|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 5MM 1516-50-905
|
Facility
|
OP
|
$7,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.76 |
| Max. Negotiated Rate |
$7,408.50 |
| Rate for Payer: Aetna Commercial |
$7,247.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,925.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,254.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,234.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,026.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,865.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,267.94
|
| Rate for Payer: Cash Price |
$2,322.90
|
| Rate for Payer: Cigna Commercial |
$7,408.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,506.43
|
| Rate for Payer: Health EOS Commercial |
$7,166.92
|
| Rate for Payer: HFN Commercial |
$7,408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,039.54
|
| Rate for Payer: Multiplan Commercial |
$6,442.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,408.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,945.83
|
| Rate for Payer: Quartz Commercial |
$5,234.27
|
| Rate for Payer: Quartz Medicare Advantage |
$4,831.63
|
| Rate for Payer: The Alliance Commercial |
$4,026.36
|
| Rate for Payer: WEA Trust Commercial |
$4,429.00
|
| Rate for Payer: WPS Commercial |
$5,964.43
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
|
OP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,893.38 |
| Max. Negotiated Rate |
$6,221.11 |
| Rate for Payer: Aetna Commercial |
$6,085.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,815.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,893.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,395.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,381.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,245.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,583.90
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$6,221.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,784.16
|
| Rate for Payer: Health EOS Commercial |
$6,018.25
|
| Rate for Payer: HFN Commercial |
$6,221.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,071.56
|
| Rate for Payer: Multiplan Commercial |
$5,409.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,057.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,221.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,313.42
|
| Rate for Payer: Quartz Commercial |
$4,395.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,057.25
|
| Rate for Payer: The Alliance Commercial |
$3,381.04
|
| Rate for Payer: WEA Trust Commercial |
$3,719.14
|
| Rate for Payer: WPS Commercial |
$5,008.49
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 6MM 1516-50-906
|
Facility
|
IP
|
$6,502.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.42 |
| Max. Negotiated Rate |
$6,221.11 |
| Rate for Payer: Aetna Commercial |
$6,085.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,815.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,583.90
|
| Rate for Payer: Cash Price |
$1,950.60
|
| Rate for Payer: Cigna Commercial |
$6,221.11
|
| Rate for Payer: Health EOS Commercial |
$6,018.25
|
| Rate for Payer: HFN Commercial |
$6,221.11
|
| Rate for Payer: Multiplan Commercial |
$5,409.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,221.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,313.42
|
| Rate for Payer: Quartz Commercial |
$4,057.25
|
| Rate for Payer: WEA Trust Commercial |
$3,719.14
|
| Rate for Payer: WPS Commercial |
$5,008.49
|
|
|
TIBIAL INSERT ROTATING PLATFORM PS ATTUNE SZ 9 7MM 1516-50-907
|
Facility
|
OP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
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 9 7MM 1516-50-907
|
Facility
|
IP
|
$6,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659706
|
|
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 REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
|
OP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,226.44 |
| Max. Negotiated Rate |
$20,458.30 |
| Rate for Payer: Aetna Commercial |
$20,013.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,124.06
|
| Rate for Payer: Aetna Managed Medicare |
$6,226.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,454.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,118.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,673.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.76
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$20,458.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,444.32
|
| Rate for Payer: Health EOS Commercial |
$19,791.18
|
| Rate for Payer: HFN Commercial |
$20,458.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,677.96
|
| Rate for Payer: Multiplan Commercial |
$17,789.82
|
| Rate for Payer: NAPHCARE Commercial |
$13,342.37
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.30
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.27
|
| Rate for Payer: Quartz Commercial |
$14,454.23
|
| Rate for Payer: Quartz Medicare Advantage |
$13,342.37
|
| Rate for Payer: The Alliance Commercial |
$11,118.64
|
| Rate for Payer: WEA Trust Commercial |
$12,230.50
|
| Rate for Payer: WPS Commercial |
$16,470.55
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
|
IP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,896.27 |
| Max. Negotiated Rate |
$20,458.30 |
| Rate for Payer: Aetna Commercial |
$20,013.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,124.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.76
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$20,458.30
|
| Rate for Payer: Health EOS Commercial |
$19,791.18
|
| Rate for Payer: HFN Commercial |
$20,458.30
|
| Rate for Payer: Multiplan Commercial |
$17,789.82
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.30
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.27
|
| Rate for Payer: Quartz Commercial |
$13,342.37
|
| Rate for Payer: WEA Trust Commercial |
$12,230.50
|
| Rate for Payer: WPS Commercial |
$16,470.55
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
|
OP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,475.41 |
| Max. Negotiated Rate |
$21,276.36 |
| Rate for Payer: Aetna Commercial |
$20,813.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,888.77
|
| Rate for Payer: Aetna Managed Medicare |
$6,475.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,032.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,563.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,100.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,257.03
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$21,276.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,941.93
|
| Rate for Payer: Health EOS Commercial |
$20,582.57
|
| Rate for Payer: HFN Commercial |
$21,276.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,344.86
|
| Rate for Payer: Multiplan Commercial |
$18,501.18
|
| Rate for Payer: NAPHCARE Commercial |
$13,875.89
|
| Rate for Payer: Preferred Network Access Commercial |
$21,276.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,331.98
|
| Rate for Payer: Quartz Commercial |
$15,032.21
|
| Rate for Payer: Quartz Medicare Advantage |
$13,875.89
|
| Rate for Payer: The Alliance Commercial |
$11,563.24
|
| Rate for Payer: WEA Trust Commercial |
$12,719.56
|
| Rate for Payer: WPS Commercial |
$17,129.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
|
IP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,331.98 |
| Max. Negotiated Rate |
$21,276.36 |
| Rate for Payer: Aetna Commercial |
$20,813.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,888.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,257.03
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$21,276.36
|
| Rate for Payer: Health EOS Commercial |
$20,582.57
|
| Rate for Payer: HFN Commercial |
$21,276.36
|
| Rate for Payer: Multiplan Commercial |
$18,501.18
|
| Rate for Payer: Preferred Network Access Commercial |
$21,276.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,331.98
|
| Rate for Payer: Quartz Commercial |
$13,875.89
|
| Rate for Payer: WEA Trust Commercial |
$12,719.56
|
| Rate for Payer: WPS Commercial |
$17,129.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.71 |
| Max. Negotiated Rate |
$12,731.18 |
| Rate for Payer: Aetna Commercial |
$12,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.89
|
| Rate for Payer: Aetna Managed Medicare |
$3,874.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,994.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,919.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,642.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.27
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,731.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,744.09
|
| Rate for Payer: Health EOS Commercial |
$12,316.03
|
| Rate for Payer: HFN Commercial |
$12,731.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,378.68
|
| Rate for Payer: Multiplan Commercial |
$11,070.59
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.94
|
| Rate for Payer: Preferred Network Access Commercial |
$12,731.18
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.74
|
| Rate for Payer: Quartz Commercial |
$8,994.86
|
| Rate for Payer: Quartz Medicare Advantage |
$8,302.94
|
| Rate for Payer: The Alliance Commercial |
$6,919.12
|
| Rate for Payer: WEA Trust Commercial |
$7,611.03
|
| Rate for Payer: WPS Commercial |
$10,249.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,780.74 |
| Max. Negotiated Rate |
$12,731.18 |
| Rate for Payer: Aetna Commercial |
$12,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.27
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,731.18
|
| Rate for Payer: Health EOS Commercial |
$12,316.03
|
| Rate for Payer: HFN Commercial |
$12,731.18
|
| Rate for Payer: Multiplan Commercial |
$11,070.59
|
| Rate for Payer: Preferred Network Access Commercial |
$12,731.18
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.74
|
| Rate for Payer: Quartz Commercial |
$8,302.94
|
| Rate for Payer: WEA Trust Commercial |
$7,611.03
|
| Rate for Payer: WPS Commercial |
$10,249.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,780.74 |
| Max. Negotiated Rate |
$12,731.18 |
| Rate for Payer: Aetna Commercial |
$12,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.27
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,731.18
|
| Rate for Payer: Health EOS Commercial |
$12,316.03
|
| Rate for Payer: HFN Commercial |
$12,731.18
|
| Rate for Payer: Multiplan Commercial |
$11,070.59
|
| Rate for Payer: Preferred Network Access Commercial |
$12,731.18
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.74
|
| Rate for Payer: Quartz Commercial |
$8,302.94
|
| Rate for Payer: WEA Trust Commercial |
$7,611.03
|
| Rate for Payer: WPS Commercial |
$10,249.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.71 |
| Max. Negotiated Rate |
$12,731.18 |
| Rate for Payer: Aetna Commercial |
$12,454.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.89
|
| Rate for Payer: Aetna Managed Medicare |
$3,874.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,994.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,919.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,642.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.27
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,731.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,744.09
|
| Rate for Payer: Health EOS Commercial |
$12,316.03
|
| Rate for Payer: HFN Commercial |
$12,731.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,378.68
|
| Rate for Payer: Multiplan Commercial |
$11,070.59
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.94
|
| Rate for Payer: Preferred Network Access Commercial |
$12,731.18
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.74
|
| Rate for Payer: Quartz Commercial |
$8,994.86
|
| Rate for Payer: Quartz Medicare Advantage |
$8,302.94
|
| Rate for Payer: The Alliance Commercial |
$6,919.12
|
| Rate for Payer: WEA Trust Commercial |
$7,611.03
|
| Rate for Payer: WPS Commercial |
$10,249.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
|
OP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,266.08 |
| Max. Negotiated Rate |
$14,017.12 |
| Rate for Payer: Aetna Commercial |
$13,712.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,102.96
|
| Rate for Payer: Aetna Managed Medicare |
$4,266.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,903.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,618.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,313.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,075.08
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$14,017.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,526.30
|
| Rate for Payer: Health EOS Commercial |
$13,560.04
|
| Rate for Payer: HFN Commercial |
$14,017.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,427.00
|
| Rate for Payer: Multiplan Commercial |
$12,188.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14,017.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,465.64
|
| Rate for Payer: Quartz Commercial |
$9,903.40
|
| Rate for Payer: Quartz Medicare Advantage |
$9,141.60
|
| Rate for Payer: The Alliance Commercial |
$7,618.00
|
| Rate for Payer: WEA Trust Commercial |
$8,379.80
|
| Rate for Payer: WPS Commercial |
$11,284.90
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
|
IP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,465.64 |
| Max. Negotiated Rate |
$14,017.12 |
| Rate for Payer: Aetna Commercial |
$13,712.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,102.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,075.08
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$14,017.12
|
| Rate for Payer: Health EOS Commercial |
$13,560.04
|
| Rate for Payer: HFN Commercial |
$14,017.12
|
| Rate for Payer: Multiplan Commercial |
$12,188.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,017.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,465.64
|
| Rate for Payer: Quartz Commercial |
$9,141.60
|
| Rate for Payer: WEA Trust Commercial |
$8,379.80
|
| Rate for Payer: WPS Commercial |
$11,284.90
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
|
OP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.63 |
| Max. Negotiated Rate |
$13,240.20 |
| Rate for Payer: Aetna Commercial |
$12,952.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,376.71
|
| Rate for Payer: Aetna Managed Medicare |
$4,029.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,354.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,195.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,907.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.51
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$13,240.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,053.72
|
| Rate for Payer: Health EOS Commercial |
$12,808.45
|
| Rate for Payer: HFN Commercial |
$13,240.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,793.64
|
| Rate for Payer: Multiplan Commercial |
$11,513.22
|
| Rate for Payer: NAPHCARE Commercial |
$8,634.91
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,051.84
|
| Rate for Payer: Quartz Commercial |
$9,354.49
|
| Rate for Payer: Quartz Medicare Advantage |
$8,634.91
|
| Rate for Payer: The Alliance Commercial |
$7,195.76
|
| Rate for Payer: WEA Trust Commercial |
$7,915.34
|
| Rate for Payer: WPS Commercial |
$10,659.41
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
|
IP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,051.84 |
| Max. Negotiated Rate |
$13,240.20 |
| Rate for Payer: Aetna Commercial |
$12,952.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,376.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.51
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$13,240.20
|
| Rate for Payer: Health EOS Commercial |
$12,808.45
|
| Rate for Payer: HFN Commercial |
$13,240.20
|
| Rate for Payer: Multiplan Commercial |
$11,513.22
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,051.84
|
| Rate for Payer: Quartz Commercial |
$8,634.91
|
| Rate for Payer: WEA Trust Commercial |
$7,915.34
|
| Rate for Payer: WPS Commercial |
$10,659.41
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
|
IP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,334.16 |
| Max. Negotiated Rate |
$13,770.27 |
| Rate for Payer: Aetna Commercial |
$13,470.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,872.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,932.87
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,770.27
|
| Rate for Payer: Health EOS Commercial |
$13,321.24
|
| Rate for Payer: HFN Commercial |
$13,770.27
|
| Rate for Payer: Multiplan Commercial |
$11,974.14
|
| Rate for Payer: Preferred Network Access Commercial |
$13,770.27
|
| Rate for Payer: Quartz Beloit One Network |
$7,334.16
|
| Rate for Payer: Quartz Commercial |
$8,980.61
|
| Rate for Payer: WEA Trust Commercial |
$8,232.22
|
| Rate for Payer: WPS Commercial |
$11,086.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
|
OP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,190.95 |
| Max. Negotiated Rate |
$13,770.27 |
| Rate for Payer: Aetna Commercial |
$13,470.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,872.20
|
| Rate for Payer: Aetna Managed Medicare |
$4,190.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,728.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,483.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,184.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,932.87
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,770.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,376.14
|
| Rate for Payer: Health EOS Commercial |
$13,321.24
|
| Rate for Payer: HFN Commercial |
$13,770.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,225.76
|
| Rate for Payer: Multiplan Commercial |
$11,974.14
|
| Rate for Payer: NAPHCARE Commercial |
$8,980.61
|
| Rate for Payer: Preferred Network Access Commercial |
$13,770.27
|
| Rate for Payer: Quartz Beloit One Network |
$7,334.16
|
| Rate for Payer: Quartz Commercial |
$9,728.99
|
| Rate for Payer: Quartz Medicare Advantage |
$8,980.61
|
| Rate for Payer: The Alliance Commercial |
$7,483.84
|
| Rate for Payer: WEA Trust Commercial |
$8,232.22
|
| Rate for Payer: WPS Commercial |
$11,086.16
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
IP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,624.16 |
| Max. Negotiated Rate |
$25,580.05 |
| Rate for Payer: Aetna Commercial |
$25,023.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,911.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,736.33
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$25,580.05
|
| Rate for Payer: Health EOS Commercial |
$24,745.92
|
| Rate for Payer: HFN Commercial |
$25,580.05
|
| Rate for Payer: Multiplan Commercial |
$22,243.52
|
| Rate for Payer: Preferred Network Access Commercial |
$25,580.05
|
| Rate for Payer: Quartz Beloit One Network |
$13,624.16
|
| Rate for Payer: Quartz Commercial |
$16,682.64
|
| Rate for Payer: WEA Trust Commercial |
$15,292.42
|
| Rate for Payer: WPS Commercial |
$20,593.97
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
OP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,785.23 |
| Max. Negotiated Rate |
$25,580.05 |
| Rate for Payer: Aetna Commercial |
$25,023.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,911.78
|
| Rate for Payer: Aetna Managed Medicare |
$7,785.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,072.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,902.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,346.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,736.33
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$25,580.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,559.77
|
| Rate for Payer: Health EOS Commercial |
$24,745.92
|
| Rate for Payer: HFN Commercial |
$25,580.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,853.30
|
| Rate for Payer: Multiplan Commercial |
$22,243.52
|
| Rate for Payer: NAPHCARE Commercial |
$16,682.64
|
| Rate for Payer: Preferred Network Access Commercial |
$25,580.05
|
| Rate for Payer: Quartz Beloit One Network |
$13,624.16
|
| Rate for Payer: Quartz Commercial |
$18,072.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16,682.64
|
| Rate for Payer: The Alliance Commercial |
$13,902.20
|
| Rate for Payer: WEA Trust Commercial |
$15,292.42
|
| Rate for Payer: WPS Commercial |
$20,593.97
|
|
|
TIBIAL INSERT ROTATING PLATFORM SZ 4 12.5MM STABILIZING 96-2142
|
Facility
|
IP
|
$7,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3333504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,572.81 |
| Max. Negotiated Rate |
$6,708.12 |
| Rate for Payer: Aetna Commercial |
$6,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,270.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,864.46
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,708.12
|
| Rate for Payer: Health EOS Commercial |
$6,489.38
|
| Rate for Payer: HFN Commercial |
$6,708.12
|
| Rate for Payer: Multiplan Commercial |
$5,833.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,708.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,572.81
|
| Rate for Payer: Quartz Commercial |
$4,374.86
|
| Rate for Payer: WEA Trust Commercial |
$4,010.29
|
| Rate for Payer: WPS Commercial |
$5,400.57
|
|
|
TIBIAL INSERT ROTATING PLATFORM SZ 4 12.5MM STABILIZING 96-2142
|
Facility
|
OP
|
$7,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3333504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,041.60 |
| Max. Negotiated Rate |
$6,708.12 |
| Rate for Payer: Aetna Commercial |
$6,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,270.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,041.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,739.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,645.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,499.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,864.46
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,708.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,080.40
|
| Rate for Payer: Health EOS Commercial |
$6,489.38
|
| Rate for Payer: HFN Commercial |
$6,708.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,468.58
|
| Rate for Payer: Multiplan Commercial |
$5,833.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,374.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,708.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,572.81
|
| Rate for Payer: Quartz Commercial |
$4,739.44
|
| Rate for Payer: Quartz Medicare Advantage |
$4,374.86
|
| Rate for Payer: The Alliance Commercial |
$3,645.72
|
| Rate for Payer: WEA Trust Commercial |
$4,010.29
|
| Rate for Payer: WPS Commercial |
$5,400.57
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,739.63 |
| Max. Negotiated Rate |
$5,715.92 |
| Rate for Payer: Aetna Commercial |
$5,591.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,739.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,038.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,106.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,982.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.87
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,715.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,476.87
|
| Rate for Payer: Health EOS Commercial |
$5,529.53
|
| Rate for Payer: HFN Commercial |
$5,715.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,659.72
|
| Rate for Payer: Multiplan Commercial |
$4,970.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,727.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.35
|
| Rate for Payer: Quartz Commercial |
$4,038.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,727.78
|
| Rate for Payer: The Alliance Commercial |
$3,106.48
|
| Rate for Payer: WEA Trust Commercial |
$3,417.13
|
| Rate for Payer: WPS Commercial |
$4,601.77
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,044.35 |
| Max. Negotiated Rate |
$5,715.92 |
| Rate for Payer: Aetna Commercial |
$5,591.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.87
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,715.92
|
| Rate for Payer: Health EOS Commercial |
$5,529.53
|
| Rate for Payer: HFN Commercial |
$5,715.92
|
| Rate for Payer: Multiplan Commercial |
$4,970.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.35
|
| Rate for Payer: Quartz Commercial |
$3,727.78
|
| Rate for Payer: WEA Trust Commercial |
$3,417.13
|
| Rate for Payer: WPS Commercial |
$4,601.77
|
|
