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Service Code CPT 80299
Hospital Charge Code 977949
Hospital Revenue Code 300
Min. Negotiated Rate $18.64
Max. Negotiated Rate $178.48
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Aetna Managed Medicare $18.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $69.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $32.62
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $30.94
Rate for Payer: Anthem Medicaid $19.26
Rate for Payer: Anthem Medicare Advantage $18.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $18.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $18.64
Rate for Payer: Cash Price $58.20
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $18.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $19.26
Rate for Payer: Dean Health DHI/DHP/ASO $108.56
Rate for Payer: Dean Health Medicaid $19.26
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $18.64
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $69.34
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $18.64
Rate for Payer: Independent Care Health Plan Medicaid $19.26
Rate for Payer: Independent Care Health Plan Medicare $18.64
Rate for Payer: Managed Health Services Medicaid $20.03
Rate for Payer: Managed Health Services Medicare Advantage $18.64
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $18.64
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $27.96
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $19.26
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $126.10
Rate for Payer: Quartz Medicare Advantage $18.64
Rate for Payer: The Alliance Commercial $74.56
Rate for Payer: United Healthcare Medicaid $19.26
Rate for Payer: United Healthcare Medicare Advantage $18.64
Rate for Payer: United Healthcare PPO $145.50
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: Wellcare Medicare $18.64
Rate for Payer: WMAP Medicaid $19.26
Rate for Payer: WPS Commercial $143.70
Service Code CPT 80299
Hospital Charge Code 977949
Hospital Revenue Code 300
Min. Negotiated Rate $95.06
Max. Negotiated Rate $178.48
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $116.40
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $116.40
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Service Code CPT 80299
Hospital Charge Code 977949
Hospital Revenue Code 300
Min. Negotiated Rate $65.80
Max. Negotiated Rate $184.30
Rate for Payer: Aetna Commercial $184.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Cash Price $58.20
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $184.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $97.00
Rate for Payer: Dean Health DHI/DHP/ASO $116.40
Rate for Payer: Health EOS Commercial $176.54
Rate for Payer: HFN Commercial $184.30
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $65.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $65.80
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: Preferred Network Access Commercial $184.30
Rate for Payer: Quartz Beloit One Network $85.36
Rate for Payer: Quartz Commercial $110.58
Rate for Payer: The Alliance Commercial $97.00
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Service Code MSDRG 748
Min. Negotiated Rate $13,550.74
Max. Negotiated Rate $37,671.00
Rate for Payer: Aetna Managed Medicare $13,550.74
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,372.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $22,513.40
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $21,389.20
Rate for Payer: Anthem Medicare Advantage $13,550.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $13,550.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $13,550.74
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $13,550.74
Rate for Payer: Dean Health DHI/DHP/ASO $23,743.97
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $13,550.74
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,395.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $13,550.74
Rate for Payer: Independent Care Health Plan Medicare $13,550.74
Rate for Payer: Managed Health Services Medicare Advantage $13,550.74
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $13,550.74
Rate for Payer: NAPHCARE Commercial $20,326.11
Rate for Payer: Quartz Medicare Advantage $13,550.74
Rate for Payer: The Alliance Commercial $37,671.00
Rate for Payer: United Healthcare Medicare Advantage $13,550.74
Rate for Payer: United Healthcare PPO $21,327.79
Rate for Payer: Wellcare Medicare $13,550.74
Service Code HCPCS C1776
Hospital Charge Code 2967684
Hospital Revenue Code 278
Min. Negotiated Rate $9,113.02
Max. Negotiated Rate $17,110.16
Rate for Payer: Aetna Commercial $16,738.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,994.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,856.94
Rate for Payer: Cash Price $5,579.40
Rate for Payer: Cigna Commercial $17,110.16
Rate for Payer: Health EOS Commercial $16,552.22
Rate for Payer: HFN Commercial $17,110.16
Rate for Payer: Multiplan Commercial $14,878.40
Rate for Payer: NAPHCARE Commercial $11,158.80
Rate for Payer: Preferred Network Access Commercial $17,110.16
Rate for Payer: Quartz Beloit One Network $9,113.02
Rate for Payer: Quartz Commercial $11,158.80
Rate for Payer: WEA Trust Commercial $10,228.90
Rate for Payer: WPS Commercial $13,775.54
Service Code HCPCS C1776
Hospital Charge Code 2967684
Hospital Revenue Code 278
Min. Negotiated Rate $5,207.44
Max. Negotiated Rate $74,392.00
Rate for Payer: Aetna Commercial $16,738.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,994.28
Rate for Payer: Aetna Managed Medicare $5,207.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $12,088.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $9,299.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,927.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,856.94
Rate for Payer: Cash Price $5,579.40
Rate for Payer: Cigna Commercial $17,110.16
Rate for Payer: Dean Health DHI/DHP/ASO $10,407.44
Rate for Payer: Health EOS Commercial $16,552.22
Rate for Payer: HFN Commercial $17,110.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,948.50
Rate for Payer: Multiplan Commercial $14,878.40
Rate for Payer: NAPHCARE Commercial $11,158.80
Rate for Payer: Preferred Network Access Commercial $17,110.16
Rate for Payer: Quartz Beloit One Network $9,113.02
Rate for Payer: Quartz Commercial $12,088.70
Rate for Payer: Quartz Medicare Advantage $11,158.80
Rate for Payer: The Alliance Commercial $74,392.00
Rate for Payer: WEA Trust Commercial $10,228.90
Rate for Payer: WPS Commercial $13,775.54
Hospital Charge Code 2967466
Hospital Revenue Code 278
Min. Negotiated Rate $11,088.21
Max. Negotiated Rate $20,818.68
Rate for Payer: Aetna Commercial $20,366.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19,460.94
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $11,993.37
Rate for Payer: Cash Price $6,788.70
Rate for Payer: Cigna Commercial $20,818.68
Rate for Payer: Health EOS Commercial $20,139.81
Rate for Payer: HFN Commercial $20,818.68
Rate for Payer: Multiplan Commercial $18,103.20
Rate for Payer: NAPHCARE Commercial $13,577.40
Rate for Payer: Preferred Network Access Commercial $20,818.68
Rate for Payer: Quartz Beloit One Network $11,088.21
Rate for Payer: Quartz Commercial $13,577.40
Rate for Payer: WEA Trust Commercial $12,445.95
Rate for Payer: WPS Commercial $16,761.30
Hospital Charge Code 2967466
Hospital Revenue Code 278
Min. Negotiated Rate $6,336.12
Max. Negotiated Rate $90,516.00
Rate for Payer: Aetna Commercial $20,366.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19,460.94
Rate for Payer: Aetna Managed Medicare $6,336.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $14,708.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $11,314.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $10,861.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $11,993.37
Rate for Payer: Cash Price $6,788.70
Rate for Payer: Cigna Commercial $20,818.68
Rate for Payer: Dean Health DHI/DHP/ASO $12,663.19
Rate for Payer: Health EOS Commercial $20,139.81
Rate for Payer: HFN Commercial $20,818.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $16,971.75
Rate for Payer: Multiplan Commercial $18,103.20
Rate for Payer: NAPHCARE Commercial $13,577.40
Rate for Payer: Preferred Network Access Commercial $20,818.68
Rate for Payer: Quartz Beloit One Network $11,088.21
Rate for Payer: Quartz Commercial $14,708.85
Rate for Payer: Quartz Medicare Advantage $13,577.40
Rate for Payer: The Alliance Commercial $90,516.00
Rate for Payer: WEA Trust Commercial $12,445.95
Rate for Payer: WPS Commercial $16,761.30
Service Code HCPCS C1776
Hospital Charge Code 3227468
Hospital Revenue Code 278
Min. Negotiated Rate $2,541.28
Max. Negotiated Rate $36,304.00
Rate for Payer: Aetna Commercial $8,168.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,805.36
Rate for Payer: Aetna Managed Medicare $2,541.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,899.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,538.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,356.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,810.28
Rate for Payer: Cash Price $2,722.80
Rate for Payer: Cigna Commercial $8,349.92
Rate for Payer: Dean Health DHI/DHP/ASO $5,078.93
Rate for Payer: Health EOS Commercial $8,077.64
Rate for Payer: HFN Commercial $8,349.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,807.00
Rate for Payer: Multiplan Commercial $7,260.80
Rate for Payer: NAPHCARE Commercial $5,445.60
Rate for Payer: Preferred Network Access Commercial $8,349.92
Rate for Payer: Quartz Beloit One Network $4,447.24
Rate for Payer: Quartz Commercial $5,899.40
Rate for Payer: Quartz Medicare Advantage $5,445.60
Rate for Payer: The Alliance Commercial $36,304.00
Rate for Payer: WEA Trust Commercial $4,991.80
Rate for Payer: WPS Commercial $6,722.59
Service Code HCPCS C1776
Hospital Charge Code 3227468
Hospital Revenue Code 278
Min. Negotiated Rate $4,447.24
Max. Negotiated Rate $8,349.92
Rate for Payer: Aetna Commercial $8,168.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,805.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,810.28
Rate for Payer: Cash Price $2,722.80
Rate for Payer: Cigna Commercial $8,349.92
Rate for Payer: Health EOS Commercial $8,077.64
Rate for Payer: HFN Commercial $8,349.92
Rate for Payer: Multiplan Commercial $7,260.80
Rate for Payer: NAPHCARE Commercial $5,445.60
Rate for Payer: Preferred Network Access Commercial $8,349.92
Rate for Payer: Quartz Beloit One Network $4,447.24
Rate for Payer: Quartz Commercial $5,445.60
Rate for Payer: WEA Trust Commercial $4,991.80
Rate for Payer: WPS Commercial $6,722.59
Service Code HCPCS C1776
Hospital Charge Code 5528748
Hospital Revenue Code 278
Min. Negotiated Rate $2,555.84
Max. Negotiated Rate $36,512.00
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Aetna Managed Medicare $2,555.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,933.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,564.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,381.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Dean Health DHI/DHP/ASO $5,108.03
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,846.00
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,933.20
Rate for Payer: Quartz Medicare Advantage $5,476.80
Rate for Payer: The Alliance Commercial $36,512.00
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528748
Hospital Revenue Code 278
Min. Negotiated Rate $4,472.72
Max. Negotiated Rate $8,397.76
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,476.80
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528736
Hospital Revenue Code 278
Min. Negotiated Rate $4,472.72
Max. Negotiated Rate $8,397.76
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,476.80
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528736
Hospital Revenue Code 278
Min. Negotiated Rate $2,555.84
Max. Negotiated Rate $36,512.00
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Aetna Managed Medicare $2,555.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,933.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,564.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,381.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Dean Health DHI/DHP/ASO $5,108.03
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,846.00
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,933.20
Rate for Payer: Quartz Medicare Advantage $5,476.80
Rate for Payer: The Alliance Commercial $36,512.00
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5563680
Hospital Revenue Code 278
Min. Negotiated Rate $1,736.56
Max. Negotiated Rate $24,808.00
Rate for Payer: Aetna Commercial $5,581.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,333.72
Rate for Payer: Aetna Managed Medicare $1,736.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,031.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,101.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,976.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,287.06
Rate for Payer: Cash Price $1,860.60
Rate for Payer: Cigna Commercial $5,705.84
Rate for Payer: Dean Health DHI/DHP/ASO $3,470.64
Rate for Payer: Health EOS Commercial $5,519.78
Rate for Payer: HFN Commercial $5,705.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,651.50
Rate for Payer: Multiplan Commercial $4,961.60
Rate for Payer: NAPHCARE Commercial $3,721.20
Rate for Payer: Preferred Network Access Commercial $5,705.84
Rate for Payer: Quartz Beloit One Network $3,038.98
Rate for Payer: Quartz Commercial $4,031.30
Rate for Payer: Quartz Medicare Advantage $3,721.20
Rate for Payer: The Alliance Commercial $24,808.00
Rate for Payer: WEA Trust Commercial $3,411.10
Rate for Payer: WPS Commercial $4,593.82
Service Code HCPCS C1776
Hospital Charge Code 5563680
Hospital Revenue Code 278
Min. Negotiated Rate $3,038.98
Max. Negotiated Rate $5,705.84
Rate for Payer: Aetna Commercial $5,581.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,333.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,287.06
Rate for Payer: Cash Price $1,860.60
Rate for Payer: Cigna Commercial $5,705.84
Rate for Payer: Health EOS Commercial $5,519.78
Rate for Payer: HFN Commercial $5,705.84
Rate for Payer: Multiplan Commercial $4,961.60
Rate for Payer: NAPHCARE Commercial $3,721.20
Rate for Payer: Preferred Network Access Commercial $5,705.84
Rate for Payer: Quartz Beloit One Network $3,038.98
Rate for Payer: Quartz Commercial $3,721.20
Rate for Payer: WEA Trust Commercial $3,411.10
Rate for Payer: WPS Commercial $4,593.82
Service Code HCPCS C1776
Hospital Charge Code 5831780
Hospital Revenue Code 278
Min. Negotiated Rate $1,669.64
Max. Negotiated Rate $23,852.00
Rate for Payer: Aetna Commercial $5,366.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,128.18
Rate for Payer: Aetna Managed Medicare $1,669.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,875.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,981.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,862.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,160.39
Rate for Payer: Cash Price $1,788.90
Rate for Payer: Cigna Commercial $5,485.96
Rate for Payer: Dean Health DHI/DHP/ASO $3,336.89
Rate for Payer: Health EOS Commercial $5,307.07
Rate for Payer: HFN Commercial $5,485.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,472.25
Rate for Payer: Multiplan Commercial $4,770.40
Rate for Payer: NAPHCARE Commercial $3,577.80
Rate for Payer: Preferred Network Access Commercial $5,485.96
Rate for Payer: Quartz Beloit One Network $2,921.87
Rate for Payer: Quartz Commercial $3,875.95
Rate for Payer: Quartz Medicare Advantage $3,577.80
Rate for Payer: The Alliance Commercial $23,852.00
Rate for Payer: WEA Trust Commercial $3,279.65
Rate for Payer: WPS Commercial $4,416.79
Service Code HCPCS C1776
Hospital Charge Code 5831780
Hospital Revenue Code 278
Min. Negotiated Rate $2,921.87
Max. Negotiated Rate $5,485.96
Rate for Payer: Aetna Commercial $5,366.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,128.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,160.39
Rate for Payer: Cash Price $1,788.90
Rate for Payer: Cigna Commercial $5,485.96
Rate for Payer: Health EOS Commercial $5,307.07
Rate for Payer: HFN Commercial $5,485.96
Rate for Payer: Multiplan Commercial $4,770.40
Rate for Payer: NAPHCARE Commercial $3,577.80
Rate for Payer: Preferred Network Access Commercial $5,485.96
Rate for Payer: Quartz Beloit One Network $2,921.87
Rate for Payer: Quartz Commercial $3,577.80
Rate for Payer: WEA Trust Commercial $3,279.65
Rate for Payer: WPS Commercial $4,416.79
Service Code HCPCS C1776
Hospital Charge Code 5831781
Hospital Revenue Code 278
Min. Negotiated Rate $2,921.87
Max. Negotiated Rate $5,485.96
Rate for Payer: Aetna Commercial $5,366.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,128.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,160.39
Rate for Payer: Cash Price $1,788.90
Rate for Payer: Cigna Commercial $5,485.96
Rate for Payer: Health EOS Commercial $5,307.07
Rate for Payer: HFN Commercial $5,485.96
Rate for Payer: Multiplan Commercial $4,770.40
Rate for Payer: NAPHCARE Commercial $3,577.80
Rate for Payer: Preferred Network Access Commercial $5,485.96
Rate for Payer: Quartz Beloit One Network $2,921.87
Rate for Payer: Quartz Commercial $3,577.80
Rate for Payer: WEA Trust Commercial $3,279.65
Rate for Payer: WPS Commercial $4,416.79
Service Code HCPCS C1776
Hospital Charge Code 5831781
Hospital Revenue Code 278
Min. Negotiated Rate $1,669.64
Max. Negotiated Rate $23,852.00
Rate for Payer: Aetna Commercial $5,366.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,128.18
Rate for Payer: Aetna Managed Medicare $1,669.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,875.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,981.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,862.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,160.39
Rate for Payer: Cash Price $1,788.90
Rate for Payer: Cigna Commercial $5,485.96
Rate for Payer: Dean Health DHI/DHP/ASO $3,336.89
Rate for Payer: Health EOS Commercial $5,307.07
Rate for Payer: HFN Commercial $5,485.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,472.25
Rate for Payer: Multiplan Commercial $4,770.40
Rate for Payer: NAPHCARE Commercial $3,577.80
Rate for Payer: Preferred Network Access Commercial $5,485.96
Rate for Payer: Quartz Beloit One Network $2,921.87
Rate for Payer: Quartz Commercial $3,875.95
Rate for Payer: Quartz Medicare Advantage $3,577.80
Rate for Payer: The Alliance Commercial $23,852.00
Rate for Payer: WEA Trust Commercial $3,279.65
Rate for Payer: WPS Commercial $4,416.79
Service Code HCPCS C1776
Hospital Charge Code 5528746
Hospital Revenue Code 278
Min. Negotiated Rate $4,472.72
Max. Negotiated Rate $8,397.76
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,476.80
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528746
Hospital Revenue Code 278
Min. Negotiated Rate $2,555.84
Max. Negotiated Rate $36,512.00
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Aetna Managed Medicare $2,555.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,933.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,564.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,381.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Dean Health DHI/DHP/ASO $5,108.03
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,846.00
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,933.20
Rate for Payer: Quartz Medicare Advantage $5,476.80
Rate for Payer: The Alliance Commercial $36,512.00
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528732
Hospital Revenue Code 278
Min. Negotiated Rate $4,472.72
Max. Negotiated Rate $8,397.76
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,476.80
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5528732
Hospital Revenue Code 278
Min. Negotiated Rate $2,555.84
Max. Negotiated Rate $36,512.00
Rate for Payer: Aetna Commercial $8,215.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,850.08
Rate for Payer: Aetna Managed Medicare $2,555.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,933.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,564.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,381.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,837.84
Rate for Payer: Cash Price $2,738.40
Rate for Payer: Cigna Commercial $8,397.76
Rate for Payer: Dean Health DHI/DHP/ASO $5,108.03
Rate for Payer: Health EOS Commercial $8,123.92
Rate for Payer: HFN Commercial $8,397.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,846.00
Rate for Payer: Multiplan Commercial $7,302.40
Rate for Payer: NAPHCARE Commercial $5,476.80
Rate for Payer: Preferred Network Access Commercial $8,397.76
Rate for Payer: Quartz Beloit One Network $4,472.72
Rate for Payer: Quartz Commercial $5,933.20
Rate for Payer: Quartz Medicare Advantage $5,476.80
Rate for Payer: The Alliance Commercial $36,512.00
Rate for Payer: WEA Trust Commercial $5,020.40
Rate for Payer: WPS Commercial $6,761.11
Service Code HCPCS C1776
Hospital Charge Code 5563681
Hospital Revenue Code 278
Min. Negotiated Rate $3,038.98
Max. Negotiated Rate $5,705.84
Rate for Payer: Aetna Commercial $5,581.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,333.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,287.06
Rate for Payer: Cash Price $1,860.60
Rate for Payer: Cigna Commercial $5,705.84
Rate for Payer: Health EOS Commercial $5,519.78
Rate for Payer: HFN Commercial $5,705.84
Rate for Payer: Multiplan Commercial $4,961.60
Rate for Payer: NAPHCARE Commercial $3,721.20
Rate for Payer: Preferred Network Access Commercial $5,705.84
Rate for Payer: Quartz Beloit One Network $3,038.98
Rate for Payer: Quartz Commercial $3,721.20
Rate for Payer: WEA Trust Commercial $3,411.10
Rate for Payer: WPS Commercial $4,593.82