|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 7MM 1516-50-707
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.56 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$4,646.40
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 7MM 1516-50-707
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| Max. Negotiated Rate |
$30,976.00 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.54
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,808.00
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$5,033.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.40
|
| Rate for Payer: The Alliance Commercial |
$30,976.00
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 8MM 1516-50-708
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| Max. Negotiated Rate |
$30,976.00 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.54
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,808.00
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$5,033.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.40
|
| Rate for Payer: The Alliance Commercial |
$30,976.00
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 8MM 1516-50-708
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.56 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$4,646.40
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 10MM 1516-50-810
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.41 |
| Max. Negotiated Rate |
$5,528.28 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,605.40
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 10MM 1516-50-810
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| Max. Negotiated Rate |
$24,036.00 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,682.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,905.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,004.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,884.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,362.64
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,506.75
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,905.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,605.40
|
| Rate for Payer: The Alliance Commercial |
$24,036.00
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 12MM 1516-50-812
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| Max. Negotiated Rate |
$30,976.00 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.54
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,808.00
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$5,033.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.40
|
| Rate for Payer: The Alliance Commercial |
$30,976.00
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 12MM 1516-50-812
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.56 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$4,646.40
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 18MM 1516-50-818
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.41 |
| Max. Negotiated Rate |
$5,528.28 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,605.40
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 18MM 1516-50-818
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| Max. Negotiated Rate |
$24,036.00 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,682.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,905.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,004.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,884.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,362.64
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,506.75
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,905.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,605.40
|
| Rate for Payer: The Alliance Commercial |
$24,036.00
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 5MM 1516-50-805
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.58 |
| Max. Negotiated Rate |
$7,398.64 |
| Rate for Payer: Aetna Commercial |
$7,237.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,916.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,262.26
|
| Rate for Payer: Cash Price |
$2,412.60
|
| Rate for Payer: Cigna Commercial |
$7,398.64
|
| Rate for Payer: Health EOS Commercial |
$7,157.38
|
| Rate for Payer: HFN Commercial |
$7,398.64
|
| Rate for Payer: Multiplan Commercial |
$6,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,825.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,398.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,940.58
|
| Rate for Payer: Quartz Commercial |
$4,825.20
|
| Rate for Payer: WEA Trust Commercial |
$4,423.10
|
| Rate for Payer: WPS Commercial |
$5,956.71
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 5MM 1516-50-805
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.76 |
| Max. Negotiated Rate |
$32,168.00 |
| Rate for Payer: Aetna Commercial |
$7,237.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,916.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,251.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,227.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,021.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,262.26
|
| Rate for Payer: Cash Price |
$2,412.60
|
| Rate for Payer: Cigna Commercial |
$7,398.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,500.30
|
| Rate for Payer: Health EOS Commercial |
$7,157.38
|
| Rate for Payer: HFN Commercial |
$7,398.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,031.50
|
| Rate for Payer: Multiplan Commercial |
$6,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,825.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,398.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,940.58
|
| Rate for Payer: Quartz Commercial |
$5,227.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,825.20
|
| Rate for Payer: The Alliance Commercial |
$32,168.00
|
| Rate for Payer: WEA Trust Commercial |
$4,423.10
|
| Rate for Payer: WPS Commercial |
$5,956.71
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 6MM 1516-50-806
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| Max. Negotiated Rate |
$24,996.00 |
| Rate for Payer: Aetna Commercial |
$5,624.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,061.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.97
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,749.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,496.94
|
| Rate for Payer: Health EOS Commercial |
$5,561.61
|
| Rate for Payer: HFN Commercial |
$5,749.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,686.75
|
| Rate for Payer: Multiplan Commercial |
$4,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.01
|
| Rate for Payer: Quartz Commercial |
$4,061.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.40
|
| Rate for Payer: The Alliance Commercial |
$24,996.00
|
| Rate for Payer: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 6MM 1516-50-806
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.01 |
| Max. Negotiated Rate |
$5,749.08 |
| Rate for Payer: Aetna Commercial |
$5,624.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.97
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,749.08
|
| Rate for Payer: Health EOS Commercial |
$5,561.61
|
| Rate for Payer: HFN Commercial |
$5,749.08
|
| Rate for Payer: Multiplan Commercial |
$4,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.01
|
| Rate for Payer: Quartz Commercial |
$3,749.40
|
| Rate for Payer: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 7MM 1516-50-807
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| Max. Negotiated Rate |
$24,996.00 |
| Rate for Payer: Aetna Commercial |
$5,624.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,061.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.97
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,749.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,496.94
|
| Rate for Payer: Health EOS Commercial |
$5,561.61
|
| Rate for Payer: HFN Commercial |
$5,749.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,686.75
|
| Rate for Payer: Multiplan Commercial |
$4,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.01
|
| Rate for Payer: Quartz Commercial |
$4,061.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.40
|
| Rate for Payer: The Alliance Commercial |
$24,996.00
|
| Rate for Payer: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 7MM 1516-50-807
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.01 |
| Max. Negotiated Rate |
$5,749.08 |
| Rate for Payer: Aetna Commercial |
$5,624.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.97
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,749.08
|
| Rate for Payer: Health EOS Commercial |
$5,561.61
|
| Rate for Payer: HFN Commercial |
$5,749.08
|
| Rate for Payer: Multiplan Commercial |
$4,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.01
|
| Rate for Payer: Quartz Commercial |
$3,749.40
|
| Rate for Payer: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 8MM 1516-50-808
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.56 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$4,646.40
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 8MM 1516-50-808
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| Max. Negotiated Rate |
$30,976.00 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.54
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,808.00
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$5,033.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.40
|
| Rate for Payer: The Alliance Commercial |
$30,976.00
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 5MM 1516-50-905
|
Facility
|
OP
|
$7,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.04 |
| Max. Negotiated Rate |
$30,972.00 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,658.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,032.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,871.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,103.79
|
| Rate for Payer: Cash Price |
$2,322.90
|
| Rate for Payer: Cigna Commercial |
$7,123.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,332.98
|
| Rate for Payer: Health EOS Commercial |
$6,891.27
|
| Rate for Payer: HFN Commercial |
$7,123.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,807.25
|
| Rate for Payer: Multiplan Commercial |
$6,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,123.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.07
|
| Rate for Payer: Quartz Commercial |
$5,032.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,645.80
|
| Rate for Payer: The Alliance Commercial |
$30,972.00
|
| Rate for Payer: WEA Trust Commercial |
$4,258.65
|
| Rate for Payer: WPS Commercial |
$5,735.24
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 5MM 1516-50-905
|
Facility
|
IP
|
$7,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.07 |
| Max. Negotiated Rate |
$7,123.56 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,658.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,103.79
|
| Rate for Payer: Cash Price |
$2,322.90
|
| Rate for Payer: Cigna Commercial |
$7,123.56
|
| Rate for Payer: Health EOS Commercial |
$6,891.27
|
| Rate for Payer: HFN Commercial |
$7,123.56
|
| Rate for Payer: Multiplan Commercial |
$6,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,123.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.07
|
| Rate for Payer: Quartz Commercial |
$4,645.80
|
| Rate for Payer: WEA Trust Commercial |
$4,258.65
|
| Rate for Payer: WPS Commercial |
$5,735.24
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
|
OP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,820.56 |
| Max. Negotiated Rate |
$26,008.00 |
| Rate for Payer: Aetna Commercial |
$5,851.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,591.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,820.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,226.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,120.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,446.06
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$5,981.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,638.52
|
| Rate for Payer: Health EOS Commercial |
$5,786.78
|
| Rate for Payer: HFN Commercial |
$5,981.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,876.50
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,901.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,981.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.98
|
| Rate for Payer: Quartz Commercial |
$4,226.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,901.20
|
| Rate for Payer: The Alliance Commercial |
$26,008.00
|
| Rate for Payer: WEA Trust Commercial |
$3,576.10
|
| Rate for Payer: WPS Commercial |
$4,816.03
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
|
IP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,185.98 |
| Max. Negotiated Rate |
$5,981.84 |
| Rate for Payer: Aetna Commercial |
$5,851.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,591.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,446.06
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$5,981.84
|
| Rate for Payer: Health EOS Commercial |
$5,786.78
|
| Rate for Payer: HFN Commercial |
$5,981.84
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,901.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,981.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.98
|
| Rate for Payer: Quartz Commercial |
$3,901.20
|
| Rate for Payer: WEA Trust Commercial |
$3,576.10
|
| Rate for Payer: WPS Commercial |
$4,816.03
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 7MM 1516-50-907
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| Max. Negotiated Rate |
$24,036.00 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,682.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,905.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,004.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,884.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,362.64
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,506.75
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,905.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,605.40
|
| Rate for Payer: The Alliance Commercial |
$24,036.00
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 7MM 1516-50-907
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.41 |
| Max. Negotiated Rate |
$5,528.28 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.77
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,528.28
|
| Rate for Payer: Health EOS Commercial |
$5,348.01
|
| Rate for Payer: HFN Commercial |
$5,528.28
|
| Rate for Payer: Multiplan Commercial |
$4,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.41
|
| Rate for Payer: Quartz Commercial |
$3,605.40
|
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
|
OP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,986.96 |
| Max. Negotiated Rate |
$85,528.00 |
| Rate for Payer: Aetna Commercial |
$19,243.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,388.52
|
| Rate for Payer: Aetna Managed Medicare |
$5,986.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,898.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,691.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,263.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,332.46
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$19,671.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,965.37
|
| Rate for Payer: Health EOS Commercial |
$19,029.98
|
| Rate for Payer: HFN Commercial |
$19,671.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,036.50
|
| Rate for Payer: Multiplan Commercial |
$17,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,671.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,477.18
|
| Rate for Payer: Quartz Commercial |
$13,898.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12,829.20
|
| Rate for Payer: The Alliance Commercial |
$85,528.00
|
| Rate for Payer: WEA Trust Commercial |
$11,760.10
|
| Rate for Payer: WPS Commercial |
$15,837.65
|
|
