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Charge Type Setting Price  
Hospital Charge Code 2960067
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 6166142
Hospital Revenue Code 278
Min. Negotiated Rate $3,632.37
Max. Negotiated Rate $6,819.96
Rate for Payer: Aetna Commercial $6,671.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,375.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,928.89
Rate for Payer: Cash Price $2,223.90
Rate for Payer: Cigna Commercial $6,819.96
Rate for Payer: Health EOS Commercial $6,597.57
Rate for Payer: HFN Commercial $6,819.96
Rate for Payer: Multiplan Commercial $5,930.40
Rate for Payer: NAPHCARE Commercial $4,447.80
Rate for Payer: Preferred Network Access Commercial $6,819.96
Rate for Payer: Quartz Beloit One Network $3,632.37
Rate for Payer: Quartz Commercial $4,447.80
Rate for Payer: WEA Trust Commercial $4,077.15
Rate for Payer: WPS Commercial $5,490.81
Service Code HCPCS C1776
Hospital Charge Code 6166142
Hospital Revenue Code 278
Min. Negotiated Rate $2,075.64
Max. Negotiated Rate $29,652.00
Rate for Payer: Aetna Commercial $6,671.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,375.18
Rate for Payer: Aetna Managed Medicare $2,075.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,818.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,706.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,558.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,928.89
Rate for Payer: Cash Price $2,223.90
Rate for Payer: Cigna Commercial $6,819.96
Rate for Payer: Dean Health DHI/DHP/ASO $4,148.31
Rate for Payer: Health EOS Commercial $6,597.57
Rate for Payer: HFN Commercial $6,819.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,559.75
Rate for Payer: Multiplan Commercial $5,930.40
Rate for Payer: NAPHCARE Commercial $4,447.80
Rate for Payer: Preferred Network Access Commercial $6,819.96
Rate for Payer: Quartz Beloit One Network $3,632.37
Rate for Payer: Quartz Commercial $4,818.45
Rate for Payer: Quartz Medicare Advantage $4,447.80
Rate for Payer: The Alliance Commercial $29,652.00
Rate for Payer: WEA Trust Commercial $4,077.15
Rate for Payer: WPS Commercial $5,490.81
Service Code HCPCS C1776
Hospital Charge Code 5547476
Hospital Revenue Code 278
Min. Negotiated Rate $2,129.68
Max. Negotiated Rate $30,424.00
Rate for Payer: Aetna Commercial $6,845.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,541.16
Rate for Payer: Aetna Managed Medicare $2,129.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,943.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,803.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,650.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,031.18
Rate for Payer: Cash Price $2,281.80
Rate for Payer: Cigna Commercial $6,997.52
Rate for Payer: Dean Health DHI/DHP/ASO $4,256.32
Rate for Payer: Health EOS Commercial $6,769.34
Rate for Payer: HFN Commercial $6,997.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,704.50
Rate for Payer: Multiplan Commercial $6,084.80
Rate for Payer: NAPHCARE Commercial $4,563.60
Rate for Payer: Preferred Network Access Commercial $6,997.52
Rate for Payer: Quartz Beloit One Network $3,726.94
Rate for Payer: Quartz Commercial $4,943.90
Rate for Payer: Quartz Medicare Advantage $4,563.60
Rate for Payer: The Alliance Commercial $30,424.00
Rate for Payer: WEA Trust Commercial $4,183.30
Rate for Payer: WPS Commercial $5,633.76
Service Code HCPCS C1776
Hospital Charge Code 5547476
Hospital Revenue Code 278
Min. Negotiated Rate $3,726.94
Max. Negotiated Rate $6,997.52
Rate for Payer: Aetna Commercial $6,845.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,541.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,031.18
Rate for Payer: Cash Price $2,281.80
Rate for Payer: Cigna Commercial $6,997.52
Rate for Payer: Health EOS Commercial $6,769.34
Rate for Payer: HFN Commercial $6,997.52
Rate for Payer: Multiplan Commercial $6,084.80
Rate for Payer: NAPHCARE Commercial $4,563.60
Rate for Payer: Preferred Network Access Commercial $6,997.52
Rate for Payer: Quartz Beloit One Network $3,726.94
Rate for Payer: Quartz Commercial $4,563.60
Rate for Payer: WEA Trust Commercial $4,183.30
Rate for Payer: WPS Commercial $5,633.76
Service Code HCPCS C1776
Hospital Charge Code 5563331
Hospital Revenue Code 278
Min. Negotiated Rate $3,726.94
Max. Negotiated Rate $6,997.52
Rate for Payer: Aetna Commercial $6,845.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,541.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,031.18
Rate for Payer: Cash Price $2,281.80
Rate for Payer: Cigna Commercial $6,997.52
Rate for Payer: Health EOS Commercial $6,769.34
Rate for Payer: HFN Commercial $6,997.52
Rate for Payer: Multiplan Commercial $6,084.80
Rate for Payer: NAPHCARE Commercial $4,563.60
Rate for Payer: Preferred Network Access Commercial $6,997.52
Rate for Payer: Quartz Beloit One Network $3,726.94
Rate for Payer: Quartz Commercial $4,563.60
Rate for Payer: WEA Trust Commercial $4,183.30
Rate for Payer: WPS Commercial $5,633.76
Service Code HCPCS C1776
Hospital Charge Code 5563331
Hospital Revenue Code 278
Min. Negotiated Rate $2,129.68
Max. Negotiated Rate $30,424.00
Rate for Payer: Aetna Commercial $6,845.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,541.16
Rate for Payer: Aetna Managed Medicare $2,129.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,943.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,803.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,650.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,031.18
Rate for Payer: Cash Price $2,281.80
Rate for Payer: Cigna Commercial $6,997.52
Rate for Payer: Dean Health DHI/DHP/ASO $4,256.32
Rate for Payer: Health EOS Commercial $6,769.34
Rate for Payer: HFN Commercial $6,997.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,704.50
Rate for Payer: Multiplan Commercial $6,084.80
Rate for Payer: NAPHCARE Commercial $4,563.60
Rate for Payer: Preferred Network Access Commercial $6,997.52
Rate for Payer: Quartz Beloit One Network $3,726.94
Rate for Payer: Quartz Commercial $4,943.90
Rate for Payer: Quartz Medicare Advantage $4,563.60
Rate for Payer: The Alliance Commercial $30,424.00
Rate for Payer: WEA Trust Commercial $4,183.30
Rate for Payer: WPS Commercial $5,633.76
Service Code HCPCS C1776
Hospital Charge Code 5459754
Hospital Revenue Code 278
Min. Negotiated Rate $4,025.35
Max. Negotiated Rate $7,557.80
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $4,929.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5459754
Hospital Revenue Code 278
Min. Negotiated Rate $2,300.20
Max. Negotiated Rate $32,860.00
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Aetna Managed Medicare $2,300.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,339.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,107.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,943.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Dean Health DHI/DHP/ASO $4,597.11
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,161.25
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $5,339.75
Rate for Payer: Quartz Medicare Advantage $4,929.00
Rate for Payer: The Alliance Commercial $32,860.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5520880
Hospital Revenue Code 278
Min. Negotiated Rate $2,214.80
Max. Negotiated Rate $31,640.00
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Aetna Managed Medicare $2,214.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,141.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,955.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,796.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Dean Health DHI/DHP/ASO $4,426.44
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,932.50
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $5,141.50
Rate for Payer: Quartz Medicare Advantage $4,746.00
Rate for Payer: The Alliance Commercial $31,640.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5520880
Hospital Revenue Code 278
Min. Negotiated Rate $3,875.90
Max. Negotiated Rate $7,277.20
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $4,746.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5799856
Hospital Revenue Code 278
Min. Negotiated Rate $3,632.37
Max. Negotiated Rate $6,819.96
Rate for Payer: Aetna Commercial $6,671.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,375.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,928.89
Rate for Payer: Cash Price $2,223.90
Rate for Payer: Cigna Commercial $6,819.96
Rate for Payer: Health EOS Commercial $6,597.57
Rate for Payer: HFN Commercial $6,819.96
Rate for Payer: Multiplan Commercial $5,930.40
Rate for Payer: NAPHCARE Commercial $4,447.80
Rate for Payer: Preferred Network Access Commercial $6,819.96
Rate for Payer: Quartz Beloit One Network $3,632.37
Rate for Payer: Quartz Commercial $4,447.80
Rate for Payer: WEA Trust Commercial $4,077.15
Rate for Payer: WPS Commercial $5,490.81
Service Code HCPCS C1776
Hospital Charge Code 5799856
Hospital Revenue Code 278
Min. Negotiated Rate $2,075.64
Max. Negotiated Rate $29,652.00
Rate for Payer: Aetna Commercial $6,671.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,375.18
Rate for Payer: Aetna Managed Medicare $2,075.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,818.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,706.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,558.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,928.89
Rate for Payer: Cash Price $2,223.90
Rate for Payer: Cigna Commercial $6,819.96
Rate for Payer: Dean Health DHI/DHP/ASO $4,148.31
Rate for Payer: Health EOS Commercial $6,597.57
Rate for Payer: HFN Commercial $6,819.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,559.75
Rate for Payer: Multiplan Commercial $5,930.40
Rate for Payer: NAPHCARE Commercial $4,447.80
Rate for Payer: Preferred Network Access Commercial $6,819.96
Rate for Payer: Quartz Beloit One Network $3,632.37
Rate for Payer: Quartz Commercial $4,818.45
Rate for Payer: Quartz Medicare Advantage $4,447.80
Rate for Payer: The Alliance Commercial $29,652.00
Rate for Payer: WEA Trust Commercial $4,077.15
Rate for Payer: WPS Commercial $5,490.81
Service Code HCPCS C1776
Hospital Charge Code 5520735
Hospital Revenue Code 278
Min. Negotiated Rate $4,025.35
Max. Negotiated Rate $7,557.80
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $4,929.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5520735
Hospital Revenue Code 278
Min. Negotiated Rate $2,300.20
Max. Negotiated Rate $32,860.00
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Aetna Managed Medicare $2,300.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,339.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,107.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,943.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Dean Health DHI/DHP/ASO $4,597.11
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,161.25
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $5,339.75
Rate for Payer: Quartz Medicare Advantage $4,929.00
Rate for Payer: The Alliance Commercial $32,860.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5520754
Hospital Revenue Code 278
Min. Negotiated Rate $3,875.90
Max. Negotiated Rate $7,277.20
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $4,746.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5520754
Hospital Revenue Code 278
Min. Negotiated Rate $2,214.80
Max. Negotiated Rate $31,640.00
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Aetna Managed Medicare $2,214.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,141.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,955.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,796.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Dean Health DHI/DHP/ASO $4,426.44
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,932.50
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $5,141.50
Rate for Payer: Quartz Medicare Advantage $4,746.00
Rate for Payer: The Alliance Commercial $31,640.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5520886
Hospital Revenue Code 278
Min. Negotiated Rate $2,300.20
Max. Negotiated Rate $32,860.00
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Aetna Managed Medicare $2,300.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,339.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,107.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,943.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Dean Health DHI/DHP/ASO $4,597.11
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,161.25
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $5,339.75
Rate for Payer: Quartz Medicare Advantage $4,929.00
Rate for Payer: The Alliance Commercial $32,860.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5520886
Hospital Revenue Code 278
Min. Negotiated Rate $4,025.35
Max. Negotiated Rate $7,557.80
Rate for Payer: Aetna Commercial $7,393.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,064.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,353.95
Rate for Payer: Cash Price $2,464.50
Rate for Payer: Cigna Commercial $7,557.80
Rate for Payer: Health EOS Commercial $7,311.35
Rate for Payer: HFN Commercial $7,557.80
Rate for Payer: Multiplan Commercial $6,572.00
Rate for Payer: NAPHCARE Commercial $4,929.00
Rate for Payer: Preferred Network Access Commercial $7,557.80
Rate for Payer: Quartz Beloit One Network $4,025.35
Rate for Payer: Quartz Commercial $4,929.00
Rate for Payer: WEA Trust Commercial $4,518.25
Rate for Payer: WPS Commercial $6,084.85
Service Code HCPCS C1776
Hospital Charge Code 5547252
Hospital Revenue Code 278
Min. Negotiated Rate $3,875.90
Max. Negotiated Rate $7,277.20
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $4,746.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5547252
Hospital Revenue Code 278
Min. Negotiated Rate $2,214.80
Max. Negotiated Rate $31,640.00
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Aetna Managed Medicare $2,214.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,141.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,955.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,796.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Dean Health DHI/DHP/ASO $4,426.44
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,932.50
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $5,141.50
Rate for Payer: Quartz Medicare Advantage $4,746.00
Rate for Payer: The Alliance Commercial $31,640.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5520797
Hospital Revenue Code 278
Min. Negotiated Rate $3,875.90
Max. Negotiated Rate $7,277.20
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $4,746.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5520797
Hospital Revenue Code 278
Min. Negotiated Rate $2,214.80
Max. Negotiated Rate $31,640.00
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Aetna Managed Medicare $2,214.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,141.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,955.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,796.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Dean Health DHI/DHP/ASO $4,426.44
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,932.50
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $5,141.50
Rate for Payer: Quartz Medicare Advantage $4,746.00
Rate for Payer: The Alliance Commercial $31,640.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5459819
Hospital Revenue Code 278
Min. Negotiated Rate $2,214.80
Max. Negotiated Rate $31,640.00
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Aetna Managed Medicare $2,214.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,141.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,955.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,796.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Dean Health DHI/DHP/ASO $4,426.44
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,932.50
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $5,141.50
Rate for Payer: Quartz Medicare Advantage $4,746.00
Rate for Payer: The Alliance Commercial $31,640.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94
Service Code HCPCS C1776
Hospital Charge Code 5459819
Hospital Revenue Code 278
Min. Negotiated Rate $3,875.90
Max. Negotiated Rate $7,277.20
Rate for Payer: Aetna Commercial $7,119.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,802.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,192.30
Rate for Payer: Cash Price $2,373.00
Rate for Payer: Cigna Commercial $7,277.20
Rate for Payer: Health EOS Commercial $7,039.90
Rate for Payer: HFN Commercial $7,277.20
Rate for Payer: Multiplan Commercial $6,328.00
Rate for Payer: NAPHCARE Commercial $4,746.00
Rate for Payer: Preferred Network Access Commercial $7,277.20
Rate for Payer: Quartz Beloit One Network $3,875.90
Rate for Payer: Quartz Commercial $4,746.00
Rate for Payer: WEA Trust Commercial $4,350.50
Rate for Payer: WPS Commercial $5,858.94