|
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
|
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 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 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 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 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 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 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
|
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 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 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
|
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 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 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
|
|
|
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
|
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 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 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
|
|
