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Service Code HCPCS C1776
Hospital Charge Code 5490755
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 5490755
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 5521118
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 5521118
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 5459758
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 5459758
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 5496832
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 5496832
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 5520973
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 5520973
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 5544762
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 5544762
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 5496863
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 5496863
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 5497056
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 5497056
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 5563333
Hospital Revenue Code 278
Min. Negotiated Rate $23,359.28
Max. Negotiated Rate $43,858.24
Rate for Payer: Aetna Commercial $42,904.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $40,997.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $25,266.16
Rate for Payer: Cash Price $14,301.60
Rate for Payer: Cigna Commercial $43,858.24
Rate for Payer: Health EOS Commercial $42,428.08
Rate for Payer: HFN Commercial $43,858.24
Rate for Payer: Multiplan Commercial $38,137.60
Rate for Payer: NAPHCARE Commercial $28,603.20
Rate for Payer: Preferred Network Access Commercial $43,858.24
Rate for Payer: Quartz Beloit One Network $23,359.28
Rate for Payer: Quartz Commercial $28,603.20
Rate for Payer: WEA Trust Commercial $26,219.60
Rate for Payer: WPS Commercial $35,310.65
Service Code HCPCS C1776
Hospital Charge Code 5563333
Hospital Revenue Code 278
Min. Negotiated Rate $13,348.16
Max. Negotiated Rate $190,688.00
Rate for Payer: Aetna Commercial $42,904.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $40,997.92
Rate for Payer: Aetna Managed Medicare $13,348.16
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $30,986.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $23,836.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $22,882.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $25,266.16
Rate for Payer: Cash Price $14,301.60
Rate for Payer: Cigna Commercial $43,858.24
Rate for Payer: Dean Health DHI/DHP/ASO $26,677.25
Rate for Payer: Health EOS Commercial $42,428.08
Rate for Payer: HFN Commercial $43,858.24
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $35,754.00
Rate for Payer: Multiplan Commercial $38,137.60
Rate for Payer: NAPHCARE Commercial $28,603.20
Rate for Payer: Preferred Network Access Commercial $43,858.24
Rate for Payer: Quartz Beloit One Network $23,359.28
Rate for Payer: Quartz Commercial $30,986.80
Rate for Payer: Quartz Medicare Advantage $28,603.20
Rate for Payer: The Alliance Commercial $190,688.00
Rate for Payer: WEA Trust Commercial $26,219.60
Rate for Payer: WPS Commercial $35,310.65
Service Code HCPCS C1776
Hospital Charge Code 6177673
Hospital Revenue Code 278
Min. Negotiated Rate $8,943.20
Max. Negotiated Rate $127,760.00
Rate for Payer: Aetna Commercial $28,746.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,468.40
Rate for Payer: Aetna Managed Medicare $8,943.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $20,761.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $15,970.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $15,331.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,928.20
Rate for Payer: Cash Price $9,582.00
Rate for Payer: Cigna Commercial $29,384.80
Rate for Payer: Dean Health DHI/DHP/ASO $17,873.62
Rate for Payer: Health EOS Commercial $28,426.60
Rate for Payer: HFN Commercial $29,384.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $23,955.00
Rate for Payer: Multiplan Commercial $25,552.00
Rate for Payer: NAPHCARE Commercial $19,164.00
Rate for Payer: Preferred Network Access Commercial $29,384.80
Rate for Payer: Quartz Beloit One Network $15,650.60
Rate for Payer: Quartz Commercial $20,761.00
Rate for Payer: Quartz Medicare Advantage $19,164.00
Rate for Payer: The Alliance Commercial $127,760.00
Rate for Payer: WEA Trust Commercial $17,567.00
Rate for Payer: WPS Commercial $23,657.96
Service Code HCPCS C1776
Hospital Charge Code 6177673
Hospital Revenue Code 278
Min. Negotiated Rate $15,650.60
Max. Negotiated Rate $29,384.80
Rate for Payer: Aetna Commercial $28,746.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,468.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,928.20
Rate for Payer: Cash Price $9,582.00
Rate for Payer: Cigna Commercial $29,384.80
Rate for Payer: Health EOS Commercial $28,426.60
Rate for Payer: HFN Commercial $29,384.80
Rate for Payer: Multiplan Commercial $25,552.00
Rate for Payer: NAPHCARE Commercial $19,164.00
Rate for Payer: Preferred Network Access Commercial $29,384.80
Rate for Payer: Quartz Beloit One Network $15,650.60
Rate for Payer: Quartz Commercial $19,164.00
Rate for Payer: WEA Trust Commercial $17,567.00
Rate for Payer: WPS Commercial $23,657.96
Service Code HCPCS C1776
Hospital Charge Code 6151662
Hospital Revenue Code 278
Min. Negotiated Rate $15,650.60
Max. Negotiated Rate $29,384.80
Rate for Payer: Aetna Commercial $28,746.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,468.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,928.20
Rate for Payer: Cash Price $9,582.00
Rate for Payer: Cigna Commercial $29,384.80
Rate for Payer: Health EOS Commercial $28,426.60
Rate for Payer: HFN Commercial $29,384.80
Rate for Payer: Multiplan Commercial $25,552.00
Rate for Payer: NAPHCARE Commercial $19,164.00
Rate for Payer: Preferred Network Access Commercial $29,384.80
Rate for Payer: Quartz Beloit One Network $15,650.60
Rate for Payer: Quartz Commercial $19,164.00
Rate for Payer: WEA Trust Commercial $17,567.00
Rate for Payer: WPS Commercial $23,657.96
Service Code HCPCS C1776
Hospital Charge Code 6151662
Hospital Revenue Code 278
Min. Negotiated Rate $8,943.20
Max. Negotiated Rate $127,760.00
Rate for Payer: Aetna Commercial $28,746.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $27,468.40
Rate for Payer: Aetna Managed Medicare $8,943.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $20,761.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $15,970.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $15,331.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16,928.20
Rate for Payer: Cash Price $9,582.00
Rate for Payer: Cigna Commercial $29,384.80
Rate for Payer: Dean Health DHI/DHP/ASO $17,873.62
Rate for Payer: Health EOS Commercial $28,426.60
Rate for Payer: HFN Commercial $29,384.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $23,955.00
Rate for Payer: Multiplan Commercial $25,552.00
Rate for Payer: NAPHCARE Commercial $19,164.00
Rate for Payer: Preferred Network Access Commercial $29,384.80
Rate for Payer: Quartz Beloit One Network $15,650.60
Rate for Payer: Quartz Commercial $20,761.00
Rate for Payer: Quartz Medicare Advantage $19,164.00
Rate for Payer: The Alliance Commercial $127,760.00
Rate for Payer: WEA Trust Commercial $17,567.00
Rate for Payer: WPS Commercial $23,657.96
Service Code HCPCS C1776
Hospital Charge Code 5528738
Hospital Revenue Code 278
Min. Negotiated Rate $13,825.84
Max. Negotiated Rate $197,512.00
Rate for Payer: Aetna Commercial $44,440.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $42,465.08
Rate for Payer: Aetna Managed Medicare $13,825.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $32,095.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $24,689.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $23,701.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $26,170.34
Rate for Payer: Cash Price $14,813.40
Rate for Payer: Cigna Commercial $45,427.76
Rate for Payer: Dean Health DHI/DHP/ASO $27,631.93
Rate for Payer: Health EOS Commercial $43,946.42
Rate for Payer: HFN Commercial $45,427.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $37,033.50
Rate for Payer: Multiplan Commercial $39,502.40
Rate for Payer: NAPHCARE Commercial $29,626.80
Rate for Payer: Preferred Network Access Commercial $45,427.76
Rate for Payer: Quartz Beloit One Network $24,195.22
Rate for Payer: Quartz Commercial $32,095.70
Rate for Payer: Quartz Medicare Advantage $29,626.80
Rate for Payer: The Alliance Commercial $197,512.00
Rate for Payer: WEA Trust Commercial $27,157.90
Rate for Payer: WPS Commercial $36,574.28
Service Code HCPCS C1776
Hospital Charge Code 5528738
Hospital Revenue Code 278
Min. Negotiated Rate $24,195.22
Max. Negotiated Rate $45,427.76
Rate for Payer: Aetna Commercial $44,440.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $42,465.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $26,170.34
Rate for Payer: Cash Price $14,813.40
Rate for Payer: Cigna Commercial $45,427.76
Rate for Payer: Health EOS Commercial $43,946.42
Rate for Payer: HFN Commercial $45,427.76
Rate for Payer: Multiplan Commercial $39,502.40
Rate for Payer: NAPHCARE Commercial $29,626.80
Rate for Payer: Preferred Network Access Commercial $45,427.76
Rate for Payer: Quartz Beloit One Network $24,195.22
Rate for Payer: Quartz Commercial $29,626.80
Rate for Payer: WEA Trust Commercial $27,157.90
Rate for Payer: WPS Commercial $36,574.28
Service Code HCPCS C1776
Hospital Charge Code 6226145
Hospital Revenue Code 278
Min. Negotiated Rate $9,467.92
Max. Negotiated Rate $135,256.00
Rate for Payer: Aetna Commercial $30,432.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $29,080.04
Rate for Payer: Aetna Managed Medicare $9,467.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $21,979.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $16,907.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $16,230.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $17,921.42
Rate for Payer: Cash Price $10,144.20
Rate for Payer: Cigna Commercial $31,108.88
Rate for Payer: Dean Health DHI/DHP/ASO $18,922.31
Rate for Payer: Health EOS Commercial $30,094.46
Rate for Payer: HFN Commercial $31,108.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $25,360.50
Rate for Payer: Multiplan Commercial $27,051.20
Rate for Payer: NAPHCARE Commercial $20,288.40
Rate for Payer: Preferred Network Access Commercial $31,108.88
Rate for Payer: Quartz Beloit One Network $16,568.86
Rate for Payer: Quartz Commercial $21,979.10
Rate for Payer: Quartz Medicare Advantage $20,288.40
Rate for Payer: The Alliance Commercial $135,256.00
Rate for Payer: WEA Trust Commercial $18,597.70
Rate for Payer: WPS Commercial $25,046.03