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Service Code HCPCS C1713
Hospital Charge Code 6202971
Hospital Revenue Code 278
Min. Negotiated Rate $760.76
Max. Negotiated Rate $10,868.00
Rate for Payer: Aetna Commercial $2,445.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,336.62
Rate for Payer: Aetna Managed Medicare $760.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,766.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,358.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,304.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,440.01
Rate for Payer: Cash Price $815.10
Rate for Payer: Cigna Commercial $2,499.64
Rate for Payer: Dean Health DHI/DHP/ASO $1,520.43
Rate for Payer: Health EOS Commercial $2,418.13
Rate for Payer: HFN Commercial $2,499.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,037.75
Rate for Payer: Multiplan Commercial $2,173.60
Rate for Payer: NAPHCARE Commercial $1,630.20
Rate for Payer: Preferred Network Access Commercial $2,499.64
Rate for Payer: Quartz Beloit One Network $1,331.33
Rate for Payer: Quartz Commercial $1,766.05
Rate for Payer: Quartz Medicare Advantage $1,630.20
Rate for Payer: The Alliance Commercial $10,868.00
Rate for Payer: WEA Trust Commercial $1,494.35
Rate for Payer: WPS Commercial $2,012.48
Hospital Charge Code 2966992
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 2966992
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
Hospital Charge Code 2966994
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 2966994
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 4508991
Hospital Revenue Code 278
Min. Negotiated Rate $922.18
Max. Negotiated Rate $1,731.44
Rate for Payer: Aetna Commercial $1,693.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,618.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $997.46
Rate for Payer: Cash Price $564.60
Rate for Payer: Cigna Commercial $1,731.44
Rate for Payer: Health EOS Commercial $1,674.98
Rate for Payer: HFN Commercial $1,731.44
Rate for Payer: Multiplan Commercial $1,505.60
Rate for Payer: NAPHCARE Commercial $1,129.20
Rate for Payer: Preferred Network Access Commercial $1,731.44
Rate for Payer: Quartz Beloit One Network $922.18
Rate for Payer: Quartz Commercial $1,129.20
Rate for Payer: WEA Trust Commercial $1,035.10
Rate for Payer: WPS Commercial $1,394.00
Service Code HCPCS C1713
Hospital Charge Code 4508991
Hospital Revenue Code 278
Min. Negotiated Rate $526.96
Max. Negotiated Rate $7,528.00
Rate for Payer: Aetna Commercial $1,693.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,618.52
Rate for Payer: Aetna Managed Medicare $526.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,223.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $941.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $903.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $997.46
Rate for Payer: Cash Price $564.60
Rate for Payer: Cigna Commercial $1,731.44
Rate for Payer: Dean Health DHI/DHP/ASO $1,053.17
Rate for Payer: Health EOS Commercial $1,674.98
Rate for Payer: HFN Commercial $1,731.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,411.50
Rate for Payer: Multiplan Commercial $1,505.60
Rate for Payer: NAPHCARE Commercial $1,129.20
Rate for Payer: Preferred Network Access Commercial $1,731.44
Rate for Payer: Quartz Beloit One Network $922.18
Rate for Payer: Quartz Commercial $1,223.30
Rate for Payer: Quartz Medicare Advantage $1,129.20
Rate for Payer: The Alliance Commercial $7,528.00
Rate for Payer: WEA Trust Commercial $1,035.10
Rate for Payer: WPS Commercial $1,394.00
Hospital Charge Code 2966995
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
Hospital Charge Code 2966995
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 4494423
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 4494423
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
Service Code HCPCS C1713
Hospital Charge Code 4520291
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 4520291
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
Service Code HCPCS C1713
Hospital Charge Code 5415198
Hospital Revenue Code 278
Min. Negotiated Rate $985.88
Max. Negotiated Rate $1,851.04
Rate for Payer: Aetna Commercial $1,810.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,730.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,066.36
Rate for Payer: Cash Price $603.60
Rate for Payer: Cigna Commercial $1,851.04
Rate for Payer: Health EOS Commercial $1,790.68
Rate for Payer: HFN Commercial $1,851.04
Rate for Payer: Multiplan Commercial $1,609.60
Rate for Payer: NAPHCARE Commercial $1,207.20
Rate for Payer: Preferred Network Access Commercial $1,851.04
Rate for Payer: Quartz Beloit One Network $985.88
Rate for Payer: Quartz Commercial $1,207.20
Rate for Payer: WEA Trust Commercial $1,106.60
Rate for Payer: WPS Commercial $1,490.29
Service Code HCPCS C1713
Hospital Charge Code 5415198
Hospital Revenue Code 278
Min. Negotiated Rate $563.36
Max. Negotiated Rate $8,048.00
Rate for Payer: Aetna Commercial $1,810.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,730.32
Rate for Payer: Aetna Managed Medicare $563.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,307.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,006.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $965.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,066.36
Rate for Payer: Cash Price $603.60
Rate for Payer: Cigna Commercial $1,851.04
Rate for Payer: Dean Health DHI/DHP/ASO $1,125.92
Rate for Payer: Health EOS Commercial $1,790.68
Rate for Payer: HFN Commercial $1,851.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,509.00
Rate for Payer: Multiplan Commercial $1,609.60
Rate for Payer: NAPHCARE Commercial $1,207.20
Rate for Payer: Preferred Network Access Commercial $1,851.04
Rate for Payer: Quartz Beloit One Network $985.88
Rate for Payer: Quartz Commercial $1,307.80
Rate for Payer: Quartz Medicare Advantage $1,207.20
Rate for Payer: The Alliance Commercial $8,048.00
Rate for Payer: WEA Trust Commercial $1,106.60
Rate for Payer: WPS Commercial $1,490.29
Hospital Charge Code 2966996
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 2966996
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
Hospital Charge Code 2966997
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 2966997
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 4508992
Hospital Revenue Code 278
Min. Negotiated Rate $922.18
Max. Negotiated Rate $1,731.44
Rate for Payer: Aetna Commercial $1,693.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,618.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $997.46
Rate for Payer: Cash Price $564.60
Rate for Payer: Cigna Commercial $1,731.44
Rate for Payer: Health EOS Commercial $1,674.98
Rate for Payer: HFN Commercial $1,731.44
Rate for Payer: Multiplan Commercial $1,505.60
Rate for Payer: NAPHCARE Commercial $1,129.20
Rate for Payer: Preferred Network Access Commercial $1,731.44
Rate for Payer: Quartz Beloit One Network $922.18
Rate for Payer: Quartz Commercial $1,129.20
Rate for Payer: WEA Trust Commercial $1,035.10
Rate for Payer: WPS Commercial $1,394.00
Service Code HCPCS C1713
Hospital Charge Code 4508992
Hospital Revenue Code 278
Min. Negotiated Rate $526.96
Max. Negotiated Rate $7,528.00
Rate for Payer: Aetna Commercial $1,693.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,618.52
Rate for Payer: Aetna Managed Medicare $526.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,223.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $941.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $903.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $997.46
Rate for Payer: Cash Price $564.60
Rate for Payer: Cigna Commercial $1,731.44
Rate for Payer: Dean Health DHI/DHP/ASO $1,053.17
Rate for Payer: Health EOS Commercial $1,674.98
Rate for Payer: HFN Commercial $1,731.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,411.50
Rate for Payer: Multiplan Commercial $1,505.60
Rate for Payer: NAPHCARE Commercial $1,129.20
Rate for Payer: Preferred Network Access Commercial $1,731.44
Rate for Payer: Quartz Beloit One Network $922.18
Rate for Payer: Quartz Commercial $1,223.30
Rate for Payer: Quartz Medicare Advantage $1,129.20
Rate for Payer: The Alliance Commercial $7,528.00
Rate for Payer: WEA Trust Commercial $1,035.10
Rate for Payer: WPS Commercial $1,394.00
Service Code HCPCS C1713
Hospital Charge Code 4494424
Hospital Revenue Code 278
Min. Negotiated Rate $1,147.58
Max. Negotiated Rate $2,154.64
Rate for Payer: Aetna Commercial $2,107.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,014.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,241.26
Rate for Payer: Cash Price $702.60
Rate for Payer: Cigna Commercial $2,154.64
Rate for Payer: Health EOS Commercial $2,084.38
Rate for Payer: HFN Commercial $2,154.64
Rate for Payer: Multiplan Commercial $1,873.60
Rate for Payer: NAPHCARE Commercial $1,405.20
Rate for Payer: Preferred Network Access Commercial $2,154.64
Rate for Payer: Quartz Beloit One Network $1,147.58
Rate for Payer: Quartz Commercial $1,405.20
Rate for Payer: WEA Trust Commercial $1,288.10
Rate for Payer: WPS Commercial $1,734.72
Service Code HCPCS C1713
Hospital Charge Code 4494424
Hospital Revenue Code 278
Min. Negotiated Rate $655.76
Max. Negotiated Rate $9,368.00
Rate for Payer: Aetna Commercial $2,107.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,014.12
Rate for Payer: Aetna Managed Medicare $655.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,522.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,171.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,124.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,241.26
Rate for Payer: Cash Price $702.60
Rate for Payer: Cigna Commercial $2,154.64
Rate for Payer: Dean Health DHI/DHP/ASO $1,310.58
Rate for Payer: Health EOS Commercial $2,084.38
Rate for Payer: HFN Commercial $2,154.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,756.50
Rate for Payer: Multiplan Commercial $1,873.60
Rate for Payer: NAPHCARE Commercial $1,405.20
Rate for Payer: Preferred Network Access Commercial $2,154.64
Rate for Payer: Quartz Beloit One Network $1,147.58
Rate for Payer: Quartz Commercial $1,522.30
Rate for Payer: Quartz Medicare Advantage $1,405.20
Rate for Payer: The Alliance Commercial $9,368.00
Rate for Payer: WEA Trust Commercial $1,288.10
Rate for Payer: WPS Commercial $1,734.72
Service Code HCPCS C1713
Hospital Charge Code 6202970
Hospital Revenue Code 278
Min. Negotiated Rate $1,331.33
Max. Negotiated Rate $2,499.64
Rate for Payer: Aetna Commercial $2,445.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,336.62
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,440.01
Rate for Payer: Cash Price $815.10
Rate for Payer: Cigna Commercial $2,499.64
Rate for Payer: Health EOS Commercial $2,418.13
Rate for Payer: HFN Commercial $2,499.64
Rate for Payer: Multiplan Commercial $2,173.60
Rate for Payer: NAPHCARE Commercial $1,630.20
Rate for Payer: Preferred Network Access Commercial $2,499.64
Rate for Payer: Quartz Beloit One Network $1,331.33
Rate for Payer: Quartz Commercial $1,630.20
Rate for Payer: WEA Trust Commercial $1,494.35
Rate for Payer: WPS Commercial $2,012.48
Service Code HCPCS C1713
Hospital Charge Code 6202970
Hospital Revenue Code 278
Min. Negotiated Rate $760.76
Max. Negotiated Rate $10,868.00
Rate for Payer: Aetna Commercial $2,445.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,336.62
Rate for Payer: Aetna Managed Medicare $760.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,766.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,358.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,304.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,440.01
Rate for Payer: Cash Price $815.10
Rate for Payer: Cigna Commercial $2,499.64
Rate for Payer: Dean Health DHI/DHP/ASO $1,520.43
Rate for Payer: Health EOS Commercial $2,418.13
Rate for Payer: HFN Commercial $2,499.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,037.75
Rate for Payer: Multiplan Commercial $2,173.60
Rate for Payer: NAPHCARE Commercial $1,630.20
Rate for Payer: Preferred Network Access Commercial $2,499.64
Rate for Payer: Quartz Beloit One Network $1,331.33
Rate for Payer: Quartz Commercial $1,766.05
Rate for Payer: Quartz Medicare Advantage $1,630.20
Rate for Payer: The Alliance Commercial $10,868.00
Rate for Payer: WEA Trust Commercial $1,494.35
Rate for Payer: WPS Commercial $2,012.48