|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 8MM 1516-50-608
|
Facility
IP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.54 |
| Max. Negotiated Rate |
$6,850.32 |
| Rate for Payer: Aetna Commercial |
$6,701.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.38
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$6,850.32
|
| Rate for Payer: Health EOS Commercial |
$6,626.94
|
| Rate for Payer: HFN Commercial |
$6,850.32
|
| Rate for Payer: Multiplan Commercial |
$5,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,467.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.54
|
| Rate for Payer: Quartz Commercial |
$4,467.60
|
| Rate for Payer: WEA Trust Commercial |
$4,095.30
|
| Rate for Payer: WPS Commercial |
$5,515.25
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 8MM 1516-50-608
|
Facility
OP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.88 |
| Max. Negotiated Rate |
$6,850.32 |
| Rate for Payer: Aetna Commercial |
$6,701.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,403.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,084.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,839.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,723.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,574.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.38
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$6,850.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,166.78
|
| Rate for Payer: Health EOS Commercial |
$6,626.94
|
| Rate for Payer: HFN Commercial |
$6,850.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,584.50
|
| Rate for Payer: Multiplan Commercial |
$5,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,467.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.54
|
| Rate for Payer: Quartz Commercial |
$4,839.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,467.60
|
| Rate for Payer: WEA Trust Commercial |
$4,095.30
|
| Rate for Payer: WPS Commercial |
$5,515.25
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 10MM 1516-50-710
|
Facility
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521077
|
|
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 7 10MM 1516-50-710
|
Facility
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521077
|
|
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 7 14MM 1516-50-714
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| Max. Negotiated Rate |
$5,749.08 |
| Rate for Payer: WEA Trust Commercial |
$3,436.95
|
| 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: WPS Commercial |
$4,628.63
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 14MM 1516-50-714
|
Facility
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563684
|
|
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 7 5MM 1516-50-705
|
Facility
OP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.88 |
| Max. Negotiated Rate |
$6,850.32 |
| Rate for Payer: Aetna Commercial |
$6,701.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,403.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,084.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,839.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,723.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,574.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.38
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$6,850.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,166.78
|
| Rate for Payer: Health EOS Commercial |
$6,626.94
|
| Rate for Payer: HFN Commercial |
$6,850.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,584.50
|
| Rate for Payer: Multiplan Commercial |
$5,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,467.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.54
|
| Rate for Payer: Quartz Commercial |
$4,839.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,467.60
|
| Rate for Payer: WEA Trust Commercial |
$4,095.30
|
| Rate for Payer: WPS Commercial |
$5,515.25
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 5MM 1516-50-705
|
Facility
IP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.54 |
| Max. Negotiated Rate |
$6,850.32 |
| Rate for Payer: Aetna Commercial |
$6,701.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.38
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$6,850.32
|
| Rate for Payer: Health EOS Commercial |
$6,626.94
|
| Rate for Payer: HFN Commercial |
$6,850.32
|
| Rate for Payer: Multiplan Commercial |
$5,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,467.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.54
|
| Rate for Payer: Quartz Commercial |
$4,467.60
|
| Rate for Payer: WEA Trust Commercial |
$4,095.30
|
| Rate for Payer: WPS Commercial |
$5,515.25
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 6MM 1516-50-706
|
Facility
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520969
|
|
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 7 6MM 1516-50-706
|
Facility
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520969
|
|
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 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 |
$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 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: 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 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 |
$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 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: 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
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 |
$5,528.28 |
| Rate for Payer: WEA Trust Commercial |
$3,304.95
|
| 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: WPS Commercial |
$4,450.87
|
|
|
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: 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 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: 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 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 |
$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 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 |
$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 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: 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 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: 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 |
$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 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: 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 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 |
$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 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: 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
|
|
