|
TIBIAL INSERT HINGE UNIVERSAL XSMALL 16MM LPS 1987-27-116
|
Facility
OP
|
$22,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,437.76 |
| Max. Negotiated Rate |
$21,152.64 |
| Rate for Payer: Aetna Commercial |
$20,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,773.12
|
| Rate for Payer: Aetna Managed Medicare |
$6,437.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,036.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,185.76
|
| Rate for Payer: Cash Price |
$6,897.60
|
| Rate for Payer: Cigna Commercial |
$21,152.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,866.32
|
| Rate for Payer: Health EOS Commercial |
$20,462.88
|
| Rate for Payer: HFN Commercial |
$21,152.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,244.00
|
| Rate for Payer: Multiplan Commercial |
$18,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,152.64
|
| Rate for Payer: Quartz Beloit One Network |
$11,266.08
|
| Rate for Payer: Quartz Commercial |
$14,944.80
|
| Rate for Payer: Quartz Medicare Advantage |
$13,795.20
|
| Rate for Payer: WEA Trust Commercial |
$12,645.60
|
| Rate for Payer: WPS Commercial |
$17,030.17
|
|
|
TIBIAL INSERT HINGE UNIVERSAL XSMALL 16MM LPS 1987-27-116
|
Facility
IP
|
$22,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,266.08 |
| Max. Negotiated Rate |
$21,152.64 |
| Rate for Payer: Aetna Commercial |
$20,692.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,185.76
|
| Rate for Payer: Cash Price |
$6,897.60
|
| Rate for Payer: Cigna Commercial |
$21,152.64
|
| Rate for Payer: Health EOS Commercial |
$20,462.88
|
| Rate for Payer: HFN Commercial |
$21,152.64
|
| Rate for Payer: Multiplan Commercial |
$18,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,152.64
|
| Rate for Payer: Quartz Beloit One Network |
$11,266.08
|
| Rate for Payer: Quartz Commercial |
$13,795.20
|
| Rate for Payer: WEA Trust Commercial |
$12,645.60
|
| Rate for Payer: WPS Commercial |
$17,030.17
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 10 5MM 1516-51-005
|
Facility
IP
|
$5,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.22 |
| Max. Negotiated Rate |
$5,315.76 |
| Rate for Payer: Aetna Commercial |
$5,200.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,062.34
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,315.76
|
| Rate for Payer: Health EOS Commercial |
$5,142.42
|
| Rate for Payer: HFN Commercial |
$5,315.76
|
| Rate for Payer: Multiplan Commercial |
$4,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,315.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,831.22
|
| Rate for Payer: Quartz Commercial |
$3,466.80
|
| Rate for Payer: WEA Trust Commercial |
$3,177.90
|
| Rate for Payer: WPS Commercial |
$4,279.76
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 10 5MM 1516-51-005
|
Facility
OP
|
$5,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,617.84 |
| Max. Negotiated Rate |
$5,315.76 |
| Rate for Payer: Aetna Commercial |
$5,200.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,969.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,617.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,755.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,889.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,773.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,062.34
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,315.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,233.37
|
| Rate for Payer: Health EOS Commercial |
$5,142.42
|
| Rate for Payer: HFN Commercial |
$5,315.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,333.50
|
| Rate for Payer: Multiplan Commercial |
$4,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,315.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,831.22
|
| Rate for Payer: Quartz Commercial |
$3,755.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,466.80
|
| Rate for Payer: WEA Trust Commercial |
$3,177.90
|
| Rate for Payer: WPS Commercial |
$4,279.76
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 12MM 1516-50-312
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| 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: 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: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 12MM 1516-50-312
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685627
|
|
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: 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 3 5MM 1516-50-305
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685625
|
|
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: 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 3 5MM 1516-50-305
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| 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: 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: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 6MM 1516-50-306
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611654
|
|
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: 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 3 6MM 1516-50-306
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| 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: 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: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 7MM 1516-50-307
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729912
|
|
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: 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 3 7MM 1516-50-307
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| 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: 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: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 8MM 1516-50-308
|
Facility
IP
|
$6,248.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,061.52 |
| Max. Negotiated Rate |
$5,748.16 |
| Rate for Payer: Aetna Commercial |
$5,623.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.44
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$5,748.16
|
| Rate for Payer: Health EOS Commercial |
$5,560.72
|
| Rate for Payer: HFN Commercial |
$5,748.16
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,748.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,061.52
|
| Rate for Payer: Quartz Commercial |
$3,748.80
|
| Rate for Payer: WEA Trust Commercial |
$3,436.40
|
| Rate for Payer: WPS Commercial |
$4,627.89
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 8MM 1516-50-308
|
Facility
OP
|
$6,248.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.44 |
| Max. Negotiated Rate |
$5,748.16 |
| Rate for Payer: Aetna Commercial |
$5,623.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,373.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,061.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,311.44
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$5,748.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,496.38
|
| Rate for Payer: Health EOS Commercial |
$5,560.72
|
| Rate for Payer: HFN Commercial |
$5,748.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,686.00
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,748.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,061.52
|
| Rate for Payer: Quartz Commercial |
$4,061.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,748.80
|
| Rate for Payer: WEA Trust Commercial |
$3,436.40
|
| Rate for Payer: WPS Commercial |
$4,627.89
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 10MM 1516-50-410
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547352
|
|
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: 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 4 10MM 1516-50-410
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| 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: 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: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 12MM 1516-50-412
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627701
|
|
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: 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 4 12MM 1516-50-412
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| 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: 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: WEA Trust Commercial |
$3,304.95
|
| Rate for Payer: WPS Commercial |
$4,450.87
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 5MM 1516-50-405
|
Facility
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459753
|
|
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: 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 4 5MM 1516-50-405
|
Facility
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.76 |
| 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: 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: WEA Trust Commercial |
$4,423.10
|
| Rate for Payer: WPS Commercial |
$5,956.71
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 6MM 1516-50-406
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| 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: 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: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 6MM 1516-50-406
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599726
|
|
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: 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 4 7MM 1516-50-407
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| 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: 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: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 7MM 1516-50-407
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547478
|
|
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: 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 4 8MM 1516-50-408
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5605787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| 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: 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: WEA Trust Commercial |
$3,436.95
|
| Rate for Payer: WPS Commercial |
$4,628.63
|
|
