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Service Code HCPCS C1713
Hospital Charge Code 2967236
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967236
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967226
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967226
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967017
Hospital Revenue Code 278
Min. Negotiated Rate $345.24
Max. Negotiated Rate $4,932.00
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Aetna Managed Medicare $345.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $801.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $616.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $591.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Dean Health DHI/DHP/ASO $689.99
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $924.75
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $801.45
Rate for Payer: Quartz Medicare Advantage $739.80
Rate for Payer: The Alliance Commercial $4,932.00
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967017
Hospital Revenue Code 278
Min. Negotiated Rate $604.17
Max. Negotiated Rate $1,134.36
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $739.80
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967237
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967237
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967227
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967227
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967018
Hospital Revenue Code 278
Min. Negotiated Rate $604.17
Max. Negotiated Rate $1,134.36
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $739.80
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967018
Hospital Revenue Code 278
Min. Negotiated Rate $345.24
Max. Negotiated Rate $4,932.00
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Aetna Managed Medicare $345.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $801.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $616.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $591.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Dean Health DHI/DHP/ASO $689.99
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $924.75
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $801.45
Rate for Payer: Quartz Medicare Advantage $739.80
Rate for Payer: The Alliance Commercial $4,932.00
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967238
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967238
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967228
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967228
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967019
Hospital Revenue Code 278
Min. Negotiated Rate $604.17
Max. Negotiated Rate $1,134.36
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $739.80
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967019
Hospital Revenue Code 278
Min. Negotiated Rate $345.24
Max. Negotiated Rate $4,932.00
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Aetna Managed Medicare $345.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $801.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $616.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $591.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Dean Health DHI/DHP/ASO $689.99
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $924.75
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $801.45
Rate for Payer: Quartz Medicare Advantage $739.80
Rate for Payer: The Alliance Commercial $4,932.00
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967239
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967239
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967229
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967229
Hospital Revenue Code 278
Min. Negotiated Rate $1,499.40
Max. Negotiated Rate $2,815.20
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,836.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54
Service Code HCPCS C1713
Hospital Charge Code 2967020
Hospital Revenue Code 278
Min. Negotiated Rate $604.17
Max. Negotiated Rate $1,134.36
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $739.80
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967020
Hospital Revenue Code 278
Min. Negotiated Rate $345.24
Max. Negotiated Rate $4,932.00
Rate for Payer: Aetna Commercial $1,109.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,060.38
Rate for Payer: Aetna Managed Medicare $345.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $801.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $616.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $591.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $653.49
Rate for Payer: Cash Price $369.90
Rate for Payer: Cigna Commercial $1,134.36
Rate for Payer: Dean Health DHI/DHP/ASO $689.99
Rate for Payer: Health EOS Commercial $1,097.37
Rate for Payer: HFN Commercial $1,134.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $924.75
Rate for Payer: Multiplan Commercial $986.40
Rate for Payer: NAPHCARE Commercial $739.80
Rate for Payer: Preferred Network Access Commercial $1,134.36
Rate for Payer: Quartz Beloit One Network $604.17
Rate for Payer: Quartz Commercial $801.45
Rate for Payer: Quartz Medicare Advantage $739.80
Rate for Payer: The Alliance Commercial $4,932.00
Rate for Payer: WEA Trust Commercial $678.15
Rate for Payer: WPS Commercial $913.28
Service Code HCPCS C1713
Hospital Charge Code 2967240
Hospital Revenue Code 278
Min. Negotiated Rate $856.80
Max. Negotiated Rate $12,240.00
Rate for Payer: Aetna Commercial $2,754.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,631.60
Rate for Payer: Aetna Managed Medicare $856.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,989.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,530.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,468.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,621.80
Rate for Payer: Cash Price $918.00
Rate for Payer: Cigna Commercial $2,815.20
Rate for Payer: Dean Health DHI/DHP/ASO $1,712.38
Rate for Payer: Health EOS Commercial $2,723.40
Rate for Payer: HFN Commercial $2,815.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,295.00
Rate for Payer: Multiplan Commercial $2,448.00
Rate for Payer: NAPHCARE Commercial $1,836.00
Rate for Payer: Preferred Network Access Commercial $2,815.20
Rate for Payer: Quartz Beloit One Network $1,499.40
Rate for Payer: Quartz Commercial $1,989.00
Rate for Payer: Quartz Medicare Advantage $1,836.00
Rate for Payer: The Alliance Commercial $12,240.00
Rate for Payer: WEA Trust Commercial $1,683.00
Rate for Payer: WPS Commercial $2,266.54