|
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
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 10MM 1516-50-510
|
Facility
IP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.78 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 10MM 1516-50-510
|
Facility
OP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$370.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.79
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 12MM 1516-50-512
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5801643
|
|
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 5 12MM 1516-50-512
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5801643
|
|
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 5 14MM 1516-50-514
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685803
|
|
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 5 14MM 1516-50-514
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685803
|
|
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 5 5MM 1516-50-505
|
Facility
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459771
|
|
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 5 5MM 1516-50-505
|
Facility
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459771
|
|
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 5 6MM 1516-50-506
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611540
|
|
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 5 6MM 1516-50-506
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611540
|
|
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 5 7MM 1516-50-507
|
Facility
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| 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: 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: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 7MM 1516-50-507
|
Facility
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520796
|
|
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: 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 5 8MM 1516-50-508
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.75 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$825.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 8MM 1516-50-508
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.50
|
| Rate for Payer: Aetna Managed Medicare |
$385.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.45
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$893.75
|
| Rate for Payer: Quartz Medicare Advantage |
$825.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 10MM 1516-50-610
|
Facility
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| 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: 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: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 10MM 1516-50-610
|
Facility
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520927
|
|
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: 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 6 12MM 1516-50-612
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767845
|
|
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 6 12MM 1516-50-612
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767845
|
|
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 6 5MM 1516-50-605
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547351
|
|
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 6 5MM 1516-50-605
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547351
|
|
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 6 5MM 1516-50-606
|
Facility
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459823
|
|
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 6 5MM 1516-50-606
|
Facility
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459823
|
|
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 6 7MM 1516-50-607
|
Facility
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490757
|
|
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 6 7MM 1516-50-607
|
Facility
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490757
|
|
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
|
|
