|
HUMERAL STEM APEX UNIVERS REVERS SZ 10 AR-9501-10S
|
Facility
|
IP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,480.83 |
| Max. Negotiated Rate |
$14,045.64 |
| Rate for Payer: Aetna Commercial |
$13,740.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.51
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,045.64
|
| Rate for Payer: Health EOS Commercial |
$13,587.63
|
| Rate for Payer: HFN Commercial |
$14,045.64
|
| Rate for Payer: Multiplan Commercial |
$12,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.83
|
| Rate for Payer: Quartz Commercial |
$9,160.20
|
| Rate for Payer: WEA Trust Commercial |
$8,396.85
|
| Rate for Payer: WPS Commercial |
$11,308.27
|
|
|
HUMERAL STEM APEX UNIVERS REVERS SZ 10 AR-9501-10S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.76 |
| Max. Negotiated Rate |
$61,068.00 |
| Rate for Payer: Aetna Commercial |
$13,740.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.62
|
| Rate for Payer: Aetna Managed Medicare |
$4,274.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,923.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,633.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,328.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.51
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,045.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,543.41
|
| Rate for Payer: Health EOS Commercial |
$13,587.63
|
| Rate for Payer: HFN Commercial |
$14,045.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,450.25
|
| Rate for Payer: Multiplan Commercial |
$12,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.83
|
| Rate for Payer: Quartz Commercial |
$9,923.55
|
| Rate for Payer: Quartz Medicare Advantage |
$9,160.20
|
| Rate for Payer: The Alliance Commercial |
$61,068.00
|
| Rate for Payer: WEA Trust Commercial |
$8,396.85
|
| Rate for Payer: WPS Commercial |
$11,308.27
|
|
|
HUMERAL STEM APEX UNIVERS REVERS SZ 9 AR-9501-09S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.76 |
| Max. Negotiated Rate |
$61,068.00 |
| Rate for Payer: Aetna Commercial |
$13,740.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.62
|
| Rate for Payer: Aetna Managed Medicare |
$4,274.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,923.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,633.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,328.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.51
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,045.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,543.41
|
| Rate for Payer: Health EOS Commercial |
$13,587.63
|
| Rate for Payer: HFN Commercial |
$14,045.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,450.25
|
| Rate for Payer: Multiplan Commercial |
$12,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.83
|
| Rate for Payer: Quartz Commercial |
$9,923.55
|
| Rate for Payer: Quartz Medicare Advantage |
$9,160.20
|
| Rate for Payer: The Alliance Commercial |
$61,068.00
|
| Rate for Payer: WEA Trust Commercial |
$8,396.85
|
| Rate for Payer: WPS Commercial |
$11,308.27
|
|
|
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 |
$7,480.83 |
| Max. Negotiated Rate |
$14,045.64 |
| Rate for Payer: Aetna Commercial |
$13,740.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,129.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,091.51
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,045.64
|
| Rate for Payer: Health EOS Commercial |
$13,587.63
|
| Rate for Payer: HFN Commercial |
$14,045.64
|
| Rate for Payer: Multiplan Commercial |
$12,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,045.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,480.83
|
| Rate for Payer: Quartz Commercial |
$9,160.20
|
| Rate for Payer: WEA Trust Commercial |
$8,396.85
|
| Rate for Payer: WPS Commercial |
$11,308.27
|
|
|
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 |
$4,678.52 |
| Max. Negotiated Rate |
$8,784.17 |
| Rate for Payer: Aetna Commercial |
$8,593.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,211.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,060.45
|
| Rate for Payer: Cash Price |
$2,864.40
|
| Rate for Payer: Cigna Commercial |
$8,784.17
|
| Rate for Payer: Health EOS Commercial |
$8,497.73
|
| Rate for Payer: HFN Commercial |
$8,784.17
|
| Rate for Payer: Multiplan Commercial |
$7,638.41
|
| Rate for Payer: NAPHCARE Commercial |
$5,728.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,784.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,678.52
|
| Rate for Payer: Quartz Commercial |
$5,728.81
|
| Rate for Payer: WEA Trust Commercial |
$5,251.41
|
| Rate for Payer: WPS Commercial |
$7,072.21
|
|
|
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 |
$2,673.44 |
| Max. Negotiated Rate |
$38,192.04 |
| Rate for Payer: Aetna Commercial |
$8,593.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,211.29
|
| Rate for Payer: Aetna Managed Medicare |
$2,673.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,206.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,774.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,583.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,060.45
|
| Rate for Payer: Cash Price |
$2,864.40
|
| Rate for Payer: Cigna Commercial |
$8,784.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,343.07
|
| Rate for Payer: Health EOS Commercial |
$8,497.73
|
| Rate for Payer: HFN Commercial |
$8,784.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,161.01
|
| Rate for Payer: Multiplan Commercial |
$7,638.41
|
| Rate for Payer: NAPHCARE Commercial |
$5,728.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,784.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,678.52
|
| Rate for Payer: Quartz Commercial |
$6,206.21
|
| Rate for Payer: Quartz Medicare Advantage |
$5,728.81
|
| Rate for Payer: The Alliance Commercial |
$38,192.04
|
| Rate for Payer: WEA Trust Commercial |
$5,251.41
|
| Rate for Payer: WPS Commercial |
$7,072.21
|
|
|
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 |
$2,189.68 |
| Max. Negotiated Rate |
$31,281.08 |
| Rate for Payer: Aetna Commercial |
$7,038.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,725.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,189.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,083.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,910.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,753.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,144.74
|
| Rate for Payer: Cash Price |
$2,346.08
|
| Rate for Payer: Cigna Commercial |
$7,194.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,376.22
|
| Rate for Payer: Health EOS Commercial |
$6,960.04
|
| Rate for Payer: HFN Commercial |
$7,194.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,865.20
|
| Rate for Payer: Multiplan Commercial |
$6,256.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,692.16
|
| Rate for Payer: Preferred Network Access Commercial |
$7,194.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,831.93
|
| Rate for Payer: Quartz Commercial |
$5,083.18
|
| Rate for Payer: Quartz Medicare Advantage |
$4,692.16
|
| Rate for Payer: The Alliance Commercial |
$31,281.08
|
| Rate for Payer: WEA Trust Commercial |
$4,301.15
|
| Rate for Payer: WPS Commercial |
$5,792.47
|
|
|
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 |
$3,831.93 |
| Max. Negotiated Rate |
$7,194.65 |
| Rate for Payer: Aetna Commercial |
$7,038.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,725.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,144.74
|
| Rate for Payer: Cash Price |
$2,346.08
|
| Rate for Payer: Cigna Commercial |
$7,194.65
|
| Rate for Payer: Health EOS Commercial |
$6,960.04
|
| Rate for Payer: HFN Commercial |
$7,194.65
|
| Rate for Payer: Multiplan Commercial |
$6,256.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,692.16
|
| Rate for Payer: Preferred Network Access Commercial |
$7,194.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,831.93
|
| Rate for Payer: Quartz Commercial |
$4,692.16
|
| Rate for Payer: WEA Trust Commercial |
$4,301.15
|
| Rate for Payer: WPS Commercial |
$5,792.47
|
|
|
HUMERAL STEM SZ 12 PRESS-FIT
|
Facility
|
OP
|
$23,098.00
|
|
| Hospital Charge Code |
2966255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,467.44 |
| Max. Negotiated Rate |
$92,392.00 |
| Rate for Payer: Aetna Commercial |
$20,788.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,864.28
|
| Rate for Payer: Aetna Managed Medicare |
$6,467.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,013.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,549.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,087.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,241.94
|
| Rate for Payer: Cash Price |
$6,929.40
|
| Rate for Payer: Cigna Commercial |
$21,250.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,925.64
|
| Rate for Payer: Health EOS Commercial |
$20,557.22
|
| Rate for Payer: HFN Commercial |
$21,250.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,323.50
|
| Rate for Payer: Multiplan Commercial |
$18,478.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,858.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21,250.16
|
| Rate for Payer: Quartz Beloit One Network |
$11,318.02
|
| Rate for Payer: Quartz Commercial |
$15,013.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,858.80
|
| Rate for Payer: The Alliance Commercial |
$92,392.00
|
| Rate for Payer: WEA Trust Commercial |
$12,703.90
|
| Rate for Payer: WPS Commercial |
$17,108.69
|
|
|
HUMERAL STEM SZ 12 PRESS-FIT
|
Facility
|
IP
|
$23,098.00
|
|
| Hospital Charge Code |
2966255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,318.02 |
| Max. Negotiated Rate |
$21,250.16 |
| Rate for Payer: Aetna Commercial |
$20,788.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,864.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,241.94
|
| Rate for Payer: Cash Price |
$6,929.40
|
| Rate for Payer: Cigna Commercial |
$21,250.16
|
| Rate for Payer: Health EOS Commercial |
$20,557.22
|
| Rate for Payer: HFN Commercial |
$21,250.16
|
| Rate for Payer: Multiplan Commercial |
$18,478.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,858.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21,250.16
|
| Rate for Payer: Quartz Beloit One Network |
$11,318.02
|
| Rate for Payer: Quartz Commercial |
$13,858.80
|
| Rate for Payer: WEA Trust Commercial |
$12,703.90
|
| Rate for Payer: WPS Commercial |
$17,108.69
|
|
|
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 |
$9,673.58 |
| Max. Negotiated Rate |
$18,162.64 |
| Rate for Payer: Aetna Commercial |
$17,767.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,978.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,463.26
|
| Rate for Payer: Cash Price |
$5,922.60
|
| Rate for Payer: Cigna Commercial |
$18,162.64
|
| Rate for Payer: Health EOS Commercial |
$17,570.38
|
| Rate for Payer: HFN Commercial |
$18,162.64
|
| Rate for Payer: Multiplan Commercial |
$15,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,845.20
|
| Rate for Payer: Preferred Network Access Commercial |
$18,162.64
|
| Rate for Payer: Quartz Beloit One Network |
$9,673.58
|
| Rate for Payer: Quartz Commercial |
$11,845.20
|
| Rate for Payer: WEA Trust Commercial |
$10,858.10
|
| Rate for Payer: WPS Commercial |
$14,622.90
|
|
|
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 |
$5,527.76 |
| Max. Negotiated Rate |
$78,968.00 |
| Rate for Payer: Aetna Commercial |
$17,767.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,978.12
|
| Rate for Payer: Aetna Managed Medicare |
$5,527.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,832.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,476.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,463.26
|
| Rate for Payer: Cash Price |
$5,922.60
|
| Rate for Payer: Cigna Commercial |
$18,162.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,047.62
|
| Rate for Payer: Health EOS Commercial |
$17,570.38
|
| Rate for Payer: HFN Commercial |
$18,162.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,806.50
|
| Rate for Payer: Multiplan Commercial |
$15,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,845.20
|
| Rate for Payer: Preferred Network Access Commercial |
$18,162.64
|
| Rate for Payer: Quartz Beloit One Network |
$9,673.58
|
| Rate for Payer: Quartz Commercial |
$12,832.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11,845.20
|
| Rate for Payer: The Alliance Commercial |
$78,968.00
|
| Rate for Payer: WEA Trust Commercial |
$10,858.10
|
| Rate for Payer: WPS Commercial |
$14,622.90
|
|
|
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 |
$8,514.73 |
| Max. Negotiated Rate |
$15,986.84 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$10,426.20
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$4,865.56 |
| Max. Negotiated Rate |
$69,508.00 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Aetna Managed Medicare |
$4,865.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,295.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,340.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,724.17
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,032.75
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$11,295.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,426.20
|
| Rate for Payer: The Alliance Commercial |
$69,508.00
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$8,514.73 |
| Max. Negotiated Rate |
$15,986.84 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$10,426.20
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$4,865.56 |
| Max. Negotiated Rate |
$69,508.00 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Aetna Managed Medicare |
$4,865.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,295.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,340.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,724.17
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,032.75
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$11,295.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,426.20
|
| Rate for Payer: The Alliance Commercial |
$69,508.00
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$8,514.73 |
| Max. Negotiated Rate |
$15,986.84 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$10,426.20
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$4,865.56 |
| Max. Negotiated Rate |
$69,508.00 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Aetna Managed Medicare |
$4,865.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,295.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,340.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,724.17
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,032.75
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$11,295.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,426.20
|
| Rate for Payer: The Alliance Commercial |
$69,508.00
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$4,865.56 |
| Max. Negotiated Rate |
$69,508.00 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Aetna Managed Medicare |
$4,865.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,295.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,340.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,724.17
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,032.75
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$11,295.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,426.20
|
| Rate for Payer: The Alliance Commercial |
$69,508.00
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$8,514.73 |
| Max. Negotiated Rate |
$15,986.84 |
| Rate for Payer: Aetna Commercial |
$15,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,944.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,209.81
|
| Rate for Payer: Cash Price |
$5,213.10
|
| Rate for Payer: Cigna Commercial |
$15,986.84
|
| Rate for Payer: Health EOS Commercial |
$15,465.53
|
| Rate for Payer: HFN Commercial |
$15,986.84
|
| Rate for Payer: Multiplan Commercial |
$13,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,986.84
|
| Rate for Payer: Quartz Beloit One Network |
$8,514.73
|
| Rate for Payer: Quartz Commercial |
$10,426.20
|
| Rate for Payer: WEA Trust Commercial |
$9,557.35
|
| Rate for Payer: WPS Commercial |
$12,871.14
|
|
|
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 |
$7,193.20 |
| Max. Negotiated Rate |
$13,505.60 |
| Rate for Payer: Aetna Commercial |
$13,212.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.40
|
| Rate for Payer: Cash Price |
$4,404.00
|
| Rate for Payer: Cigna Commercial |
$13,505.60
|
| Rate for Payer: Health EOS Commercial |
$13,065.20
|
| Rate for Payer: HFN Commercial |
$13,505.60
|
| Rate for Payer: Multiplan Commercial |
$11,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,808.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.20
|
| Rate for Payer: Quartz Commercial |
$8,808.00
|
| Rate for Payer: WEA Trust Commercial |
$8,074.00
|
| Rate for Payer: WPS Commercial |
$10,873.48
|
|
|
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 |
$4,110.40 |
| Max. Negotiated Rate |
$58,720.00 |
| Rate for Payer: Aetna Commercial |
$13,212.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,624.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,110.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,542.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,340.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,046.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,780.40
|
| Rate for Payer: Cash Price |
$4,404.00
|
| Rate for Payer: Cigna Commercial |
$13,505.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,214.93
|
| Rate for Payer: Health EOS Commercial |
$13,065.20
|
| Rate for Payer: HFN Commercial |
$13,505.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,010.00
|
| Rate for Payer: Multiplan Commercial |
$11,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,808.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,505.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,193.20
|
| Rate for Payer: Quartz Commercial |
$9,542.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,808.00
|
| Rate for Payer: The Alliance Commercial |
$58,720.00
|
| Rate for Payer: WEA Trust Commercial |
$8,074.00
|
| Rate for Payer: WPS Commercial |
$10,873.48
|
|
|
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 |
$6,916.35 |
| Max. Negotiated Rate |
$12,985.80 |
| Rate for Payer: Aetna Commercial |
$12,703.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,138.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,480.95
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$12,985.80
|
| Rate for Payer: Health EOS Commercial |
$12,562.35
|
| Rate for Payer: HFN Commercial |
$12,985.80
|
| Rate for Payer: Multiplan Commercial |
$11,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,469.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,985.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,916.35
|
| Rate for Payer: Quartz Commercial |
$8,469.00
|
| Rate for Payer: WEA Trust Commercial |
$7,763.25
|
| Rate for Payer: WPS Commercial |
$10,454.98
|
|
|
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 |
$3,952.20 |
| Max. Negotiated Rate |
$56,460.00 |
| Rate for Payer: Aetna Commercial |
$12,703.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,138.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,952.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,174.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,480.95
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$12,985.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,898.75
|
| Rate for Payer: Health EOS Commercial |
$12,562.35
|
| Rate for Payer: HFN Commercial |
$12,985.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,586.25
|
| Rate for Payer: Multiplan Commercial |
$11,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,469.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,985.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,916.35
|
| Rate for Payer: Quartz Commercial |
$9,174.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,469.00
|
| Rate for Payer: The Alliance Commercial |
$56,460.00
|
| Rate for Payer: WEA Trust Commercial |
$7,763.25
|
| Rate for Payer: WPS Commercial |
$10,454.98
|
|
|
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 |
$3,952.20 |
| Max. Negotiated Rate |
$56,460.00 |
| Rate for Payer: Aetna Commercial |
$12,703.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,138.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,952.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,174.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,480.95
|
| Rate for Payer: Cash Price |
$4,234.50
|
| Rate for Payer: Cigna Commercial |
$12,985.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,898.75
|
| Rate for Payer: Health EOS Commercial |
$12,562.35
|
| Rate for Payer: HFN Commercial |
$12,985.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,586.25
|
| Rate for Payer: Multiplan Commercial |
$11,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,469.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,985.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,916.35
|
| Rate for Payer: Quartz Commercial |
$9,174.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,469.00
|
| Rate for Payer: The Alliance Commercial |
$56,460.00
|
| Rate for Payer: WEA Trust Commercial |
$7,763.25
|
| Rate for Payer: WPS Commercial |
$10,454.98
|
|
