|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 4 7MM 1516-50-407
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547478
|
|
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 8MM 1516-50-408
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5605787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| 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 8MM 1516-50-408
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5605787
|
|
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 5 10MM 1516-50-510
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.97 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$384.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.40
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.16
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$824.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$893.67
|
| Rate for Payer: Quartz Medicare Advantage |
$824.93
|
| Rate for Payer: The Alliance Commercial |
$687.44
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 10MM 1516-50-510
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.69 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$824.93
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 12MM 1516-50-512
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5801643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| 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 5 12MM 1516-50-512
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5801643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 5 14MM 1516-50-514
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| 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 5 14MM 1516-50-514
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 5 5MM 1516-50-505
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 5 5MM 1516-50-505
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.83 |
| 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 5 6MM 1516-50-506
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| 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 5 6MM 1516-50-506
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| 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 5 7MM 1516-50-507
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| Max. Negotiated Rate |
$7,409.46 |
| Rate for Payer: Aetna Commercial |
$7,248.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,926.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,268.49
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,409.46
|
| Rate for Payer: Health EOS Commercial |
$7,167.85
|
| Rate for Payer: HFN Commercial |
$7,409.46
|
| Rate for Payer: Multiplan Commercial |
$6,443.01
|
| Rate for Payer: Preferred Network Access Commercial |
$7,409.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.34
|
| Rate for Payer: Quartz Commercial |
$4,832.26
|
| Rate for Payer: WEA Trust Commercial |
$4,429.57
|
| Rate for Payer: WPS Commercial |
$5,965.20
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 7MM 1516-50-507
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| Max. Negotiated Rate |
$7,409.46 |
| Rate for Payer: Aetna Commercial |
$7,248.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,926.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,255.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,234.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,026.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,865.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,268.49
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,409.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,507.01
|
| Rate for Payer: Health EOS Commercial |
$7,167.85
|
| Rate for Payer: HFN Commercial |
$7,409.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,040.32
|
| Rate for Payer: Multiplan Commercial |
$6,443.01
|
| Rate for Payer: NAPHCARE Commercial |
$4,832.26
|
| Rate for Payer: Preferred Network Access Commercial |
$7,409.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.34
|
| Rate for Payer: Quartz Commercial |
$5,234.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,832.26
|
| Rate for Payer: The Alliance Commercial |
$4,026.88
|
| Rate for Payer: WEA Trust Commercial |
$4,429.57
|
| Rate for Payer: WPS Commercial |
$5,965.20
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 8MM 1516-50-508
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.25
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$715.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 5 8MM 1516-50-508
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5599766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 10MM 1516-50-610
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| Max. Negotiated Rate |
$7,409.46 |
| Rate for Payer: Aetna Commercial |
$7,248.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,926.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,268.49
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,409.46
|
| Rate for Payer: Health EOS Commercial |
$7,167.85
|
| Rate for Payer: HFN Commercial |
$7,409.46
|
| Rate for Payer: Multiplan Commercial |
$6,443.01
|
| Rate for Payer: Preferred Network Access Commercial |
$7,409.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.34
|
| Rate for Payer: Quartz Commercial |
$4,832.26
|
| Rate for Payer: WEA Trust Commercial |
$4,429.57
|
| Rate for Payer: WPS Commercial |
$5,965.20
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 10MM 1516-50-610
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| Max. Negotiated Rate |
$7,409.46 |
| Rate for Payer: Aetna Commercial |
$7,248.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,926.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,255.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,234.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,026.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,865.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,268.49
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cigna Commercial |
$7,409.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,507.01
|
| Rate for Payer: Health EOS Commercial |
$7,167.85
|
| Rate for Payer: HFN Commercial |
$7,409.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,040.32
|
| Rate for Payer: Multiplan Commercial |
$6,443.01
|
| Rate for Payer: NAPHCARE Commercial |
$4,832.26
|
| Rate for Payer: Preferred Network Access Commercial |
$7,409.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,946.34
|
| Rate for Payer: Quartz Commercial |
$5,234.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,832.26
|
| Rate for Payer: The Alliance Commercial |
$4,026.88
|
| Rate for Payer: WEA Trust Commercial |
$4,429.57
|
| Rate for Payer: WPS Commercial |
$5,965.20
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 12MM 1516-50-612
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 6 12MM 1516-50-612
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| 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 6 5MM 1516-50-605
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| 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 6 5MM 1516-50-605
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| 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 6 5MM 1516-50-606
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 6 5MM 1516-50-606
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.83 |
| 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
|
|
