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Service Code HCPCS C1776
Hospital Charge Code 5563681
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 5563682
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 5563682
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 5831794
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 5831794
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
Hospital Charge Code 2963268
Hospital Revenue Code 272
Min. Negotiated Rate $244.02
Max. Negotiated Rate $458.16
Rate for Payer: Aetna Commercial $448.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $428.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $263.94
Rate for Payer: Cash Price $149.40
Rate for Payer: Cigna Commercial $458.16
Rate for Payer: Health EOS Commercial $443.22
Rate for Payer: HFN Commercial $458.16
Rate for Payer: Multiplan Commercial $398.40
Rate for Payer: NAPHCARE Commercial $298.80
Rate for Payer: Preferred Network Access Commercial $458.16
Rate for Payer: Quartz Beloit One Network $244.02
Rate for Payer: Quartz Commercial $298.80
Rate for Payer: WEA Trust Commercial $273.90
Rate for Payer: WPS Commercial $368.87
Hospital Charge Code 2963268
Hospital Revenue Code 272
Min. Negotiated Rate $139.44
Max. Negotiated Rate $1,992.00
Rate for Payer: Aetna Commercial $448.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $428.28
Rate for Payer: Aetna Managed Medicare $139.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $323.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $249.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $239.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $263.94
Rate for Payer: Cash Price $149.40
Rate for Payer: Cigna Commercial $458.16
Rate for Payer: Dean Health DHI/DHP/ASO $278.68
Rate for Payer: Health EOS Commercial $443.22
Rate for Payer: HFN Commercial $458.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $373.50
Rate for Payer: Multiplan Commercial $398.40
Rate for Payer: NAPHCARE Commercial $298.80
Rate for Payer: Preferred Network Access Commercial $458.16
Rate for Payer: Quartz Beloit One Network $244.02
Rate for Payer: Quartz Commercial $323.70
Rate for Payer: Quartz Medicare Advantage $298.80
Rate for Payer: The Alliance Commercial $1,992.00
Rate for Payer: WEA Trust Commercial $273.90
Rate for Payer: WPS Commercial $368.87
Hospital Charge Code 2963803
Hospital Revenue Code 272
Min. Negotiated Rate $244.02
Max. Negotiated Rate $458.16
Rate for Payer: Aetna Commercial $448.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $428.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $263.94
Rate for Payer: Cash Price $149.40
Rate for Payer: Cigna Commercial $458.16
Rate for Payer: Health EOS Commercial $443.22
Rate for Payer: HFN Commercial $458.16
Rate for Payer: Multiplan Commercial $398.40
Rate for Payer: NAPHCARE Commercial $298.80
Rate for Payer: Preferred Network Access Commercial $458.16
Rate for Payer: Quartz Beloit One Network $244.02
Rate for Payer: Quartz Commercial $298.80
Rate for Payer: WEA Trust Commercial $273.90
Rate for Payer: WPS Commercial $368.87
Hospital Charge Code 2963803
Hospital Revenue Code 272
Min. Negotiated Rate $139.44
Max. Negotiated Rate $1,992.00
Rate for Payer: Aetna Commercial $448.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $428.28
Rate for Payer: Aetna Managed Medicare $139.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $323.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $249.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $239.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $263.94
Rate for Payer: Cash Price $149.40
Rate for Payer: Cigna Commercial $458.16
Rate for Payer: Dean Health DHI/DHP/ASO $278.68
Rate for Payer: Health EOS Commercial $443.22
Rate for Payer: HFN Commercial $458.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $373.50
Rate for Payer: Multiplan Commercial $398.40
Rate for Payer: NAPHCARE Commercial $298.80
Rate for Payer: Preferred Network Access Commercial $458.16
Rate for Payer: Quartz Beloit One Network $244.02
Rate for Payer: Quartz Commercial $323.70
Rate for Payer: Quartz Medicare Advantage $298.80
Rate for Payer: The Alliance Commercial $1,992.00
Rate for Payer: WEA Trust Commercial $273.90
Rate for Payer: WPS Commercial $368.87
Service Code HCPCS C1776
Hospital Charge Code 2967705
Hospital Revenue Code 278
Min. Negotiated Rate $8,804.81
Max. Negotiated Rate $16,531.48
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $10,781.40
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967705
Hospital Revenue Code 278
Min. Negotiated Rate $5,031.32
Max. Negotiated Rate $71,876.00
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Aetna Managed Medicare $5,031.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11,679.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,984.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,625.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Dean Health DHI/DHP/ASO $10,055.45
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,476.75
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $11,679.85
Rate for Payer: Quartz Medicare Advantage $10,781.40
Rate for Payer: The Alliance Commercial $71,876.00
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967706
Hospital Revenue Code 278
Min. Negotiated Rate $5,031.32
Max. Negotiated Rate $71,876.00
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Aetna Managed Medicare $5,031.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11,679.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,984.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,625.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Dean Health DHI/DHP/ASO $10,055.45
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,476.75
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $11,679.85
Rate for Payer: Quartz Medicare Advantage $10,781.40
Rate for Payer: The Alliance Commercial $71,876.00
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967706
Hospital Revenue Code 278
Min. Negotiated Rate $8,804.81
Max. Negotiated Rate $16,531.48
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $10,781.40
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967685
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 2967685
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
Service Code HCPCS C1776
Hospital Charge Code 2967686
Hospital Revenue Code 278
Min. Negotiated Rate $5,031.32
Max. Negotiated Rate $71,876.00
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Aetna Managed Medicare $5,031.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11,679.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,984.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,625.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Dean Health DHI/DHP/ASO $10,055.45
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,476.75
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $11,679.85
Rate for Payer: Quartz Medicare Advantage $10,781.40
Rate for Payer: The Alliance Commercial $71,876.00
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967686
Hospital Revenue Code 278
Min. Negotiated Rate $8,804.81
Max. Negotiated Rate $16,531.48
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $10,781.40
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967687
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
Service Code HCPCS C1776
Hospital Charge Code 2967687
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 2967700
Hospital Revenue Code 278
Min. Negotiated Rate $5,031.32
Max. Negotiated Rate $71,876.00
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Aetna Managed Medicare $5,031.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11,679.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,984.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,625.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Dean Health DHI/DHP/ASO $10,055.45
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,476.75
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $11,679.85
Rate for Payer: Quartz Medicare Advantage $10,781.40
Rate for Payer: The Alliance Commercial $71,876.00
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967700
Hospital Revenue Code 278
Min. Negotiated Rate $8,804.81
Max. Negotiated Rate $16,531.48
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $10,781.40
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967688
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
Service Code HCPCS C1776
Hospital Charge Code 2967688
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 2967701
Hospital Revenue Code 278
Min. Negotiated Rate $8,804.81
Max. Negotiated Rate $16,531.48
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $10,781.40
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64
Service Code HCPCS C1776
Hospital Charge Code 2967701
Hospital Revenue Code 278
Min. Negotiated Rate $5,031.32
Max. Negotiated Rate $71,876.00
Rate for Payer: Aetna Commercial $16,172.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,453.34
Rate for Payer: Aetna Managed Medicare $5,031.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11,679.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,984.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,625.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,523.57
Rate for Payer: Cash Price $5,390.70
Rate for Payer: Cigna Commercial $16,531.48
Rate for Payer: Dean Health DHI/DHP/ASO $10,055.45
Rate for Payer: Health EOS Commercial $15,992.41
Rate for Payer: HFN Commercial $16,531.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,476.75
Rate for Payer: Multiplan Commercial $14,375.20
Rate for Payer: NAPHCARE Commercial $10,781.40
Rate for Payer: Preferred Network Access Commercial $16,531.48
Rate for Payer: Quartz Beloit One Network $8,804.81
Rate for Payer: Quartz Commercial $11,679.85
Rate for Payer: Quartz Medicare Advantage $10,781.40
Rate for Payer: The Alliance Commercial $71,876.00
Rate for Payer: WEA Trust Commercial $9,882.95
Rate for Payer: WPS Commercial $13,309.64