|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 7MM 1516-50-807
|
Facility
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.72 |
| Max. Negotiated Rate |
$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 8MM 1516-50-808
|
Facility
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.56 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: Aetna Commercial |
$6,969.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.32
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,124.48
|
| Rate for Payer: Health EOS Commercial |
$6,892.16
|
| Rate for Payer: HFN Commercial |
$7,124.48
|
| Rate for Payer: Multiplan Commercial |
$6,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.56
|
| Rate for Payer: Quartz Commercial |
$4,646.40
|
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| Rate for Payer: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 8 8MM 1516-50-808
|
Facility
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.32 |
| Max. Negotiated Rate |
$7,124.48 |
| Rate for Payer: WEA Trust Commercial |
$4,259.20
|
| 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: WPS Commercial |
$5,735.98
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 5MM 1516-50-905
|
Facility
OP
|
$7,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.04 |
| Max. Negotiated Rate |
$7,123.56 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,658.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,032.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,871.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,103.79
|
| Rate for Payer: Cash Price |
$2,322.90
|
| Rate for Payer: Cigna Commercial |
$7,123.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,332.98
|
| Rate for Payer: Health EOS Commercial |
$6,891.27
|
| Rate for Payer: HFN Commercial |
$7,123.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,807.25
|
| Rate for Payer: Multiplan Commercial |
$6,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,123.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.07
|
| Rate for Payer: Quartz Commercial |
$5,032.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,645.80
|
| Rate for Payer: WEA Trust Commercial |
$4,258.65
|
| Rate for Payer: WPS Commercial |
$5,735.24
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 5MM 1516-50-905
|
Facility
IP
|
$7,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.07 |
| Max. Negotiated Rate |
$7,123.56 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,103.79
|
| Rate for Payer: Cash Price |
$2,322.90
|
| Rate for Payer: Cigna Commercial |
$7,123.56
|
| Rate for Payer: Health EOS Commercial |
$6,891.27
|
| Rate for Payer: HFN Commercial |
$7,123.56
|
| Rate for Payer: Multiplan Commercial |
$6,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,123.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.07
|
| Rate for Payer: Quartz Commercial |
$4,645.80
|
| Rate for Payer: WEA Trust Commercial |
$4,258.65
|
| Rate for Payer: WPS Commercial |
$5,735.24
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
IP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,185.98 |
| Max. Negotiated Rate |
$5,981.84 |
| Rate for Payer: Aetna Commercial |
$5,851.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,446.06
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$5,981.84
|
| Rate for Payer: Health EOS Commercial |
$5,786.78
|
| Rate for Payer: HFN Commercial |
$5,981.84
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,901.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,981.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.98
|
| Rate for Payer: Quartz Commercial |
$3,901.20
|
| Rate for Payer: WEA Trust Commercial |
$3,576.10
|
| Rate for Payer: WPS Commercial |
$4,816.03
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
OP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,820.56 |
| Max. Negotiated Rate |
$5,981.84 |
| Rate for Payer: Aetna Commercial |
$5,851.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,591.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,820.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,226.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,120.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,446.06
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$5,981.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,638.52
|
| Rate for Payer: Health EOS Commercial |
$5,786.78
|
| Rate for Payer: HFN Commercial |
$5,981.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,876.50
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,901.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,981.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.98
|
| Rate for Payer: Quartz Commercial |
$4,226.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,901.20
|
| Rate for Payer: WEA Trust Commercial |
$3,576.10
|
| Rate for Payer: WPS Commercial |
$4,816.03
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 7MM 1516-50-907
|
Facility
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.41 |
| Max. Negotiated Rate |
$5,528.28 |
| Rate for Payer: Aetna Commercial |
$5,408.10
|
| Rate for Payer: 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 9 7MM 1516-50-907
|
Facility
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.52 |
| Max. Negotiated Rate |
$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 REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
OP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,986.96 |
| Max. Negotiated Rate |
$19,671.44 |
| Rate for Payer: Aetna Commercial |
$19,243.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,388.52
|
| Rate for Payer: Aetna Managed Medicare |
$5,986.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,898.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,691.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,263.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,332.46
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$19,671.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,965.37
|
| Rate for Payer: Health EOS Commercial |
$19,029.98
|
| Rate for Payer: HFN Commercial |
$19,671.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,036.50
|
| Rate for Payer: Multiplan Commercial |
$17,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,671.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,477.18
|
| Rate for Payer: Quartz Commercial |
$13,898.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12,829.20
|
| Rate for Payer: WEA Trust Commercial |
$11,760.10
|
| Rate for Payer: WPS Commercial |
$15,837.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
IP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,477.18 |
| Max. Negotiated Rate |
$19,671.44 |
| Rate for Payer: Aetna Commercial |
$19,243.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,332.46
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$19,671.44
|
| Rate for Payer: Health EOS Commercial |
$19,029.98
|
| Rate for Payer: HFN Commercial |
$19,671.44
|
| Rate for Payer: Multiplan Commercial |
$17,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,671.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,477.18
|
| Rate for Payer: Quartz Commercial |
$12,829.20
|
| Rate for Payer: WEA Trust Commercial |
$11,760.10
|
| Rate for Payer: WPS Commercial |
$15,837.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
OP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,226.36 |
| Max. Negotiated Rate |
$20,458.04 |
| Rate for Payer: Aetna Commercial |
$20,013.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,123.82
|
| Rate for Payer: Aetna Managed Medicare |
$6,226.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,454.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,118.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,673.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.61
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$20,458.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,443.83
|
| Rate for Payer: Health EOS Commercial |
$19,790.93
|
| Rate for Payer: HFN Commercial |
$20,458.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,677.75
|
| Rate for Payer: Multiplan Commercial |
$17,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.04
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.13
|
| Rate for Payer: Quartz Commercial |
$14,454.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13,342.20
|
| Rate for Payer: WEA Trust Commercial |
$12,230.35
|
| Rate for Payer: WPS Commercial |
$16,470.95
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
IP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,896.13 |
| Max. Negotiated Rate |
$20,458.04 |
| Rate for Payer: Aetna Commercial |
$20,013.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.61
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$20,458.04
|
| Rate for Payer: Health EOS Commercial |
$19,790.93
|
| Rate for Payer: HFN Commercial |
$20,458.04
|
| Rate for Payer: Multiplan Commercial |
$17,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.04
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.13
|
| Rate for Payer: Quartz Commercial |
$13,342.20
|
| Rate for Payer: WEA Trust Commercial |
$12,230.35
|
| Rate for Payer: WPS Commercial |
$16,470.95
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,725.68 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,725.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,648.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,446.04
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,979.50
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$8,648.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,519.94 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,725.68 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,725.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,648.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,446.04
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,979.50
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$8,648.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,519.94 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
OP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,102.00 |
| Max. Negotiated Rate |
$13,478.00 |
| Rate for Payer: Aetna Commercial |
$13,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,599.00
|
| Rate for Payer: Aetna Managed Medicare |
$4,102.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,522.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,032.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,764.50
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$13,478.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,198.14
|
| Rate for Payer: Health EOS Commercial |
$13,038.50
|
| Rate for Payer: HFN Commercial |
$13,478.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,987.50
|
| Rate for Payer: Multiplan Commercial |
$11,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,478.00
|
| Rate for Payer: Quartz Beloit One Network |
$7,178.50
|
| Rate for Payer: Quartz Commercial |
$9,522.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,790.00
|
| Rate for Payer: WEA Trust Commercial |
$8,057.50
|
| Rate for Payer: WPS Commercial |
$10,851.26
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
IP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,178.50 |
| Max. Negotiated Rate |
$13,478.00 |
| Rate for Payer: Aetna Commercial |
$13,185.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,764.50
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$13,478.00
|
| Rate for Payer: Health EOS Commercial |
$13,038.50
|
| Rate for Payer: HFN Commercial |
$13,478.00
|
| Rate for Payer: Multiplan Commercial |
$11,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,478.00
|
| Rate for Payer: Quartz Beloit One Network |
$7,178.50
|
| Rate for Payer: Quartz Commercial |
$8,790.00
|
| Rate for Payer: WEA Trust Commercial |
$8,057.50
|
| Rate for Payer: WPS Commercial |
$10,851.26
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
OP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.64 |
| Max. Negotiated Rate |
$12,730.96 |
| Rate for Payer: Aetna Commercial |
$12,454.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.68
|
| Rate for Payer: Aetna Managed Medicare |
$3,874.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,994.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,919.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,642.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.14
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$12,730.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,743.74
|
| Rate for Payer: Health EOS Commercial |
$12,315.82
|
| Rate for Payer: HFN Commercial |
$12,730.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,378.50
|
| Rate for Payer: Multiplan Commercial |
$11,070.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.80
|
| Rate for Payer: Preferred Network Access Commercial |
$12,730.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.62
|
| Rate for Payer: Quartz Commercial |
$8,994.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,302.80
|
| Rate for Payer: WEA Trust Commercial |
$7,610.90
|
| Rate for Payer: WPS Commercial |
$10,249.81
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
IP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,780.62 |
| Max. Negotiated Rate |
$12,730.96 |
| Rate for Payer: Aetna Commercial |
$12,454.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.14
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$12,730.96
|
| Rate for Payer: Health EOS Commercial |
$12,315.82
|
| Rate for Payer: HFN Commercial |
$12,730.96
|
| Rate for Payer: Multiplan Commercial |
$11,070.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.80
|
| Rate for Payer: Preferred Network Access Commercial |
$12,730.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.62
|
| Rate for Payer: Quartz Commercial |
$8,302.80
|
| Rate for Payer: WEA Trust Commercial |
$7,610.90
|
| Rate for Payer: WPS Commercial |
$10,249.81
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
OP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.76 |
| Max. Negotiated Rate |
$13,240.64 |
| Rate for Payer: Aetna Commercial |
$12,952.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,377.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,029.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,354.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,196.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,908.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.76
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,240.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,053.76
|
| Rate for Payer: Health EOS Commercial |
$12,808.88
|
| Rate for Payer: HFN Commercial |
$13,240.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,794.00
|
| Rate for Payer: Multiplan Commercial |
$11,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,052.08
|
| Rate for Payer: Quartz Commercial |
$9,354.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,635.20
|
| Rate for Payer: WEA Trust Commercial |
$7,915.60
|
| Rate for Payer: WPS Commercial |
$10,660.15
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
IP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,052.08 |
| Max. Negotiated Rate |
$13,240.64 |
| Rate for Payer: Aetna Commercial |
$12,952.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.76
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,240.64
|
| Rate for Payer: Health EOS Commercial |
$12,808.88
|
| Rate for Payer: HFN Commercial |
$13,240.64
|
| Rate for Payer: Multiplan Commercial |
$11,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,052.08
|
| Rate for Payer: Quartz Commercial |
$8,635.20
|
| Rate for Payer: WEA Trust Commercial |
$7,915.60
|
| Rate for Payer: WPS Commercial |
$10,660.15
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
IP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,100.15 |
| Max. Negotiated Rate |
$24,596.20 |
| Rate for Payer: Aetna Commercial |
$24,061.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,169.55
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$24,596.20
|
| Rate for Payer: Health EOS Commercial |
$23,794.15
|
| Rate for Payer: HFN Commercial |
$24,596.20
|
| Rate for Payer: Multiplan Commercial |
$21,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$16,041.00
|
| Rate for Payer: Preferred Network Access Commercial |
$24,596.20
|
| Rate for Payer: Quartz Beloit One Network |
$13,100.15
|
| Rate for Payer: Quartz Commercial |
$16,041.00
|
| Rate for Payer: WEA Trust Commercial |
$14,704.25
|
| Rate for Payer: WPS Commercial |
$19,802.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
OP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,485.80 |
| Max. Negotiated Rate |
$24,596.20 |
| Rate for Payer: Aetna Commercial |
$24,061.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,992.10
|
| Rate for Payer: Aetna Managed Medicare |
$7,485.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,377.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,169.55
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$24,596.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,960.91
|
| Rate for Payer: Health EOS Commercial |
$23,794.15
|
| Rate for Payer: HFN Commercial |
$24,596.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,051.25
|
| Rate for Payer: Multiplan Commercial |
$21,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$16,041.00
|
| Rate for Payer: Preferred Network Access Commercial |
$24,596.20
|
| Rate for Payer: Quartz Beloit One Network |
$13,100.15
|
| Rate for Payer: Quartz Commercial |
$17,377.75
|
| Rate for Payer: Quartz Medicare Advantage |
$16,041.00
|
| Rate for Payer: WEA Trust Commercial |
$14,704.25
|
| Rate for Payer: WPS Commercial |
$19,802.61
|
|
