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Charge Type Setting Price  
Hospital Charge Code 2969424
Hospital Revenue Code 278
Min. Negotiated Rate $15,677.55
Max. Negotiated Rate $29,435.40
Rate for Payer: Aetna Commercial $28,795.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,515.70
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,957.35
Rate for Payer: Cash Price $9,598.50
Rate for Payer: Cigna Commercial $29,435.40
Rate for Payer: Health EOS Commercial $28,475.55
Rate for Payer: HFN Commercial $29,435.40
Rate for Payer: Multiplan Commercial $25,596.00
Rate for Payer: NAPHCARE Commercial $19,197.00
Rate for Payer: Preferred Network Access Commercial $29,435.40
Rate for Payer: Quartz Beloit One Network $15,677.55
Rate for Payer: Quartz Commercial $19,197.00
Rate for Payer: WEA Trust Commercial $17,597.25
Rate for Payer: WPS Commercial $23,698.70
Hospital Charge Code 2969424
Hospital Revenue Code 278
Min. Negotiated Rate $8,958.60
Max. Negotiated Rate $127,980.00
Rate for Payer: Aetna Commercial $28,795.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,515.70
Rate for Payer: Aetna Managed Medicare $8,958.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $20,796.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $15,997.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $15,357.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,957.35
Rate for Payer: Cash Price $9,598.50
Rate for Payer: Cigna Commercial $29,435.40
Rate for Payer: Dean Health DHI/DHP/ASO $17,904.40
Rate for Payer: Health EOS Commercial $28,475.55
Rate for Payer: HFN Commercial $29,435.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $23,996.25
Rate for Payer: Multiplan Commercial $25,596.00
Rate for Payer: NAPHCARE Commercial $19,197.00
Rate for Payer: Preferred Network Access Commercial $29,435.40
Rate for Payer: Quartz Beloit One Network $15,677.55
Rate for Payer: Quartz Commercial $20,796.75
Rate for Payer: Quartz Medicare Advantage $19,197.00
Rate for Payer: The Alliance Commercial $127,980.00
Rate for Payer: WEA Trust Commercial $17,597.25
Rate for Payer: WPS Commercial $23,698.70
Service Code HCPCS C1776
Hospital Charge Code 2967689
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 2967689
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 2967702
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 2967702
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 2967690
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 2967690
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 2967699
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 2967699
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 2967691
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 2967691
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 2967703
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 2967703
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 2967692
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 2967692
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 2967693
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 2967693
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 2967694
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 2967694
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 2967704
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 2967704
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
Hospital Charge Code 2967468
Hospital Revenue Code 278
Min. Negotiated Rate $5,585.02
Max. Negotiated Rate $10,486.16
Rate for Payer: Aetna Commercial $10,258.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $9,802.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,040.94
Rate for Payer: Cash Price $3,419.40
Rate for Payer: Cigna Commercial $10,486.16
Rate for Payer: Health EOS Commercial $10,144.22
Rate for Payer: HFN Commercial $10,486.16
Rate for Payer: Multiplan Commercial $9,118.40
Rate for Payer: NAPHCARE Commercial $6,838.80
Rate for Payer: Preferred Network Access Commercial $10,486.16
Rate for Payer: Quartz Beloit One Network $5,585.02
Rate for Payer: Quartz Commercial $6,838.80
Rate for Payer: WEA Trust Commercial $6,268.90
Rate for Payer: WPS Commercial $8,442.50
Hospital Charge Code 2967468
Hospital Revenue Code 278
Min. Negotiated Rate $3,191.44
Max. Negotiated Rate $45,592.00
Rate for Payer: Aetna Commercial $10,258.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $9,802.28
Rate for Payer: Aetna Managed Medicare $3,191.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $7,408.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $5,699.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5,471.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,040.94
Rate for Payer: Cash Price $3,419.40
Rate for Payer: Cigna Commercial $10,486.16
Rate for Payer: Dean Health DHI/DHP/ASO $6,378.32
Rate for Payer: Health EOS Commercial $10,144.22
Rate for Payer: HFN Commercial $10,486.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,548.50
Rate for Payer: Multiplan Commercial $9,118.40
Rate for Payer: NAPHCARE Commercial $6,838.80
Rate for Payer: Preferred Network Access Commercial $10,486.16
Rate for Payer: Quartz Beloit One Network $5,585.02
Rate for Payer: Quartz Commercial $7,408.70
Rate for Payer: Quartz Medicare Advantage $6,838.80
Rate for Payer: The Alliance Commercial $45,592.00
Rate for Payer: WEA Trust Commercial $6,268.90
Rate for Payer: WPS Commercial $8,442.50
Hospital Charge Code 2967469
Hospital Revenue Code 278
Min. Negotiated Rate $3,191.44
Max. Negotiated Rate $45,592.00
Rate for Payer: Aetna Commercial $10,258.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $9,802.28
Rate for Payer: Aetna Managed Medicare $3,191.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $7,408.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $5,699.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5,471.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,040.94
Rate for Payer: Cash Price $3,419.40
Rate for Payer: Cigna Commercial $10,486.16
Rate for Payer: Dean Health DHI/DHP/ASO $6,378.32
Rate for Payer: Health EOS Commercial $10,144.22
Rate for Payer: HFN Commercial $10,486.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,548.50
Rate for Payer: Multiplan Commercial $9,118.40
Rate for Payer: NAPHCARE Commercial $6,838.80
Rate for Payer: Preferred Network Access Commercial $10,486.16
Rate for Payer: Quartz Beloit One Network $5,585.02
Rate for Payer: Quartz Commercial $7,408.70
Rate for Payer: Quartz Medicare Advantage $6,838.80
Rate for Payer: The Alliance Commercial $45,592.00
Rate for Payer: WEA Trust Commercial $6,268.90
Rate for Payer: WPS Commercial $8,442.50