Payer: Cigna Commercial |
$12,150.40
|
| Rate for Payer: Health EOS Commercial |
$11,754.19
|
| Rate for Payer: HFN Commercial |
$12,150.40
|
| Rate for Payer: Multiplan Commercial |
$10,565.57
|
| Rate for Payer: Preferred Network Access Commercial |
$12,150.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,471.41
|
| Rate for Payer: Quartz Commercial |
$7,924.18
|
| Rate for Payer: WEA Trust Commercial |
$7,263.83
|
| Rate for Payer: WPS Commercial |
$9,782.04
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 AR-9501-05P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 AR-9501-05P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 MOMOBLOCK AR-9501-05-135CPC
|
Facility
|
IP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,961.15 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$12,197.33
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 MOMOBLOCK AR-9501-05-135CPC
|
Facility
|
OP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.09 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,692.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,213.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,164.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,757.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,376.35
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,246.66
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: NAPHCARE Commercial |
$12,197.33
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$13,213.77
|
| Rate for Payer: Quartz Medicare Advantage |
$12,197.33
|
| Rate for Payer: The Alliance Commercial |
$10,164.44
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 6 AR-9501-06CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
