|
HUMERAL STEM UNIVERS REVERS SZ 12 AR-9501-12P
|
Facility
|
IP
|
$12,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,471.41 |
| Max. Negotiated Rate |
$12,150.40 |
| Rate for Payer: Aetna Commercial |
$11,886.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,357.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,999.69
|
| Rate for Payer: Cash Price |
$3,809.70
|
| Rate for Payer: Cigna Commercial |
$12,150.40
|
| Rate for Payer: Health EOS Commercial |
$11,754.19
|
| Rate for Payer: HFN Commercial |
$12,150.40
|
| Rate for Payer: Multiplan Commercial |
$10,565.57
|
| Rate for Payer: Preferred Network Access Commercial |
$12,150.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,471.41
|
| Rate for Payer: Quartz Commercial |
$7,924.18
|
| Rate for Payer: WEA Trust Commercial |
$7,263.83
|
| Rate for Payer: WPS Commercial |
$9,782.04
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 AR-9501-05P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 AR-9501-05P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 MOMOBLOCK AR-9501-05-135CPC
|
Facility
|
IP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,961.15 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$12,197.33
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 5 MOMOBLOCK AR-9501-05-135CPC
|
Facility
|
OP
|
$19,547.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.09 |
| Max. Negotiated Rate |
$18,702.57 |
| Rate for Payer: Aetna Commercial |
$18,295.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,482.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,692.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,213.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,164.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,757.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,774.31
|
| Rate for Payer: Cash Price |
$5,864.10
|
| Rate for Payer: Cigna Commercial |
$18,702.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,376.35
|
| Rate for Payer: Health EOS Commercial |
$18,092.70
|
| Rate for Payer: HFN Commercial |
$18,702.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,246.66
|
| Rate for Payer: Multiplan Commercial |
$16,263.10
|
| Rate for Payer: NAPHCARE Commercial |
$12,197.33
|
| Rate for Payer: Preferred Network Access Commercial |
$18,702.57
|
| Rate for Payer: Quartz Beloit One Network |
$9,961.15
|
| Rate for Payer: Quartz Commercial |
$13,213.77
|
| Rate for Payer: Quartz Medicare Advantage |
$12,197.33
|
| Rate for Payer: The Alliance Commercial |
$10,164.44
|
| Rate for Payer: WEA Trust Commercial |
$11,180.88
|
| Rate for Payer: WPS Commercial |
$15,057.05
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 6 AR-9501-06CPC
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 6 AR-9501-06CPC
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
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 |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 6 AR-9501-06P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 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 |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 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 |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 7 AR-9501-07P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5348954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 7 AR-9501-07P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5348954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 7 AR-9501-07S
|
Facility
|
OP
|
$12,709.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,700.86 |
| Max. Negotiated Rate |
$12,159.97 |
| Rate for Payer: Aetna Commercial |
$11,895.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.93
|
| Rate for Payer: Aetna Managed Medicare |
$3,700.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,591.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,608.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,344.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.20
|
| Rate for Payer: Cash Price |
$3,812.70
|
| Rate for Payer: Cigna Commercial |
$12,159.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,396.64
|
| Rate for Payer: Health EOS Commercial |
$11,763.45
|
| Rate for Payer: HFN Commercial |
$12,159.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,913.02
|
| Rate for Payer: Multiplan Commercial |
$10,573.89
|
| Rate for Payer: NAPHCARE Commercial |
$7,930.42
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.97
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.51
|
| Rate for Payer: Quartz Commercial |
$8,591.28
|
| Rate for Payer: Quartz Medicare Advantage |
$7,930.42
|
| Rate for Payer: The Alliance Commercial |
$6,608.68
|
| Rate for Payer: WEA Trust Commercial |
$7,269.55
|
| Rate for Payer: WPS Commercial |
$9,789.74
|
|
|
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 |
$6,476.51 |
| Max. Negotiated Rate |
$12,159.97 |
| Rate for Payer: Aetna Commercial |
$11,895.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,366.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,005.20
|
| Rate for Payer: Cash Price |
$3,812.70
|
| Rate for Payer: Cigna Commercial |
$12,159.97
|
| Rate for Payer: Health EOS Commercial |
$11,763.45
|
| Rate for Payer: HFN Commercial |
$12,159.97
|
| Rate for Payer: Multiplan Commercial |
$10,573.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,159.97
|
| Rate for Payer: Quartz Beloit One Network |
$6,476.51
|
| Rate for Payer: Quartz Commercial |
$7,930.42
|
| Rate for Payer: WEA Trust Commercial |
$7,269.55
|
| Rate for Payer: WPS Commercial |
$9,789.74
|
|
|
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 |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 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 |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 8 AR-9501-08P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 8 AR-9501-08P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 9 AR-9501-09P
|
Facility
|
OP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,848.79 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,848.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,934.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,872.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,597.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,692.29
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,309.26
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,247.41
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,934.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8,247.41
|
| Rate for Payer: The Alliance Commercial |
$6,872.84
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL STEM UNIVERS REVERS SZ 9 AR-9501-09P
|
Facility
|
IP
|
$13,217.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,735.38 |
| Max. Negotiated Rate |
$12,646.03 |
| Rate for Payer: Aetna Commercial |
$12,371.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,285.21
|
| Rate for Payer: Cash Price |
$3,965.10
|
| Rate for Payer: Cigna Commercial |
$12,646.03
|
| Rate for Payer: Health EOS Commercial |
$12,233.66
|
| Rate for Payer: HFN Commercial |
$12,646.03
|
| Rate for Payer: Multiplan Commercial |
$10,996.54
|
| Rate for Payer: Preferred Network Access Commercial |
$12,646.03
|
| Rate for Payer: Quartz Beloit One Network |
$6,735.38
|
| Rate for Payer: Quartz Commercial |
$8,247.41
|
| Rate for Payer: WEA Trust Commercial |
$7,560.12
|
| Rate for Payer: WPS Commercial |
$10,181.06
|
|
|
HUMERAL 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 |
$3,948.38 |
| Max. Negotiated Rate |
$7,413.29 |
| Rate for Payer: Aetna Commercial |
$7,252.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,929.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,270.70
|
| Rate for Payer: Cash Price |
$2,324.40
|
| Rate for Payer: Cigna Commercial |
$7,413.29
|
| Rate for Payer: Health EOS Commercial |
$7,171.55
|
| Rate for Payer: HFN Commercial |
$7,413.29
|
| Rate for Payer: Multiplan Commercial |
$6,446.34
|
| Rate for Payer: Preferred Network Access Commercial |
$7,413.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,948.38
|
| Rate for Payer: Quartz Commercial |
$4,834.75
|
| Rate for Payer: WEA Trust Commercial |
$4,431.86
|
| Rate for Payer: WPS Commercial |
$5,968.28
|
|
|
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 |
$2,256.22 |
| Max. Negotiated Rate |
$7,413.29 |
| Rate for Payer: Aetna Commercial |
$7,252.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,929.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,256.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,237.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,028.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,867.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,270.70
|
| Rate for Payer: Cash Price |
$2,324.40
|
| Rate for Payer: Cigna Commercial |
$7,413.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,509.34
|
| Rate for Payer: Health EOS Commercial |
$7,171.55
|
| Rate for Payer: HFN Commercial |
$7,413.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,043.44
|
| Rate for Payer: Multiplan Commercial |
$6,446.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,834.75
|
| Rate for Payer: Preferred Network Access Commercial |
$7,413.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,948.38
|
| Rate for Payer: Quartz Commercial |
$5,237.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,834.75
|
| Rate for Payer: The Alliance Commercial |
$4,028.96
|
| Rate for Payer: WEA Trust Commercial |
$4,431.86
|
| Rate for Payer: WPS Commercial |
$5,968.28
|
|
|
HUMERUS INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$4,923.00
|
|
| Hospital Charge Code |
2960151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,508.76 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,071.95
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
HUMERUS INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$4,923.00
|
|
| Hospital Charge Code |
2960151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.58 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,327.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,559.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,457.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.19
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,839.94
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,071.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,327.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,071.95
|
| Rate for Payer: The Alliance Commercial |
$2,559.96
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
