|
TIBIAL COMPONENT P.F.C. SIGMA ALL POLY CURVE SZ 4 10MM CEMENTED 96-0651
|
Facility
|
OP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL COMPONENT P.F.C. SIGMA ALL POLY CURVE SZ 4 10MM CEMENTED 96-0651
|
Facility
|
IP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL INSERT HINGE UNIVERSAL XSMALL 16MM LPS 1987-27-116
|
Facility
|
IP
|
$22,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,716.72 |
| Max. Negotiated Rate |
$21,998.75 |
| Rate for Payer: Aetna Commercial |
$21,520.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,564.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,673.19
|
| Rate for Payer: Cash Price |
$6,897.60
|
| Rate for Payer: Cigna Commercial |
$21,998.75
|
| Rate for Payer: Health EOS Commercial |
$21,281.40
|
| Rate for Payer: HFN Commercial |
$21,998.75
|
| Rate for Payer: Multiplan Commercial |
$19,129.34
|
| Rate for Payer: Preferred Network Access Commercial |
$21,998.75
|
| Rate for Payer: Quartz Beloit One Network |
$11,716.72
|
| Rate for Payer: Quartz Commercial |
$14,347.01
|
| Rate for Payer: WEA Trust Commercial |
$13,151.42
|
| Rate for Payer: WPS Commercial |
$17,710.74
|
|
|
TIBIAL INSERT HINGE UNIVERSAL XSMALL 16MM LPS 1987-27-116
|
Facility
|
OP
|
$22,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,695.27 |
| Max. Negotiated Rate |
$21,998.75 |
| Rate for Payer: Aetna Commercial |
$21,520.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,564.04
|
| Rate for Payer: Aetna Managed Medicare |
$6,695.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,542.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,955.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,477.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,673.19
|
| Rate for Payer: Cash Price |
$6,897.60
|
| Rate for Payer: Cigna Commercial |
$21,998.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,381.34
|
| Rate for Payer: Health EOS Commercial |
$21,281.40
|
| Rate for Payer: HFN Commercial |
$21,998.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,933.76
|
| Rate for Payer: Multiplan Commercial |
$19,129.34
|
| Rate for Payer: NAPHCARE Commercial |
$14,347.01
|
| Rate for Payer: Preferred Network Access Commercial |
$21,998.75
|
| Rate for Payer: Quartz Beloit One Network |
$11,716.72
|
| Rate for Payer: Quartz Commercial |
$15,542.59
|
| Rate for Payer: Quartz Medicare Advantage |
$14,347.01
|
| Rate for Payer: The Alliance Commercial |
$11,955.84
|
| Rate for Payer: WEA Trust Commercial |
$13,151.42
|
| Rate for Payer: WPS Commercial |
$17,710.74
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 10 5MM 1516-51-005
|
Facility
|
IP
|
$5,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.47 |
| Max. Negotiated Rate |
$5,528.39 |
| Rate for Payer: Aetna Commercial |
$5,408.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.83
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,528.39
|
| Rate for Payer: Health EOS Commercial |
$5,348.12
|
| Rate for Payer: HFN Commercial |
$5,528.39
|
| Rate for Payer: Multiplan Commercial |
$4,807.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.47
|
| Rate for Payer: Quartz Commercial |
$3,605.47
|
| Rate for Payer: WEA Trust Commercial |
$3,305.02
|
| Rate for Payer: WPS Commercial |
$4,450.79
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 10 5MM 1516-51-005
|
Facility
|
OP
|
$5,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.55 |
| Max. Negotiated Rate |
$5,528.39 |
| Rate for Payer: Aetna Commercial |
$5,408.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,682.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,905.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,004.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,884.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.83
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,528.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,362.80
|
| Rate for Payer: Health EOS Commercial |
$5,348.12
|
| Rate for Payer: HFN Commercial |
$5,528.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,506.84
|
| Rate for Payer: Multiplan Commercial |
$4,807.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.47
|
| Rate for Payer: Quartz Commercial |
$3,905.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,605.47
|
| Rate for Payer: The Alliance Commercial |
$3,004.56
|
| Rate for Payer: WEA Trust Commercial |
$3,305.02
|
| Rate for Payer: WPS Commercial |
$4,450.79
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 12MM 1516-50-312
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.24
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.02
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$4,062.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.62
|
| Rate for Payer: The Alliance Commercial |
$3,124.68
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 12MM 1516-50-312
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.19 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$3,749.62
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 5MM 1516-50-305
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.24
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.02
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$4,062.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.62
|
| Rate for Payer: The Alliance Commercial |
$3,124.68
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 5MM 1516-50-305
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.19 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$3,749.62
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 6MM 1516-50-306
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.19 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$3,749.62
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 6MM 1516-50-306
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.24
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.02
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$4,062.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.62
|
| Rate for Payer: The Alliance Commercial |
$3,124.68
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 7MM 1516-50-307
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.24
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.02
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$4,062.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.62
|
| Rate for Payer: The Alliance Commercial |
$3,124.68
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 7MM 1516-50-307
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.19 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$3,749.62
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 8MM 1516-50-308
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.42 |
| Max. Negotiated Rate |
$5,978.09 |
| Rate for Payer: Aetna Commercial |
$5,848.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,588.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,819.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,223.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,248.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,119.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,443.90
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$5,978.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,636.34
|
| Rate for Payer: Health EOS Commercial |
$5,783.15
|
| Rate for Payer: HFN Commercial |
$5,978.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,873.44
|
| Rate for Payer: Multiplan Commercial |
$5,198.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,898.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,978.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,183.98
|
| Rate for Payer: Quartz Commercial |
$4,223.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,898.75
|
| Rate for Payer: The Alliance Commercial |
$3,248.96
|
| Rate for Payer: WEA Trust Commercial |
$3,573.86
|
| Rate for Payer: WPS Commercial |
$4,812.83
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 3 8MM 1516-50-308
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,183.98 |
| Max. Negotiated Rate |
$5,978.09 |
| Rate for Payer: Aetna Commercial |
$5,848.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,588.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,443.90
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$5,978.09
|
| Rate for Payer: Health EOS Commercial |
$5,783.15
|
| Rate for Payer: HFN Commercial |
$5,978.09
|
| Rate for Payer: Multiplan Commercial |
$5,198.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,978.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,183.98
|
| Rate for Payer: Quartz Commercial |
$3,898.75
|
| Rate for Payer: WEA Trust Commercial |
$3,573.86
|
| Rate for Payer: WPS Commercial |
$4,812.83
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 10MM 1516-50-410
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| Max. Negotiated Rate |
$5,979.04 |
| Rate for Payer: Aetna Commercial |
$5,849.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,589.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,444.45
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,979.04
|
| Rate for Payer: Health EOS Commercial |
$5,784.07
|
| Rate for Payer: HFN Commercial |
$5,979.04
|
| Rate for Payer: Multiplan Commercial |
$5,199.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,979.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,184.49
|
| Rate for Payer: Quartz Commercial |
$3,899.38
|
| Rate for Payer: WEA Trust Commercial |
$3,574.43
|
| Rate for Payer: WPS Commercial |
$4,813.60
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 10MM 1516-50-410
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| Max. Negotiated Rate |
$5,979.04 |
| Rate for Payer: Aetna Commercial |
$5,849.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,589.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,819.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,224.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,249.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,119.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,444.45
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,979.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,636.92
|
| Rate for Payer: Health EOS Commercial |
$5,784.07
|
| Rate for Payer: HFN Commercial |
$5,979.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,874.22
|
| Rate for Payer: Multiplan Commercial |
$5,199.17
|
| Rate for Payer: NAPHCARE Commercial |
$3,899.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,979.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,184.49
|
| Rate for Payer: Quartz Commercial |
$4,224.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,899.38
|
| Rate for Payer: The Alliance Commercial |
$3,249.48
|
| Rate for Payer: WEA Trust Commercial |
$3,574.43
|
| Rate for Payer: WPS Commercial |
$4,813.60
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 12MM 1516-50-412
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.19 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$3,749.62
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 12MM 1516-50-412
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| Max. Negotiated Rate |
$5,749.41 |
| Rate for Payer: Aetna Commercial |
$5,624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,374.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,749.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,124.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,999.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.16
|
| Rate for Payer: Cash Price |
$1,802.70
|
| Rate for Payer: Cigna Commercial |
$5,749.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.24
|
| Rate for Payer: Health EOS Commercial |
$5,561.93
|
| Rate for Payer: HFN Commercial |
$5,749.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.02
|
| Rate for Payer: Multiplan Commercial |
$4,999.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,749.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,749.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.19
|
| Rate for Payer: Quartz Commercial |
$4,062.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,749.62
|
| Rate for Payer: The Alliance Commercial |
$3,124.68
|
| Rate for Payer: WEA Trust Commercial |
$3,437.15
|
| Rate for Payer: WPS Commercial |
$4,628.73
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 5MM 1516-50-405
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,098.20 |
| Max. Negotiated Rate |
$7,694.59 |
| Rate for Payer: Aetna Commercial |
$7,527.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,192.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,432.75
|
| Rate for Payer: Cash Price |
$2,412.60
|
| Rate for Payer: Cigna Commercial |
$7,694.59
|
| Rate for Payer: Health EOS Commercial |
$7,443.68
|
| Rate for Payer: HFN Commercial |
$7,694.59
|
| Rate for Payer: Multiplan Commercial |
$6,690.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,694.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,098.20
|
| Rate for Payer: Quartz Commercial |
$5,018.21
|
| Rate for Payer: WEA Trust Commercial |
$4,600.02
|
| Rate for Payer: WPS Commercial |
$6,194.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 5MM 1516-50-405
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.83 |
| Max. Negotiated Rate |
$7,694.59 |
| Rate for Payer: Aetna Commercial |
$7,527.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,192.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,341.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,436.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,181.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,014.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,432.75
|
| Rate for Payer: Cash Price |
$2,412.60
|
| Rate for Payer: Cigna Commercial |
$7,694.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,680.44
|
| Rate for Payer: Health EOS Commercial |
$7,443.68
|
| Rate for Payer: HFN Commercial |
$7,694.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,272.76
|
| Rate for Payer: Multiplan Commercial |
$6,690.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,018.21
|
| Rate for Payer: Preferred Network Access Commercial |
$7,694.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,098.20
|
| Rate for Payer: Quartz Commercial |
$5,436.39
|
| Rate for Payer: Quartz Medicare Advantage |
$5,018.21
|
| Rate for Payer: The Alliance Commercial |
$4,181.84
|
| Rate for Payer: WEA Trust Commercial |
$4,600.02
|
| Rate for Payer: WPS Commercial |
$6,194.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 6MM 1516-50-406
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| Max. Negotiated Rate |
$5,979.04 |
| Rate for Payer: Aetna Commercial |
$5,849.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,589.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,819.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,224.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,249.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,119.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,444.45
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,979.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,636.92
|
| Rate for Payer: Health EOS Commercial |
$5,784.07
|
| Rate for Payer: HFN Commercial |
$5,979.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,874.22
|
| Rate for Payer: Multiplan Commercial |
$5,199.17
|
| Rate for Payer: NAPHCARE Commercial |
$3,899.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,979.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,184.49
|
| Rate for Payer: Quartz Commercial |
$4,224.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,899.38
|
| Rate for Payer: The Alliance Commercial |
$3,249.48
|
| Rate for Payer: WEA Trust Commercial |
$3,574.43
|
| Rate for Payer: WPS Commercial |
$4,813.60
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 6MM 1516-50-406
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| Max. Negotiated Rate |
$5,979.04 |
| Rate for Payer: Aetna Commercial |
$5,849.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,589.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,444.45
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,979.04
|
| Rate for Payer: Health EOS Commercial |
$5,784.07
|
| Rate for Payer: HFN Commercial |
$5,979.04
|
| Rate for Payer: Multiplan Commercial |
$5,199.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,979.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,184.49
|
| Rate for Payer: Quartz Commercial |
$3,899.38
|
| Rate for Payer: WEA Trust Commercial |
$3,574.43
|
| Rate for Payer: WPS Commercial |
$4,813.60
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 7MM 1516-50-407
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| Max. Negotiated Rate |
$5,979.04 |
| Rate for Payer: Aetna Commercial |
$5,849.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,589.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,444.45
|
| Rate for Payer: Cash Price |
$1,874.70
|
| Rate for Payer: Cigna Commercial |
$5,979.04
|
| Rate for Payer: Health EOS Commercial |
$5,784.07
|
| Rate for Payer: HFN Commercial |
$5,979.04
|
| Rate for Payer: Multiplan Commercial |
$5,199.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,979.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,184.49
|
| Rate for Payer: Quartz Commercial |
$3,899.38
|
| Rate for Payer: WEA Trust Commercial |
$3,574.43
|
| Rate for Payer: WPS Commercial |
$4,813.60
|
|
