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All Charges

Charge Type Price  
Service Code HCPCS C1760
Hospital Charge Code 3613524
Hospital Revenue Code 278
Min. Negotiated Rate $812.28
Max. Negotiated Rate $2,668.92
Rate for Payer: Aetna Commercial $2,610.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,494.86
Rate for Payer: Aetna Managed Medicare $812.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,885.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,450.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,392.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,537.53
Rate for Payer: Cash Price $870.30
Rate for Payer: Cigna Commercial $2,668.92
Rate for Payer: Dean Health DHI/DHP/ASO $1,623.40
Rate for Payer: Health EOS Commercial $2,581.89
Rate for Payer: HFN Commercial $2,668.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,175.75
Rate for Payer: Multiplan Commercial $2,320.80
Rate for Payer: NAPHCARE Commercial $1,740.60
Rate for Payer: Preferred Network Access Commercial $2,668.92
Rate for Payer: Quartz Beloit One Network $1,421.49
Rate for Payer: Quartz Commercial $1,885.65
Rate for Payer: Quartz Medicare Advantage $1,740.60
Rate for Payer: WEA Trust Commercial $1,595.55
Rate for Payer: WPS Commercial $2,148.77