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Service Code HCPCS C1713
Hospital Charge Code 4494426
Hospital Revenue Code 278
Min. Negotiated Rate $1,104.95
Max. Negotiated Rate $2,074.60
Rate for Payer: Aetna Commercial $2,029.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,939.30
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,195.15
Rate for Payer: Cash Price $676.50
Rate for Payer: Cigna Commercial $2,074.60
Rate for Payer: Health EOS Commercial $2,006.95
Rate for Payer: HFN Commercial $2,074.60
Rate for Payer: Multiplan Commercial $1,804.00
Rate for Payer: NAPHCARE Commercial $1,353.00
Rate for Payer: Preferred Network Access Commercial $2,074.60
Rate for Payer: Quartz Beloit One Network $1,104.95
Rate for Payer: Quartz Commercial $1,353.00
Rate for Payer: WEA Trust Commercial $1,240.25
Rate for Payer: WPS Commercial $1,670.28
Hospital Charge Code 2966974
Hospital Revenue Code 278
Min. Negotiated Rate $939.33
Max. Negotiated Rate $1,763.64
Rate for Payer: Aetna Commercial $1,725.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,648.62
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,016.01
Rate for Payer: Cash Price $575.10
Rate for Payer: Cigna Commercial $1,763.64
Rate for Payer: Health EOS Commercial $1,706.13
Rate for Payer: HFN Commercial $1,763.64
Rate for Payer: Multiplan Commercial $1,533.60
Rate for Payer: NAPHCARE Commercial $1,150.20
Rate for Payer: Preferred Network Access Commercial $1,763.64
Rate for Payer: Quartz Beloit One Network $939.33
Rate for Payer: Quartz Commercial $1,150.20
Rate for Payer: WEA Trust Commercial $1,054.35
Rate for Payer: WPS Commercial $1,419.92
Hospital Charge Code 2966974
Hospital Revenue Code 278
Min. Negotiated Rate $536.76
Max. Negotiated Rate $7,668.00
Rate for Payer: Aetna Commercial $1,725.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,648.62
Rate for Payer: Aetna Managed Medicare $536.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,246.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $958.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $920.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,016.01
Rate for Payer: Cash Price $575.10
Rate for Payer: Cigna Commercial $1,763.64
Rate for Payer: Dean Health DHI/DHP/ASO $1,072.75
Rate for Payer: Health EOS Commercial $1,706.13
Rate for Payer: HFN Commercial $1,763.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,437.75
Rate for Payer: Multiplan Commercial $1,533.60
Rate for Payer: NAPHCARE Commercial $1,150.20
Rate for Payer: Preferred Network Access Commercial $1,763.64
Rate for Payer: Quartz Beloit One Network $939.33
Rate for Payer: Quartz Commercial $1,246.05
Rate for Payer: Quartz Medicare Advantage $1,150.20
Rate for Payer: The Alliance Commercial $7,668.00
Rate for Payer: WEA Trust Commercial $1,054.35
Rate for Payer: WPS Commercial $1,419.92
Service Code HCPCS C1713
Hospital Charge Code 3605503
Hospital Revenue Code 278
Min. Negotiated Rate $745.08
Max. Negotiated Rate $10,644.00
Rate for Payer: Aetna Commercial $2,394.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,288.46
Rate for Payer: Aetna Managed Medicare $745.08
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,729.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,330.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,277.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,410.33
Rate for Payer: Cash Price $798.30
Rate for Payer: Cigna Commercial $2,448.12
Rate for Payer: Dean Health DHI/DHP/ASO $1,489.10
Rate for Payer: Health EOS Commercial $2,368.29
Rate for Payer: HFN Commercial $2,448.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,995.75
Rate for Payer: Multiplan Commercial $2,128.80
Rate for Payer: NAPHCARE Commercial $1,596.60
Rate for Payer: Preferred Network Access Commercial $2,448.12
Rate for Payer: Quartz Beloit One Network $1,303.89
Rate for Payer: Quartz Commercial $1,729.65
Rate for Payer: Quartz Medicare Advantage $1,596.60
Rate for Payer: The Alliance Commercial $10,644.00
Rate for Payer: WEA Trust Commercial $1,463.55
Rate for Payer: WPS Commercial $1,971.00
Service Code HCPCS C1713
Hospital Charge Code 3605503
Hospital Revenue Code 278
Min. Negotiated Rate $1,303.89
Max. Negotiated Rate $2,448.12
Rate for Payer: Aetna Commercial $2,394.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,288.46
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,410.33
Rate for Payer: Cash Price $798.30
Rate for Payer: Cigna Commercial $2,448.12
Rate for Payer: Health EOS Commercial $2,368.29
Rate for Payer: HFN Commercial $2,448.12
Rate for Payer: Multiplan Commercial $2,128.80
Rate for Payer: NAPHCARE Commercial $1,596.60
Rate for Payer: Preferred Network Access Commercial $2,448.12
Rate for Payer: Quartz Beloit One Network $1,303.89
Rate for Payer: Quartz Commercial $1,596.60
Rate for Payer: WEA Trust Commercial $1,463.55
Rate for Payer: WPS Commercial $1,971.00
Service Code HCPCS C1713
Hospital Charge Code 6178983
Hospital Revenue Code 278
Min. Negotiated Rate $533.68
Max. Negotiated Rate $7,624.00
Rate for Payer: Aetna Commercial $1,715.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,639.16
Rate for Payer: Aetna Managed Medicare $533.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,238.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $953.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $914.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,010.18
Rate for Payer: Cash Price $571.80
Rate for Payer: Cigna Commercial $1,753.52
Rate for Payer: Dean Health DHI/DHP/ASO $1,066.60
Rate for Payer: Health EOS Commercial $1,696.34
Rate for Payer: HFN Commercial $1,753.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,429.50
Rate for Payer: Multiplan Commercial $1,524.80
Rate for Payer: NAPHCARE Commercial $1,143.60
Rate for Payer: Preferred Network Access Commercial $1,753.52
Rate for Payer: Quartz Beloit One Network $933.94
Rate for Payer: Quartz Commercial $1,238.90
Rate for Payer: Quartz Medicare Advantage $1,143.60
Rate for Payer: The Alliance Commercial $7,624.00
Rate for Payer: WEA Trust Commercial $1,048.30
Rate for Payer: WPS Commercial $1,411.77
Service Code HCPCS C1713
Hospital Charge Code 6178983
Hospital Revenue Code 278
Min. Negotiated Rate $933.94
Max. Negotiated Rate $1,753.52
Rate for Payer: Aetna Commercial $1,715.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,639.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,010.18
Rate for Payer: Cash Price $571.80
Rate for Payer: Cigna Commercial $1,753.52
Rate for Payer: Health EOS Commercial $1,696.34
Rate for Payer: HFN Commercial $1,753.52
Rate for Payer: Multiplan Commercial $1,524.80
Rate for Payer: NAPHCARE Commercial $1,143.60
Rate for Payer: Preferred Network Access Commercial $1,753.52
Rate for Payer: Quartz Beloit One Network $933.94
Rate for Payer: Quartz Commercial $1,143.60
Rate for Payer: WEA Trust Commercial $1,048.30
Rate for Payer: WPS Commercial $1,411.77
Service Code HCPCS C1713
Hospital Charge Code 2966530
Hospital Revenue Code 278
Min. Negotiated Rate $793.52
Max. Negotiated Rate $11,336.00
Rate for Payer: Aetna Commercial $2,550.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,437.24
Rate for Payer: Aetna Managed Medicare $793.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,842.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,417.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,360.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,502.02
Rate for Payer: Cash Price $850.20
Rate for Payer: Cigna Commercial $2,607.28
Rate for Payer: Dean Health DHI/DHP/ASO $1,585.91
Rate for Payer: Health EOS Commercial $2,522.26
Rate for Payer: HFN Commercial $2,607.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,125.50
Rate for Payer: Multiplan Commercial $2,267.20
Rate for Payer: NAPHCARE Commercial $1,700.40
Rate for Payer: Preferred Network Access Commercial $2,607.28
Rate for Payer: Quartz Beloit One Network $1,388.66
Rate for Payer: Quartz Commercial $1,842.10
Rate for Payer: Quartz Medicare Advantage $1,700.40
Rate for Payer: The Alliance Commercial $11,336.00
Rate for Payer: WEA Trust Commercial $1,558.70
Rate for Payer: WPS Commercial $2,099.14
Service Code HCPCS C1713
Hospital Charge Code 2966530
Hospital Revenue Code 278
Min. Negotiated Rate $1,388.66
Max. Negotiated Rate $2,607.28
Rate for Payer: Aetna Commercial $2,550.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,437.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,502.02
Rate for Payer: Cash Price $850.20
Rate for Payer: Cigna Commercial $2,607.28
Rate for Payer: Health EOS Commercial $2,522.26
Rate for Payer: HFN Commercial $2,607.28
Rate for Payer: Multiplan Commercial $2,267.20
Rate for Payer: NAPHCARE Commercial $1,700.40
Rate for Payer: Preferred Network Access Commercial $2,607.28
Rate for Payer: Quartz Beloit One Network $1,388.66
Rate for Payer: Quartz Commercial $1,700.40
Rate for Payer: WEA Trust Commercial $1,558.70
Rate for Payer: WPS Commercial $2,099.14
Service Code HCPCS C1713
Hospital Charge Code 6175475
Hospital Revenue Code 278
Min. Negotiated Rate $1,384.74
Max. Negotiated Rate $2,599.92
Rate for Payer: Aetna Commercial $2,543.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,430.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,497.78
Rate for Payer: Cash Price $847.80
Rate for Payer: Cigna Commercial $2,599.92
Rate for Payer: Health EOS Commercial $2,515.14
Rate for Payer: HFN Commercial $2,599.92
Rate for Payer: Multiplan Commercial $2,260.80
Rate for Payer: NAPHCARE Commercial $1,695.60
Rate for Payer: Preferred Network Access Commercial $2,599.92
Rate for Payer: Quartz Beloit One Network $1,384.74
Rate for Payer: Quartz Commercial $1,695.60
Rate for Payer: WEA Trust Commercial $1,554.30
Rate for Payer: WPS Commercial $2,093.22
Service Code HCPCS C1713
Hospital Charge Code 6175475
Hospital Revenue Code 278
Min. Negotiated Rate $791.28
Max. Negotiated Rate $11,304.00
Rate for Payer: Aetna Commercial $2,543.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,430.36
Rate for Payer: Aetna Managed Medicare $791.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,836.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,413.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,356.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,497.78
Rate for Payer: Cash Price $847.80
Rate for Payer: Cigna Commercial $2,599.92
Rate for Payer: Dean Health DHI/DHP/ASO $1,581.43
Rate for Payer: Health EOS Commercial $2,515.14
Rate for Payer: HFN Commercial $2,599.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,119.50
Rate for Payer: Multiplan Commercial $2,260.80
Rate for Payer: NAPHCARE Commercial $1,695.60
Rate for Payer: Preferred Network Access Commercial $2,599.92
Rate for Payer: Quartz Beloit One Network $1,384.74
Rate for Payer: Quartz Commercial $1,836.90
Rate for Payer: Quartz Medicare Advantage $1,695.60
Rate for Payer: The Alliance Commercial $11,304.00
Rate for Payer: WEA Trust Commercial $1,554.30
Rate for Payer: WPS Commercial $2,093.22
Service Code HCPCS C1713
Hospital Charge Code 2966975
Hospital Revenue Code 278
Min. Negotiated Rate $1,334.76
Max. Negotiated Rate $2,506.08
Rate for Payer: Aetna Commercial $2,451.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,342.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,443.72
Rate for Payer: Cash Price $817.20
Rate for Payer: Cigna Commercial $2,506.08
Rate for Payer: Health EOS Commercial $2,424.36
Rate for Payer: HFN Commercial $2,506.08
Rate for Payer: Multiplan Commercial $2,179.20
Rate for Payer: NAPHCARE Commercial $1,634.40
Rate for Payer: Preferred Network Access Commercial $2,506.08
Rate for Payer: Quartz Beloit One Network $1,334.76
Rate for Payer: Quartz Commercial $1,634.40
Rate for Payer: WEA Trust Commercial $1,498.20
Rate for Payer: WPS Commercial $2,017.67
Service Code HCPCS C1713
Hospital Charge Code 2966975
Hospital Revenue Code 278
Min. Negotiated Rate $762.72
Max. Negotiated Rate $10,896.00
Rate for Payer: Aetna Commercial $2,451.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,342.64
Rate for Payer: Aetna Managed Medicare $762.72
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,770.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,362.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,307.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,443.72
Rate for Payer: Cash Price $817.20
Rate for Payer: Cigna Commercial $2,506.08
Rate for Payer: Dean Health DHI/DHP/ASO $1,524.35
Rate for Payer: Health EOS Commercial $2,424.36
Rate for Payer: HFN Commercial $2,506.08
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,043.00
Rate for Payer: Multiplan Commercial $2,179.20
Rate for Payer: NAPHCARE Commercial $1,634.40
Rate for Payer: Preferred Network Access Commercial $2,506.08
Rate for Payer: Quartz Beloit One Network $1,334.76
Rate for Payer: Quartz Commercial $1,770.60
Rate for Payer: Quartz Medicare Advantage $1,634.40
Rate for Payer: The Alliance Commercial $10,896.00
Rate for Payer: WEA Trust Commercial $1,498.20
Rate for Payer: WPS Commercial $2,017.67
Service Code HCPCS C1713
Hospital Charge Code 4494425
Hospital Revenue Code 278
Min. Negotiated Rate $631.40
Max. Negotiated Rate $9,020.00
Rate for Payer: Aetna Commercial $2,029.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,939.30
Rate for Payer: Aetna Managed Medicare $631.40
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,465.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,127.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,082.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,195.15
Rate for Payer: Cash Price $676.50
Rate for Payer: Cigna Commercial $2,074.60
Rate for Payer: Dean Health DHI/DHP/ASO $1,261.90
Rate for Payer: Health EOS Commercial $2,006.95
Rate for Payer: HFN Commercial $2,074.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,691.25
Rate for Payer: Multiplan Commercial $1,804.00
Rate for Payer: NAPHCARE Commercial $1,353.00
Rate for Payer: Preferred Network Access Commercial $2,074.60
Rate for Payer: Quartz Beloit One Network $1,104.95
Rate for Payer: Quartz Commercial $1,465.75
Rate for Payer: Quartz Medicare Advantage $1,353.00
Rate for Payer: The Alliance Commercial $9,020.00
Rate for Payer: WEA Trust Commercial $1,240.25
Rate for Payer: WPS Commercial $1,670.28
Service Code HCPCS C1713
Hospital Charge Code 4494425
Hospital Revenue Code 278
Min. Negotiated Rate $1,104.95
Max. Negotiated Rate $2,074.60
Rate for Payer: Aetna Commercial $2,029.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,939.30
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,195.15
Rate for Payer: Cash Price $676.50
Rate for Payer: Cigna Commercial $2,074.60
Rate for Payer: Health EOS Commercial $2,006.95
Rate for Payer: HFN Commercial $2,074.60
Rate for Payer: Multiplan Commercial $1,804.00
Rate for Payer: NAPHCARE Commercial $1,353.00
Rate for Payer: Preferred Network Access Commercial $2,074.60
Rate for Payer: Quartz Beloit One Network $1,104.95
Rate for Payer: Quartz Commercial $1,353.00
Rate for Payer: WEA Trust Commercial $1,240.25
Rate for Payer: WPS Commercial $1,670.28
Hospital Charge Code 2966976
Hospital Revenue Code 278
Min. Negotiated Rate $536.76
Max. Negotiated Rate $7,668.00
Rate for Payer: Aetna Commercial $1,725.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,648.62
Rate for Payer: Aetna Managed Medicare $536.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,246.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $958.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $920.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,016.01
Rate for Payer: Cash Price $575.10
Rate for Payer: Cigna Commercial $1,763.64
Rate for Payer: Dean Health DHI/DHP/ASO $1,072.75
Rate for Payer: Health EOS Commercial $1,706.13
Rate for Payer: HFN Commercial $1,763.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,437.75
Rate for Payer: Multiplan Commercial $1,533.60
Rate for Payer: NAPHCARE Commercial $1,150.20
Rate for Payer: Preferred Network Access Commercial $1,763.64
Rate for Payer: Quartz Beloit One Network $939.33
Rate for Payer: Quartz Commercial $1,246.05
Rate for Payer: Quartz Medicare Advantage $1,150.20
Rate for Payer: The Alliance Commercial $7,668.00
Rate for Payer: WEA Trust Commercial $1,054.35
Rate for Payer: WPS Commercial $1,419.92
Hospital Charge Code 2966976
Hospital Revenue Code 278
Min. Negotiated Rate $939.33
Max. Negotiated Rate $1,763.64
Rate for Payer: Aetna Commercial $1,725.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,648.62
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,016.01
Rate for Payer: Cash Price $575.10
Rate for Payer: Cigna Commercial $1,763.64
Rate for Payer: Health EOS Commercial $1,706.13
Rate for Payer: HFN Commercial $1,763.64
Rate for Payer: Multiplan Commercial $1,533.60
Rate for Payer: NAPHCARE Commercial $1,150.20
Rate for Payer: Preferred Network Access Commercial $1,763.64
Rate for Payer: Quartz Beloit One Network $939.33
Rate for Payer: Quartz Commercial $1,150.20
Rate for Payer: WEA Trust Commercial $1,054.35
Rate for Payer: WPS Commercial $1,419.92
Service Code HCPCS C1713
Hospital Charge Code 4252225
Hospital Revenue Code 278
Min. Negotiated Rate $1,303.89
Max. Negotiated Rate $2,448.12
Rate for Payer: Aetna Commercial $2,394.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,288.46
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,410.33
Rate for Payer: Cash Price $798.30
Rate for Payer: Cigna Commercial $2,448.12
Rate for Payer: Health EOS Commercial $2,368.29
Rate for Payer: HFN Commercial $2,448.12
Rate for Payer: Multiplan Commercial $2,128.80
Rate for Payer: NAPHCARE Commercial $1,596.60
Rate for Payer: Preferred Network Access Commercial $2,448.12
Rate for Payer: Quartz Beloit One Network $1,303.89
Rate for Payer: Quartz Commercial $1,596.60
Rate for Payer: WEA Trust Commercial $1,463.55
Rate for Payer: WPS Commercial $1,971.00
Service Code HCPCS C1713
Hospital Charge Code 4252225
Hospital Revenue Code 278
Min. Negotiated Rate $745.08
Max. Negotiated Rate $10,644.00
Rate for Payer: Aetna Commercial $2,394.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,288.46
Rate for Payer: Aetna Managed Medicare $745.08
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,729.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,330.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,277.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,410.33
Rate for Payer: Cash Price $798.30
Rate for Payer: Cigna Commercial $2,448.12
Rate for Payer: Dean Health DHI/DHP/ASO $1,489.10
Rate for Payer: Health EOS Commercial $2,368.29
Rate for Payer: HFN Commercial $2,448.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,995.75
Rate for Payer: Multiplan Commercial $2,128.80
Rate for Payer: NAPHCARE Commercial $1,596.60
Rate for Payer: Preferred Network Access Commercial $2,448.12
Rate for Payer: Quartz Beloit One Network $1,303.89
Rate for Payer: Quartz Commercial $1,729.65
Rate for Payer: Quartz Medicare Advantage $1,596.60
Rate for Payer: The Alliance Commercial $10,644.00
Rate for Payer: WEA Trust Commercial $1,463.55
Rate for Payer: WPS Commercial $1,971.00
Service Code HCPCS C1713
Hospital Charge Code 5458795
Hospital Revenue Code 278
Min. Negotiated Rate $982.45
Max. Negotiated Rate $1,844.60
Rate for Payer: Aetna Commercial $1,804.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,724.30
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,062.65
Rate for Payer: Cash Price $601.50
Rate for Payer: Cigna Commercial $1,844.60
Rate for Payer: Health EOS Commercial $1,784.45
Rate for Payer: HFN Commercial $1,844.60
Rate for Payer: Multiplan Commercial $1,604.00
Rate for Payer: NAPHCARE Commercial $1,203.00
Rate for Payer: Preferred Network Access Commercial $1,844.60
Rate for Payer: Quartz Beloit One Network $982.45
Rate for Payer: Quartz Commercial $1,203.00
Rate for Payer: WEA Trust Commercial $1,102.75
Rate for Payer: WPS Commercial $1,485.10
Service Code HCPCS C1713
Hospital Charge Code 5458795
Hospital Revenue Code 278
Min. Negotiated Rate $561.40
Max. Negotiated Rate $8,020.00
Rate for Payer: Aetna Commercial $1,804.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,724.30
Rate for Payer: Aetna Managed Medicare $561.40
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,303.25
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,002.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $962.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,062.65
Rate for Payer: Cash Price $601.50
Rate for Payer: Cigna Commercial $1,844.60
Rate for Payer: Dean Health DHI/DHP/ASO $1,122.00
Rate for Payer: Health EOS Commercial $1,784.45
Rate for Payer: HFN Commercial $1,844.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,503.75
Rate for Payer: Multiplan Commercial $1,604.00
Rate for Payer: NAPHCARE Commercial $1,203.00
Rate for Payer: Preferred Network Access Commercial $1,844.60
Rate for Payer: Quartz Beloit One Network $982.45
Rate for Payer: Quartz Commercial $1,303.25
Rate for Payer: Quartz Medicare Advantage $1,203.00
Rate for Payer: The Alliance Commercial $8,020.00
Rate for Payer: WEA Trust Commercial $1,102.75
Rate for Payer: WPS Commercial $1,485.10
Service Code HCPCS C1713
Hospital Charge Code 3127486
Hospital Revenue Code 278
Min. Negotiated Rate $1,093.68
Max. Negotiated Rate $2,053.44
Rate for Payer: Aetna Commercial $2,008.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,919.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,182.96
Rate for Payer: Cash Price $669.60
Rate for Payer: Cigna Commercial $2,053.44
Rate for Payer: Health EOS Commercial $1,986.48
Rate for Payer: HFN Commercial $2,053.44
Rate for Payer: Multiplan Commercial $1,785.60
Rate for Payer: NAPHCARE Commercial $1,339.20
Rate for Payer: Preferred Network Access Commercial $2,053.44
Rate for Payer: Quartz Beloit One Network $1,093.68
Rate for Payer: Quartz Commercial $1,339.20
Rate for Payer: WEA Trust Commercial $1,227.60
Rate for Payer: WPS Commercial $1,653.24
Service Code HCPCS C1713
Hospital Charge Code 3127486
Hospital Revenue Code 278
Min. Negotiated Rate $624.96
Max. Negotiated Rate $8,928.00
Rate for Payer: Aetna Commercial $2,008.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,919.52
Rate for Payer: Aetna Managed Medicare $624.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,450.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,116.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,071.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,182.96
Rate for Payer: Cash Price $669.60
Rate for Payer: Cigna Commercial $2,053.44
Rate for Payer: Dean Health DHI/DHP/ASO $1,249.03
Rate for Payer: Health EOS Commercial $1,986.48
Rate for Payer: HFN Commercial $2,053.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,674.00
Rate for Payer: Multiplan Commercial $1,785.60
Rate for Payer: NAPHCARE Commercial $1,339.20
Rate for Payer: Preferred Network Access Commercial $2,053.44
Rate for Payer: Quartz Beloit One Network $1,093.68
Rate for Payer: Quartz Commercial $1,450.80
Rate for Payer: Quartz Medicare Advantage $1,339.20
Rate for Payer: The Alliance Commercial $8,928.00
Rate for Payer: WEA Trust Commercial $1,227.60
Rate for Payer: WPS Commercial $1,653.24
Hospital Charge Code 2966977
Hospital Revenue Code 278
Min. Negotiated Rate $1,334.76
Max. Negotiated Rate $2,506.08
Rate for Payer: Aetna Commercial $2,451.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,342.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,443.72
Rate for Payer: Cash Price $817.20
Rate for Payer: Cigna Commercial $2,506.08
Rate for Payer: Health EOS Commercial $2,424.36
Rate for Payer: HFN Commercial $2,506.08
Rate for Payer: Multiplan Commercial $2,179.20
Rate for Payer: NAPHCARE Commercial $1,634.40
Rate for Payer: Preferred Network Access Commercial $2,506.08
Rate for Payer: Quartz Beloit One Network $1,334.76
Rate for Payer: Quartz Commercial $1,634.40
Rate for Payer: WEA Trust Commercial $1,498.20
Rate for Payer: WPS Commercial $2,017.67
Hospital Charge Code 2966977
Hospital Revenue Code 278
Min. Negotiated Rate $762.72
Max. Negotiated Rate $10,896.00
Rate for Payer: Aetna Commercial $2,451.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,342.64
Rate for Payer: Aetna Managed Medicare $762.72
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,770.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,362.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,307.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,443.72
Rate for Payer: Cash Price $817.20
Rate for Payer: Cigna Commercial $2,506.08
Rate for Payer: Dean Health DHI/DHP/ASO $1,524.35
Rate for Payer: Health EOS Commercial $2,424.36
Rate for Payer: HFN Commercial $2,506.08
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,043.00
Rate for Payer: Multiplan Commercial $2,179.20
Rate for Payer: NAPHCARE Commercial $1,634.40
Rate for Payer: Preferred Network Access Commercial $2,506.08
Rate for Payer: Quartz Beloit One Network $1,334.76
Rate for Payer: Quartz Commercial $1,770.60
Rate for Payer: Quartz Medicare Advantage $1,634.40
Rate for Payer: The Alliance Commercial $10,896.00
Rate for Payer: WEA Trust Commercial $1,498.20
Rate for Payer: WPS Commercial $2,017.67