|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 5 CEMENTED 1506-80-005
|
Facility
|
IP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,390.71 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,376.38
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 5 CEMENTED 1506-80-005
|
Facility
|
OP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.98 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,508.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,824.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,480.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,301.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,014.51
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,720.48
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,376.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,824.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,376.38
|
| Rate for Payer: The Alliance Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 6 CEMENTED1506-80-006
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,228.66 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,177.95
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 6 CEMENTED1506-80-006
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,416.38 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,416.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,609.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,314.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,142.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,829.44
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,472.44
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,177.95
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,609.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,177.95
|
| Rate for Payer: The Alliance Commercial |
$4,314.96
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 7 CEMENTED 1506-80-007
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,228.66 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,177.95
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 7 CEMENTED 1506-80-007
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,416.38 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,416.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,609.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,314.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,142.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,829.44
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,472.44
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,177.95
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,609.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,177.95
|
| Rate for Payer: The Alliance Commercial |
$4,314.96
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 8 CEMENTED 1506-80-008
|
Facility
|
IP
|
$7,979.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.10 |
| Max. Negotiated Rate |
$7,634.31 |
| Rate for Payer: Aetna Commercial |
$7,468.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,136.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,398.02
|
| Rate for Payer: Cash Price |
$2,393.70
|
| Rate for Payer: Cigna Commercial |
$7,634.31
|
| Rate for Payer: Health EOS Commercial |
$7,385.36
|
| Rate for Payer: HFN Commercial |
$7,634.31
|
| Rate for Payer: Multiplan Commercial |
$6,638.53
|
| Rate for Payer: Preferred Network Access Commercial |
$7,634.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,066.10
|
| Rate for Payer: Quartz Commercial |
$4,978.90
|
| Rate for Payer: WEA Trust Commercial |
$4,563.99
|
| Rate for Payer: WPS Commercial |
$6,146.22
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 8 CEMENTED 1506-80-008
|
Facility
|
OP
|
$7,979.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.48 |
| Max. Negotiated Rate |
$7,634.31 |
| Rate for Payer: Aetna Commercial |
$7,468.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,136.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,323.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,393.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,149.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,983.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,398.02
|
| Rate for Payer: Cash Price |
$2,393.70
|
| Rate for Payer: Cigna Commercial |
$7,634.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,643.78
|
| Rate for Payer: Health EOS Commercial |
$7,385.36
|
| Rate for Payer: HFN Commercial |
$7,634.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,223.62
|
| Rate for Payer: Multiplan Commercial |
$6,638.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,978.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,634.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,066.10
|
| Rate for Payer: Quartz Commercial |
$5,393.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,978.90
|
| Rate for Payer: The Alliance Commercial |
$4,149.08
|
| Rate for Payer: WEA Trust Commercial |
$4,563.99
|
| Rate for Payer: WPS Commercial |
$6,146.22
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 9 CEMENTED 1506-80-009
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,228.66 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,177.95
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 9 CEMENTED 1506-80-009
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,416.38 |
| Max. Negotiated Rate |
$7,939.53 |
| Rate for Payer: Aetna Commercial |
$7,766.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,421.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,416.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,609.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,314.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,142.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.86
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$7,939.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,829.44
|
| Rate for Payer: Health EOS Commercial |
$7,680.63
|
| Rate for Payer: HFN Commercial |
$7,939.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,472.44
|
| Rate for Payer: Multiplan Commercial |
$6,903.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,177.95
|
| Rate for Payer: Preferred Network Access Commercial |
$7,939.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.66
|
| Rate for Payer: Quartz Commercial |
$5,609.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,177.95
|
| Rate for Payer: The Alliance Commercial |
$4,314.96
|
| Rate for Payer: WEA Trust Commercial |
$4,746.46
|
| Rate for Payer: WPS Commercial |
$6,391.95
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 3 CEMENTED 1506-60-003
|
Facility
|
IP
|
$37,257.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,986.17 |
| Max. Negotiated Rate |
$35,647.50 |
| Rate for Payer: Aetna Commercial |
$34,872.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,322.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,536.06
|
| Rate for Payer: Cash Price |
$11,177.10
|
| Rate for Payer: Cigna Commercial |
$35,647.50
|
| Rate for Payer: Health EOS Commercial |
$34,485.08
|
| Rate for Payer: HFN Commercial |
$35,647.50
|
| Rate for Payer: Multiplan Commercial |
$30,997.82
|
| Rate for Payer: Preferred Network Access Commercial |
$35,647.50
|
| Rate for Payer: Quartz Beloit One Network |
$18,986.17
|
| Rate for Payer: Quartz Commercial |
$23,248.37
|
| Rate for Payer: WEA Trust Commercial |
$21,311.00
|
| Rate for Payer: WPS Commercial |
$28,699.07
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 3 CEMENTED 1506-60-003
|
Facility
|
OP
|
$37,257.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,849.24 |
| Max. Negotiated Rate |
$35,647.50 |
| Rate for Payer: Aetna Commercial |
$34,872.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,322.66
|
| Rate for Payer: Aetna Managed Medicare |
$10,849.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,185.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,373.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,598.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,536.06
|
| Rate for Payer: Cash Price |
$11,177.10
|
| Rate for Payer: Cigna Commercial |
$35,647.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,683.57
|
| Rate for Payer: Health EOS Commercial |
$34,485.08
|
| Rate for Payer: HFN Commercial |
$35,647.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,060.46
|
| Rate for Payer: Multiplan Commercial |
$30,997.82
|
| Rate for Payer: NAPHCARE Commercial |
$23,248.37
|
| Rate for Payer: Preferred Network Access Commercial |
$35,647.50
|
| Rate for Payer: Quartz Beloit One Network |
$18,986.17
|
| Rate for Payer: Quartz Commercial |
$25,185.73
|
| Rate for Payer: Quartz Medicare Advantage |
$23,248.37
|
| Rate for Payer: The Alliance Commercial |
$19,373.64
|
| Rate for Payer: WEA Trust Commercial |
$21,311.00
|
| Rate for Payer: WPS Commercial |
$28,699.07
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 4 CEMENTED 1506-60-004
|
Facility
|
IP
|
$22,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,360.51 |
| Max. Negotiated Rate |
$21,329.94 |
| Rate for Payer: Aetna Commercial |
$20,866.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,938.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,287.90
|
| Rate for Payer: Cash Price |
$6,687.90
|
| Rate for Payer: Cigna Commercial |
$21,329.94
|
| Rate for Payer: Health EOS Commercial |
$20,634.40
|
| Rate for Payer: HFN Commercial |
$21,329.94
|
| Rate for Payer: Multiplan Commercial |
$18,547.78
|
| Rate for Payer: Preferred Network Access Commercial |
$21,329.94
|
| Rate for Payer: Quartz Beloit One Network |
$11,360.51
|
| Rate for Payer: Quartz Commercial |
$13,910.83
|
| Rate for Payer: WEA Trust Commercial |
$12,751.60
|
| Rate for Payer: WPS Commercial |
$17,172.30
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 4 CEMENTED 1506-60-004
|
Facility
|
OP
|
$22,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,491.72 |
| Max. Negotiated Rate |
$21,329.94 |
| Rate for Payer: Aetna Commercial |
$20,866.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,938.86
|
| Rate for Payer: Aetna Managed Medicare |
$6,491.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,070.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,592.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,128.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,287.90
|
| Rate for Payer: Cash Price |
$6,687.90
|
| Rate for Payer: Cigna Commercial |
$21,329.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,974.53
|
| Rate for Payer: Health EOS Commercial |
$20,634.40
|
| Rate for Payer: HFN Commercial |
$21,329.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,388.54
|
| Rate for Payer: Multiplan Commercial |
$18,547.78
|
| Rate for Payer: NAPHCARE Commercial |
$13,910.83
|
| Rate for Payer: Preferred Network Access Commercial |
$21,329.94
|
| Rate for Payer: Quartz Beloit One Network |
$11,360.51
|
| Rate for Payer: Quartz Commercial |
$15,070.07
|
| Rate for Payer: Quartz Medicare Advantage |
$13,910.83
|
| Rate for Payer: The Alliance Commercial |
$11,592.36
|
| Rate for Payer: WEA Trust Commercial |
$12,751.60
|
| Rate for Payer: WPS Commercial |
$17,172.30
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 5 CEMENTED 1506-60-005
|
Facility
|
IP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,778.73 |
| Max. Negotiated Rate |
$23,992.72 |
| Rate for Payer: Aetna Commercial |
$23,471.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,427.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,821.89
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,992.72
|
| Rate for Payer: Health EOS Commercial |
$23,210.35
|
| Rate for Payer: HFN Commercial |
$23,992.72
|
| Rate for Payer: Multiplan Commercial |
$20,863.23
|
| Rate for Payer: Preferred Network Access Commercial |
$23,992.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,778.73
|
| Rate for Payer: Quartz Commercial |
$15,647.42
|
| Rate for Payer: WEA Trust Commercial |
$14,343.47
|
| Rate for Payer: WPS Commercial |
$19,316.04
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 5 CEMENTED 1506-60-005
|
Facility
|
OP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,302.13 |
| Max. Negotiated Rate |
$23,992.72 |
| Rate for Payer: Aetna Commercial |
$23,471.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,427.97
|
| Rate for Payer: Aetna Managed Medicare |
$7,302.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,951.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,039.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,517.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,821.89
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,992.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,594.23
|
| Rate for Payer: Health EOS Commercial |
$23,210.35
|
| Rate for Payer: HFN Commercial |
$23,992.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,559.28
|
| Rate for Payer: Multiplan Commercial |
$20,863.23
|
| Rate for Payer: NAPHCARE Commercial |
$15,647.42
|
| Rate for Payer: Preferred Network Access Commercial |
$23,992.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,778.73
|
| Rate for Payer: Quartz Commercial |
$16,951.38
|
| Rate for Payer: Quartz Medicare Advantage |
$15,647.42
|
| Rate for Payer: The Alliance Commercial |
$13,039.52
|
| Rate for Payer: WEA Trust Commercial |
$14,343.47
|
| Rate for Payer: WPS Commercial |
$19,316.04
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 6 CEMENTED 1506-60-006
|
Facility
|
OP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,302.13 |
| Max. Negotiated Rate |
$23,992.72 |
| Rate for Payer: Aetna Commercial |
$23,471.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,427.97
|
| Rate for Payer: Aetna Managed Medicare |
$7,302.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,951.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,039.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,517.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,821.89
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,992.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,594.23
|
| Rate for Payer: Health EOS Commercial |
$23,210.35
|
| Rate for Payer: HFN Commercial |
$23,992.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,559.28
|
| Rate for Payer: Multiplan Commercial |
$20,863.23
|
| Rate for Payer: NAPHCARE Commercial |
$15,647.42
|
| Rate for Payer: Preferred Network Access Commercial |
$23,992.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,778.73
|
| Rate for Payer: Quartz Commercial |
$16,951.38
|
| Rate for Payer: Quartz Medicare Advantage |
$15,647.42
|
| Rate for Payer: The Alliance Commercial |
$13,039.52
|
| Rate for Payer: WEA Trust Commercial |
$14,343.47
|
| Rate for Payer: WPS Commercial |
$19,316.04
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 6 CEMENTED 1506-60-006
|
Facility
|
IP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,778.73 |
| Max. Negotiated Rate |
$23,992.72 |
| Rate for Payer: Aetna Commercial |
$23,471.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,427.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,821.89
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,992.72
|
| Rate for Payer: Health EOS Commercial |
$23,210.35
|
| Rate for Payer: HFN Commercial |
$23,992.72
|
| Rate for Payer: Multiplan Commercial |
$20,863.23
|
| Rate for Payer: Preferred Network Access Commercial |
$23,992.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,778.73
|
| Rate for Payer: Quartz Commercial |
$15,647.42
|
| Rate for Payer: WEA Trust Commercial |
$14,343.47
|
| Rate for Payer: WPS Commercial |
$19,316.04
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 7 CEMENTED 1506-60-007
|
Facility
|
IP
|
$23,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,815.08 |
| Max. Negotiated Rate |
$22,183.41 |
| Rate for Payer: Aetna Commercial |
$21,701.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,736.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,779.57
|
| Rate for Payer: Cash Price |
$6,955.50
|
| Rate for Payer: Cigna Commercial |
$22,183.41
|
| Rate for Payer: Health EOS Commercial |
$21,460.04
|
| Rate for Payer: HFN Commercial |
$22,183.41
|
| Rate for Payer: Multiplan Commercial |
$19,289.92
|
| Rate for Payer: Preferred Network Access Commercial |
$22,183.41
|
| Rate for Payer: Quartz Beloit One Network |
$11,815.08
|
| Rate for Payer: Quartz Commercial |
$14,467.44
|
| Rate for Payer: WEA Trust Commercial |
$13,261.82
|
| Rate for Payer: WPS Commercial |
$17,859.41
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 7 CEMENTED 1506-60-007
|
Facility
|
OP
|
$23,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,751.47 |
| Max. Negotiated Rate |
$22,183.41 |
| Rate for Payer: Aetna Commercial |
$21,701.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,736.66
|
| Rate for Payer: Aetna Managed Medicare |
$6,751.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,673.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,056.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,573.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,779.57
|
| Rate for Payer: Cash Price |
$6,955.50
|
| Rate for Payer: Cigna Commercial |
$22,183.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,493.67
|
| Rate for Payer: Health EOS Commercial |
$21,460.04
|
| Rate for Payer: HFN Commercial |
$22,183.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,084.30
|
| Rate for Payer: Multiplan Commercial |
$19,289.92
|
| Rate for Payer: NAPHCARE Commercial |
$14,467.44
|
| Rate for Payer: Preferred Network Access Commercial |
$22,183.41
|
| Rate for Payer: Quartz Beloit One Network |
$11,815.08
|
| Rate for Payer: Quartz Commercial |
$15,673.06
|
| Rate for Payer: Quartz Medicare Advantage |
$14,467.44
|
| Rate for Payer: The Alliance Commercial |
$12,056.20
|
| Rate for Payer: WEA Trust Commercial |
$13,261.82
|
| Rate for Payer: WPS Commercial |
$17,859.41
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 8 CEMENTED 1506-60-008
|
Facility
|
OP
|
$24,112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,021.41 |
| Max. Negotiated Rate |
$23,070.36 |
| Rate for Payer: Aetna Commercial |
$22,568.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.77
|
| Rate for Payer: Aetna Managed Medicare |
$7,021.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,299.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,538.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,036.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.53
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cigna Commercial |
$23,070.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,033.18
|
| Rate for Payer: Health EOS Commercial |
$22,318.07
|
| Rate for Payer: HFN Commercial |
$23,070.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,807.36
|
| Rate for Payer: Multiplan Commercial |
$20,061.18
|
| Rate for Payer: NAPHCARE Commercial |
$15,045.89
|
| Rate for Payer: Preferred Network Access Commercial |
$23,070.36
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.48
|
| Rate for Payer: Quartz Commercial |
$16,299.71
|
| Rate for Payer: Quartz Medicare Advantage |
$15,045.89
|
| Rate for Payer: The Alliance Commercial |
$12,538.24
|
| Rate for Payer: WEA Trust Commercial |
$13,792.06
|
| Rate for Payer: WPS Commercial |
$18,573.47
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 8 CEMENTED 1506-60-008
|
Facility
|
IP
|
$24,112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,287.48 |
| Max. Negotiated Rate |
$23,070.36 |
| Rate for Payer: Aetna Commercial |
$22,568.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.53
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cigna Commercial |
$23,070.36
|
| Rate for Payer: Health EOS Commercial |
$22,318.07
|
| Rate for Payer: HFN Commercial |
$23,070.36
|
| Rate for Payer: Multiplan Commercial |
$20,061.18
|
| Rate for Payer: Preferred Network Access Commercial |
$23,070.36
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.48
|
| Rate for Payer: Quartz Commercial |
$15,045.89
|
| Rate for Payer: WEA Trust Commercial |
$13,792.06
|
| Rate for Payer: WPS Commercial |
$18,573.47
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 11MM 5532-G-211
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 11MM 5532-G-211
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 13MM 5532-G-213
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
