|
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 |
$5,473.16 |
| 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 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 |
$9,578.03 |
| 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 SZ 6 AR-9501-06CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240355
|
|
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 6 AR-9501-06CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,700.76 |
| 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 6 AR-9501-06P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298727
|
|
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 6 AR-9501-06P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298727
|
|
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 6 CAP COATED AR-9501-06RCPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317079
|
|
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 6 CAP COATED AR-9501-06RCPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4317079
|
|
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 7 AR-9501-07P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5348954
|
|
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 7 AR-9501-07P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5348954
|
|
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 7 AR-9501-07S
|
Facility
|
IP
|
$12,709.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,227.41 |
| Max. Negotiated Rate |
$11,692.28 |
| Rate for Payer: Aetna Commercial |
$11,438.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,929.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,735.77
|
| Rate for Payer: Cash Price |
$3,812.70
|
| Rate for Payer: Cigna Commercial |
$11,692.28
|
| Rate for Payer: Health EOS Commercial |
$11,311.01
|
| Rate for Payer: HFN Commercial |
$11,692.28
|
| Rate for Payer: Multiplan Commercial |
$10,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,625.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,692.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,227.41
|
| Rate for Payer: Quartz Commercial |
$7,625.40
|
| Rate for Payer: WEA Trust Commercial |
$6,989.95
|
| Rate for Payer: WPS Commercial |
$9,413.56
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 7 AR-9501-07S
|
Facility
|
OP
|
$12,709.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,558.52 |
| Max. Negotiated Rate |
$50,836.00 |
| Rate for Payer: Aetna Commercial |
$11,438.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,929.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,558.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,260.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,100.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,735.77
|
| Rate for Payer: Cash Price |
$3,812.70
|
| Rate for Payer: Cigna Commercial |
$11,692.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,111.96
|
| Rate for Payer: Health EOS Commercial |
$11,311.01
|
| Rate for Payer: HFN Commercial |
$11,692.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,531.75
|
| Rate for Payer: Multiplan Commercial |
$10,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,625.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,692.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,227.41
|
| Rate for Payer: Quartz Commercial |
$8,260.85
|
| Rate for Payer: Quartz Medicare Advantage |
$7,625.40
|
| Rate for Payer: The Alliance Commercial |
$50,836.00
|
| Rate for Payer: WEA Trust Commercial |
$6,989.95
|
| Rate for Payer: WPS Commercial |
$9,413.56
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 7 CAP COATED AR-9501-07CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4594864
|
|
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 7 CAP COATED AR-9501-07CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4594864
|
|
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 8 AR-9501-08P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306687
|
|
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 8 AR-9501-08P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306687
|
|
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 9 AR-9501-09P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306667
|
|
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 9 AR-9501-09P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306667
|
|
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 TRAY MINI COMPREHENSIVE REVERSE SHOULDER STD THICKNESS +0 TAPER OFFSETT 40MM DIA 110031399
|
Facility
|
OP
|
$7,748.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.44 |
| Max. Negotiated Rate |
$30,992.00 |
| Rate for Payer: Aetna Commercial |
$6,973.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,663.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,169.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,036.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,874.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,719.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,106.44
|
| Rate for Payer: Cash Price |
$2,324.40
|
| Rate for Payer: Cigna Commercial |
$7,128.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,335.78
|
| Rate for Payer: Health EOS Commercial |
$6,895.72
|
| Rate for Payer: HFN Commercial |
$7,128.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,811.00
|
| Rate for Payer: Multiplan Commercial |
$6,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,648.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,128.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,796.52
|
| Rate for Payer: Quartz Commercial |
$5,036.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,648.80
|
| Rate for Payer: The Alliance Commercial |
$30,992.00
|
| Rate for Payer: WEA Trust Commercial |
$4,261.40
|
| Rate for Payer: WPS Commercial |
$5,738.94
|
|
|
HUMERAL TRAY MINI COMPREHENSIVE REVERSE SHOULDER STD THICKNESS +0 TAPER OFFSETT 40MM DIA 110031399
|
Facility
|
IP
|
$7,748.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.52 |
| Max. Negotiated Rate |
$7,128.16 |
| Rate for Payer: Aetna Commercial |
$6,973.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,663.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,106.44
|
| Rate for Payer: Cash Price |
$2,324.40
|
| Rate for Payer: Cigna Commercial |
$7,128.16
|
| Rate for Payer: Health EOS Commercial |
$6,895.72
|
| Rate for Payer: HFN Commercial |
$7,128.16
|
| Rate for Payer: Multiplan Commercial |
$6,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,648.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,128.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,796.52
|
| Rate for Payer: Quartz Commercial |
$4,648.80
|
| Rate for Payer: WEA Trust Commercial |
$4,261.40
|
| Rate for Payer: WPS Commercial |
$5,738.94
|
|
|
HUMERUS INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$4,923.00
|
|
| Hospital Charge Code |
2960151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$19,692.00 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: The Alliance Commercial |
$19,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
HUMERUS INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$4,923.00
|
|
| Hospital Charge Code |
2960151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
HUMERUS, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
HUMERUS, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
HUMIDIFIER AQUA
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2974555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
