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Charge Type Setting Price  
Hospital Charge Code 2974029
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 2974029
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 6246163
Hospital Revenue Code 278
Min. Negotiated Rate $13,503.11
Max. Negotiated Rate $25,352.78
Rate for Payer: Aetna Commercial $24,801.63
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $23,699.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14,605.41
Rate for Payer: Cash Price $8,267.21
Rate for Payer: Cigna Commercial $25,352.78
Rate for Payer: Health EOS Commercial $24,526.06
Rate for Payer: HFN Commercial $25,352.78
Rate for Payer: Multiplan Commercial $22,045.90
Rate for Payer: NAPHCARE Commercial $16,534.42
Rate for Payer: Preferred Network Access Commercial $25,352.78
Rate for Payer: Quartz Beloit One Network $13,503.11
Rate for Payer: Quartz Commercial $16,534.42
Rate for Payer: WEA Trust Commercial $15,156.55
Rate for Payer: WPS Commercial $20,411.74
Service Code HCPCS C1776
Hospital Charge Code 6246163
Hospital Revenue Code 278
Min. Negotiated Rate $7,716.06
Max. Negotiated Rate $110,229.48
Rate for Payer: Aetna Commercial $24,801.63
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $23,699.34
Rate for Payer: Aetna Managed Medicare $7,716.06
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $17,912.29
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $13,778.68
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $13,227.54
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14,605.41
Rate for Payer: Cash Price $8,267.21
Rate for Payer: Cigna Commercial $25,352.78
Rate for Payer: Dean Health DHI/DHP/ASO $15,421.10
Rate for Payer: Health EOS Commercial $24,526.06
Rate for Payer: HFN Commercial $25,352.78
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $20,668.03
Rate for Payer: Multiplan Commercial $22,045.90
Rate for Payer: NAPHCARE Commercial $16,534.42
Rate for Payer: Preferred Network Access Commercial $25,352.78
Rate for Payer: Quartz Beloit One Network $13,503.11
Rate for Payer: Quartz Commercial $17,912.29
Rate for Payer: Quartz Medicare Advantage $16,534.42
Rate for Payer: The Alliance Commercial $110,229.48
Rate for Payer: WEA Trust Commercial $15,156.55
Rate for Payer: WPS Commercial $20,411.74
Hospital Charge Code 4100374
Hospital Revenue Code 278
Min. Negotiated Rate $18,312.77
Max. Negotiated Rate $34,383.16
Rate for Payer: Aetna Commercial $33,635.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $32,140.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $19,807.69
Rate for Payer: Cash Price $11,211.90
Rate for Payer: Cigna Commercial $34,383.16
Rate for Payer: Health EOS Commercial $33,261.97
Rate for Payer: HFN Commercial $34,383.16
Rate for Payer: Multiplan Commercial $29,898.40
Rate for Payer: NAPHCARE Commercial $22,423.80
Rate for Payer: Preferred Network Access Commercial $34,383.16
Rate for Payer: Quartz Beloit One Network $18,312.77
Rate for Payer: Quartz Commercial $22,423.80
Rate for Payer: WEA Trust Commercial $20,555.15
Rate for Payer: WPS Commercial $27,682.18
Hospital Charge Code 4100374
Hospital Revenue Code 278
Min. Negotiated Rate $10,464.44
Max. Negotiated Rate $149,492.00
Rate for Payer: Aetna Commercial $33,635.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $32,140.78
Rate for Payer: Aetna Managed Medicare $10,464.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $24,292.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $18,686.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $17,939.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $19,807.69
Rate for Payer: Cash Price $11,211.90
Rate for Payer: Cigna Commercial $34,383.16
Rate for Payer: Dean Health DHI/DHP/ASO $20,913.93
Rate for Payer: Health EOS Commercial $33,261.97
Rate for Payer: HFN Commercial $34,383.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $28,029.75
Rate for Payer: Multiplan Commercial $29,898.40
Rate for Payer: NAPHCARE Commercial $22,423.80
Rate for Payer: Preferred Network Access Commercial $34,383.16
Rate for Payer: Quartz Beloit One Network $18,312.77
Rate for Payer: Quartz Commercial $24,292.45
Rate for Payer: Quartz Medicare Advantage $22,423.80
Rate for Payer: The Alliance Commercial $149,492.00
Rate for Payer: WEA Trust Commercial $20,555.15
Rate for Payer: WPS Commercial $27,682.18
Service Code HCPCS C1762
Hospital Charge Code 4509109
Hospital Revenue Code 278
Min. Negotiated Rate $2,539.18
Max. Negotiated Rate $4,767.44
Rate for Payer: Aetna Commercial $4,663.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,456.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,746.46
Rate for Payer: Cash Price $1,554.60
Rate for Payer: Cigna Commercial $4,767.44
Rate for Payer: Health EOS Commercial $4,611.98
Rate for Payer: HFN Commercial $4,767.44
Rate for Payer: Multiplan Commercial $4,145.60
Rate for Payer: NAPHCARE Commercial $3,109.20
Rate for Payer: Preferred Network Access Commercial $4,767.44
Rate for Payer: Quartz Beloit One Network $2,539.18
Rate for Payer: Quartz Commercial $3,109.20
Rate for Payer: WEA Trust Commercial $2,850.10
Rate for Payer: WPS Commercial $3,838.31
Service Code HCPCS C1762
Hospital Charge Code 4509109
Hospital Revenue Code 278
Min. Negotiated Rate $1,450.96
Max. Negotiated Rate $20,728.00
Rate for Payer: Aetna Commercial $4,663.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,456.52
Rate for Payer: Aetna Managed Medicare $1,450.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,368.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,591.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,487.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,746.46
Rate for Payer: Cash Price $1,554.60
Rate for Payer: Cigna Commercial $4,767.44
Rate for Payer: Dean Health DHI/DHP/ASO $2,899.85
Rate for Payer: Health EOS Commercial $4,611.98
Rate for Payer: HFN Commercial $4,767.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,886.50
Rate for Payer: Multiplan Commercial $4,145.60
Rate for Payer: NAPHCARE Commercial $3,109.20
Rate for Payer: Preferred Network Access Commercial $4,767.44
Rate for Payer: Quartz Beloit One Network $2,539.18
Rate for Payer: Quartz Commercial $3,368.30
Rate for Payer: Quartz Medicare Advantage $3,109.20
Rate for Payer: The Alliance Commercial $20,728.00
Rate for Payer: WEA Trust Commercial $2,850.10
Rate for Payer: WPS Commercial $3,838.31
Hospital Charge Code 3657496
Hospital Revenue Code 278
Min. Negotiated Rate $3,310.93
Max. Negotiated Rate $6,216.44
Rate for Payer: Aetna Commercial $6,081.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,811.02
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,581.21
Rate for Payer: Cash Price $2,027.10
Rate for Payer: Cigna Commercial $6,216.44
Rate for Payer: Health EOS Commercial $6,013.73
Rate for Payer: HFN Commercial $6,216.44
Rate for Payer: Multiplan Commercial $5,405.60
Rate for Payer: NAPHCARE Commercial $4,054.20
Rate for Payer: Preferred Network Access Commercial $6,216.44
Rate for Payer: Quartz Beloit One Network $3,310.93
Rate for Payer: Quartz Commercial $4,054.20
Rate for Payer: WEA Trust Commercial $3,716.35
Rate for Payer: WPS Commercial $5,004.91
Hospital Charge Code 3657496
Hospital Revenue Code 278
Min. Negotiated Rate $1,891.96
Max. Negotiated Rate $27,028.00
Rate for Payer: Aetna Commercial $6,081.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,811.02
Rate for Payer: Aetna Managed Medicare $1,891.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,392.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,378.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,243.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,581.21
Rate for Payer: Cash Price $2,027.10
Rate for Payer: Cigna Commercial $6,216.44
Rate for Payer: Dean Health DHI/DHP/ASO $3,781.22
Rate for Payer: Health EOS Commercial $6,013.73
Rate for Payer: HFN Commercial $6,216.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,067.75
Rate for Payer: Multiplan Commercial $5,405.60
Rate for Payer: NAPHCARE Commercial $4,054.20
Rate for Payer: Preferred Network Access Commercial $6,216.44
Rate for Payer: Quartz Beloit One Network $3,310.93
Rate for Payer: Quartz Commercial $4,392.05
Rate for Payer: Quartz Medicare Advantage $4,054.20
Rate for Payer: The Alliance Commercial $27,028.00
Rate for Payer: WEA Trust Commercial $3,716.35
Rate for Payer: WPS Commercial $5,004.91
Service Code HCPCS C1776
Hospital Charge Code 5787646
Hospital Revenue Code 278
Min. Negotiated Rate $1,729.28
Max. Negotiated Rate $24,704.00
Rate for Payer: Aetna Commercial $5,558.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,311.36
Rate for Payer: Aetna Managed Medicare $1,729.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,014.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,088.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,964.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,273.28
Rate for Payer: Cash Price $1,852.80
Rate for Payer: Cigna Commercial $5,681.92
Rate for Payer: Dean Health DHI/DHP/ASO $3,456.09
Rate for Payer: Health EOS Commercial $5,496.64
Rate for Payer: HFN Commercial $5,681.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,632.00
Rate for Payer: Multiplan Commercial $4,940.80
Rate for Payer: NAPHCARE Commercial $3,705.60
Rate for Payer: Preferred Network Access Commercial $5,681.92
Rate for Payer: Quartz Beloit One Network $3,026.24
Rate for Payer: Quartz Commercial $4,014.40
Rate for Payer: Quartz Medicare Advantage $3,705.60
Rate for Payer: The Alliance Commercial $24,704.00
Rate for Payer: WEA Trust Commercial $3,396.80
Rate for Payer: WPS Commercial $4,574.56
Service Code HCPCS C1776
Hospital Charge Code 5787646
Hospital Revenue Code 278
Min. Negotiated Rate $3,026.24
Max. Negotiated Rate $5,681.92
Rate for Payer: Aetna Commercial $5,558.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,311.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,273.28
Rate for Payer: Cash Price $1,852.80
Rate for Payer: Cigna Commercial $5,681.92
Rate for Payer: Health EOS Commercial $5,496.64
Rate for Payer: HFN Commercial $5,681.92
Rate for Payer: Multiplan Commercial $4,940.80
Rate for Payer: NAPHCARE Commercial $3,705.60
Rate for Payer: Preferred Network Access Commercial $5,681.92
Rate for Payer: Quartz Beloit One Network $3,026.24
Rate for Payer: Quartz Commercial $3,705.60
Rate for Payer: WEA Trust Commercial $3,396.80
Rate for Payer: WPS Commercial $4,574.56
Hospital Charge Code 2960066
Hospital Revenue Code 360
Min. Negotiated Rate $4,688.04
Max. Negotiated Rate $66,972.00
Rate for Payer: Aetna Commercial $15,068.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $14,398.98
Rate for Payer: Aetna Managed Medicare $4,688.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $10,882.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8,371.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8,036.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $8,873.79
Rate for Payer: Cash Price $5,022.90
Rate for Payer: Cigna Commercial $15,403.56
Rate for Payer: Dean Health DHI/DHP/ASO $9,369.38
Rate for Payer: Health EOS Commercial $14,901.27
Rate for Payer: HFN Commercial $15,403.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12,557.25
Rate for Payer: Multiplan Commercial $13,394.40
Rate for Payer: NAPHCARE Commercial $10,045.80
Rate for Payer: Preferred Network Access Commercial $15,403.56
Rate for Payer: Quartz Beloit One Network $8,204.07
Rate for Payer: Quartz Commercial $10,882.95
Rate for Payer: Quartz Medicare Advantage $10,045.80
Rate for Payer: The Alliance Commercial $66,972.00
Rate for Payer: WEA Trust Commercial $9,208.65
Rate for Payer: WPS Commercial $12,401.54
Hospital Charge Code 2960066
Hospital Revenue Code 360
Min. Negotiated Rate $8,204.07
Max. Negotiated Rate $15,403.56
Rate for Payer: Aetna Commercial $15,068.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $14,398.98
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $8,873.79
Rate for Payer: Cash Price $5,022.90
Rate for Payer: Cigna Commercial $15,403.56
Rate for Payer: Health EOS Commercial $14,901.27
Rate for Payer: HFN Commercial $15,403.56
Rate for Payer: Multiplan Commercial $13,394.40
Rate for Payer: NAPHCARE Commercial $10,045.80
Rate for Payer: Preferred Network Access Commercial $15,403.56
Rate for Payer: Quartz Beloit One Network $8,204.07
Rate for Payer: Quartz Commercial $10,045.80
Rate for Payer: WEA Trust Commercial $9,208.65
Rate for Payer: WPS Commercial $12,401.54
Service Code HCPCS C1776
Hospital Charge Code 2967707
Hospital Revenue Code 278
Min. Negotiated Rate $1,302.84
Max. Negotiated Rate $18,612.00
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Aetna Managed Medicare $1,302.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,024.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,326.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,233.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,603.82
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,489.75
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $3,024.45
Rate for Payer: Quartz Medicare Advantage $2,791.80
Rate for Payer: The Alliance Commercial $18,612.00
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967707
Hospital Revenue Code 278
Min. Negotiated Rate $2,279.97
Max. Negotiated Rate $4,280.76
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $2,791.80
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967709
Hospital Revenue Code 278
Min. Negotiated Rate $1,302.84
Max. Negotiated Rate $18,612.00
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Aetna Managed Medicare $1,302.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,024.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,326.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,233.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,603.82
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,489.75
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $3,024.45
Rate for Payer: Quartz Medicare Advantage $2,791.80
Rate for Payer: The Alliance Commercial $18,612.00
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967709
Hospital Revenue Code 278
Min. Negotiated Rate $2,279.97
Max. Negotiated Rate $4,280.76
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $2,791.80
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967708
Hospital Revenue Code 278
Min. Negotiated Rate $2,279.97
Max. Negotiated Rate $4,280.76
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $2,791.80
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967708
Hospital Revenue Code 278
Min. Negotiated Rate $1,302.84
Max. Negotiated Rate $18,612.00
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Aetna Managed Medicare $1,302.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,024.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,326.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,233.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,603.82
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,489.75
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $3,024.45
Rate for Payer: Quartz Medicare Advantage $2,791.80
Rate for Payer: The Alliance Commercial $18,612.00
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967546
Hospital Revenue Code 278
Min. Negotiated Rate $2,368.17
Max. Negotiated Rate $4,446.36
Rate for Payer: Aetna Commercial $4,349.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,156.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,561.49
Rate for Payer: Cash Price $1,449.90
Rate for Payer: Cigna Commercial $4,446.36
Rate for Payer: Health EOS Commercial $4,301.37
Rate for Payer: HFN Commercial $4,446.36
Rate for Payer: Multiplan Commercial $3,866.40
Rate for Payer: NAPHCARE Commercial $2,899.80
Rate for Payer: Preferred Network Access Commercial $4,446.36
Rate for Payer: Quartz Beloit One Network $2,368.17
Rate for Payer: Quartz Commercial $2,899.80
Rate for Payer: WEA Trust Commercial $2,658.15
Rate for Payer: WPS Commercial $3,579.80
Service Code HCPCS C1776
Hospital Charge Code 2967546
Hospital Revenue Code 278
Min. Negotiated Rate $1,353.24
Max. Negotiated Rate $19,332.00
Rate for Payer: Aetna Commercial $4,349.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,156.38
Rate for Payer: Aetna Managed Medicare $1,353.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,141.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,416.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,319.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,561.49
Rate for Payer: Cash Price $1,449.90
Rate for Payer: Cigna Commercial $4,446.36
Rate for Payer: Dean Health DHI/DHP/ASO $2,704.55
Rate for Payer: Health EOS Commercial $4,301.37
Rate for Payer: HFN Commercial $4,446.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,624.75
Rate for Payer: Multiplan Commercial $3,866.40
Rate for Payer: NAPHCARE Commercial $2,899.80
Rate for Payer: Preferred Network Access Commercial $4,446.36
Rate for Payer: Quartz Beloit One Network $2,368.17
Rate for Payer: Quartz Commercial $3,141.45
Rate for Payer: Quartz Medicare Advantage $2,899.80
Rate for Payer: The Alliance Commercial $19,332.00
Rate for Payer: WEA Trust Commercial $2,658.15
Rate for Payer: WPS Commercial $3,579.80
Service Code HCPCS C1776
Hospital Charge Code 2967547
Hospital Revenue Code 278
Min. Negotiated Rate $2,279.97
Max. Negotiated Rate $4,280.76
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $2,791.80
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 2967547
Hospital Revenue Code 278
Min. Negotiated Rate $1,302.84
Max. Negotiated Rate $18,612.00
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Aetna Managed Medicare $1,302.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,024.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,326.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,233.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,603.82
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,489.75
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $3,024.45
Rate for Payer: Quartz Medicare Advantage $2,791.80
Rate for Payer: The Alliance Commercial $18,612.00
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48
Service Code HCPCS C1776
Hospital Charge Code 3225465
Hospital Revenue Code 278
Min. Negotiated Rate $1,302.84
Max. Negotiated Rate $18,612.00
Rate for Payer: Aetna Commercial $4,187.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,001.58
Rate for Payer: Aetna Managed Medicare $1,302.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,024.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,326.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,233.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,466.09
Rate for Payer: Cash Price $1,395.90
Rate for Payer: Cigna Commercial $4,280.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,603.82
Rate for Payer: Health EOS Commercial $4,141.17
Rate for Payer: HFN Commercial $4,280.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,489.75
Rate for Payer: Multiplan Commercial $3,722.40
Rate for Payer: NAPHCARE Commercial $2,791.80
Rate for Payer: Preferred Network Access Commercial $4,280.76
Rate for Payer: Quartz Beloit One Network $2,279.97
Rate for Payer: Quartz Commercial $3,024.45
Rate for Payer: Quartz Medicare Advantage $2,791.80
Rate for Payer: The Alliance Commercial $18,612.00
Rate for Payer: WEA Trust Commercial $2,559.15
Rate for Payer: WPS Commercial $3,446.48