|
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
|
|
|
HUMERAL STEM UNIVERS REVERS APEX SZ 8 AR-9501-08S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.76 |
| 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 UNIVERS REVERS APEX SZ 8 AR-9501-08S
|
Facility
|
IP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,480.83 |
| 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 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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$9,578.03 |
| Max. Negotiated Rate |
$17,983.24 |
| Rate for Payer: Aetna Commercial |
$17,592.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,810.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,359.91
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$17,983.24
|
| Rate for Payer: Health EOS Commercial |
$17,396.83
|
| Rate for Payer: HFN Commercial |
$17,983.24
|
| Rate for Payer: Multiplan Commercial |
$15,637.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,728.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,983.24
|
| Rate for Payer: Quartz Beloit One Network |
$9,578.03
|
| Rate for Payer: Quartz Commercial |
$11,728.20
|
| Rate for Payer: WEA Trust Commercial |
$10,750.85
|
| Rate for Payer: WPS Commercial |
$14,478.46
|
|
|
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 |
$5,473.16 |
| Max. Negotiated Rate |
$78,188.00 |
| Rate for Payer: Aetna Commercial |
$17,592.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,810.42
|
| Rate for Payer: Aetna Managed Medicare |
$5,473.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,705.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,773.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,382.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,359.91
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$17,983.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,938.50
|
| Rate for Payer: Health EOS Commercial |
$17,396.83
|
| Rate for Payer: HFN Commercial |
$17,983.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,660.25
|
| Rate for Payer: Multiplan Commercial |
$15,637.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,728.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,983.24
|
| Rate for Payer: Quartz Beloit One Network |
$9,578.03
|
| Rate for Payer: Quartz Commercial |
$12,705.55
|
| Rate for Payer: Quartz Medicare Advantage |
$11,728.20
|
| Rate for Payer: The Alliance Commercial |
$78,188.00
|
| Rate for Payer: WEA Trust Commercial |
$10,750.85
|
| Rate for Payer: WPS Commercial |
$14,478.46
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$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 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 |
$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 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 |
$6,222.51 |
| Max. Negotiated Rate |
$11,683.08 |
| Rate for Payer: Aetna Commercial |
$11,429.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,921.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,730.47
|
| Rate for Payer: Cash Price |
$3,809.70
|
| Rate for Payer: Cigna Commercial |
$11,683.08
|
| Rate for Payer: Health EOS Commercial |
$11,302.11
|
| Rate for Payer: HFN Commercial |
$11,683.08
|
| Rate for Payer: Multiplan Commercial |
$10,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,683.08
|
| Rate for Payer: Quartz Beloit One Network |
$6,222.51
|
| Rate for Payer: Quartz Commercial |
$7,619.40
|
| Rate for Payer: WEA Trust Commercial |
$6,984.45
|
| Rate for Payer: WPS Commercial |
$9,406.15
|
|
|
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 |
$3,555.72 |
| Max. Negotiated Rate |
$50,796.00 |
| Rate for Payer: Aetna Commercial |
$11,429.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,921.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,555.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,254.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,349.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,095.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,730.47
|
| Rate for Payer: Cash Price |
$3,809.70
|
| Rate for Payer: Cigna Commercial |
$11,683.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,106.36
|
| Rate for Payer: Health EOS Commercial |
$11,302.11
|
| Rate for Payer: HFN Commercial |
$11,683.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,524.25
|
| Rate for Payer: Multiplan Commercial |
$10,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,683.08
|
| Rate for Payer: Quartz Beloit One Network |
$6,222.51
|
| Rate for Payer: Quartz Commercial |
$8,254.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,619.40
|
| Rate for Payer: The Alliance Commercial |
$50,796.00
|
| Rate for Payer: WEA Trust Commercial |
$6,984.45
|
| Rate for Payer: WPS Commercial |
$9,406.15
|
|
|
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 |
$6,476.33 |
| Max. Negotiated Rate |
$12,159.64 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$7,930.20
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
|
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 |
$3,700.76 |
| Max. Negotiated Rate |
$52,868.00 |
| Rate for Payer: Aetna Commercial |
$11,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.01
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.23
|
| Rate for Payer: Health EOS Commercial |
$11,763.13
|
| Rate for Payer: HFN Commercial |
$12,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,912.75
|
| Rate for Payer: Multiplan Commercial |
$10,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.33
|
| Rate for Payer: Quartz Commercial |
$8,591.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.20
|
| Rate for Payer: The Alliance Commercial |
$52,868.00
|
| Rate for Payer: WEA Trust Commercial |
$7,269.35
|
| Rate for Payer: WPS Commercial |
$9,789.83
|
|
