|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 7MM 1516-50-607
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490757
|
|
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 6 7MM 1516-50-607
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490757
|
|
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 8MM 1516-50-608
|
Facility
|
OP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.28 |
| Max. Negotiated Rate |
$7,124.33 |
| Rate for Payer: Aetna Commercial |
$6,969.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,871.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.24
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$7,124.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.57
|
| Rate for Payer: Health EOS Commercial |
$6,892.02
|
| Rate for Payer: HFN Commercial |
$7,124.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,807.88
|
| Rate for Payer: Multiplan Commercial |
$6,195.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.48
|
| Rate for Payer: Quartz Commercial |
$5,033.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.30
|
| Rate for Payer: The Alliance Commercial |
$3,871.92
|
| Rate for Payer: WEA Trust Commercial |
$4,259.11
|
| Rate for Payer: WPS Commercial |
$5,735.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 6 8MM 1516-50-608
|
Facility
|
IP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.48 |
| Max. Negotiated Rate |
$7,124.33 |
| Rate for Payer: Aetna Commercial |
$6,969.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.24
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$7,124.33
|
| Rate for Payer: Health EOS Commercial |
$6,892.02
|
| Rate for Payer: HFN Commercial |
$7,124.33
|
| Rate for Payer: Multiplan Commercial |
$6,195.07
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.48
|
| Rate for Payer: Quartz Commercial |
$4,646.30
|
| Rate for Payer: WEA Trust Commercial |
$4,259.11
|
| Rate for Payer: WPS Commercial |
$5,735.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 10MM 1516-50-710
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| 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 7 10MM 1516-50-710
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| 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 7 14MM 1516-50-714
|
Facility
|
OP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.71 |
| 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 7 14MM 1516-50-714
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| 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 7 5MM 1516-50-705
|
Facility
|
OP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.28 |
| Max. Negotiated Rate |
$7,124.33 |
| Rate for Payer: Aetna Commercial |
$6,969.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,033.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,871.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,717.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.24
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$7,124.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,333.57
|
| Rate for Payer: Health EOS Commercial |
$6,892.02
|
| Rate for Payer: HFN Commercial |
$7,124.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,807.88
|
| Rate for Payer: Multiplan Commercial |
$6,195.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,646.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.48
|
| Rate for Payer: Quartz Commercial |
$5,033.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,646.30
|
| Rate for Payer: The Alliance Commercial |
$3,871.92
|
| Rate for Payer: WEA Trust Commercial |
$4,259.11
|
| Rate for Payer: WPS Commercial |
$5,735.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 5MM 1516-50-705
|
Facility
|
IP
|
$7,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,794.48 |
| Max. Negotiated Rate |
$7,124.33 |
| Rate for Payer: Aetna Commercial |
$6,969.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,659.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,104.24
|
| Rate for Payer: Cash Price |
$2,233.80
|
| Rate for Payer: Cigna Commercial |
$7,124.33
|
| Rate for Payer: Health EOS Commercial |
$6,892.02
|
| Rate for Payer: HFN Commercial |
$7,124.33
|
| Rate for Payer: Multiplan Commercial |
$6,195.07
|
| Rate for Payer: Preferred Network Access Commercial |
$7,124.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.48
|
| Rate for Payer: Quartz Commercial |
$4,646.30
|
| Rate for Payer: WEA Trust Commercial |
$4,259.11
|
| Rate for Payer: WPS Commercial |
$5,735.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 7 6MM 1516-50-706
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| 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 7 6MM 1516-50-706
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| 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 7 7MM 1516-50-707
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| 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 7 7MM 1516-50-707
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| 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 7 8MM 1516-50-708
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| 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 7 8MM 1516-50-708
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| 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 8 10MM 1516-50-810
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 8 10MM 1516-50-810
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| 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 8 12MM 1516-50-812
|
Facility
|
OP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.05 |
| 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 8 12MM 1516-50-812
|
Facility
|
IP
|
$7,744.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,946.34 |
| 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 8 18MM 1516-50-818
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.82 |
| 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 8 18MM 1516-50-818
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 8 5MM 1516-50-805
|
Facility
|
OP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.83 |
| 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 8 5MM 1516-50-805
|
Facility
|
IP
|
$8,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 8 6MM 1516-50-806
|
Facility
|
IP
|
$6,249.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,184.49 |
| 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
|
|
