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Charge Type Price  
Service Code CPT 85300
Hospital Charge Code 980026
Hospital Revenue Code 300
Min. Negotiated Rate $11.85
Max. Negotiated Rate $647.90
Rate for Payer: Aetna Commercial $647.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $586.52
Rate for Payer: Aetna Managed Medicare $11.85
Rate for Payer: Anthem Medicare Advantage $11.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $11.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $11.85
Rate for Payer: Cash Price $204.60
Rate for Payer: Cash Price $204.60
Rate for Payer: Cigna Commercial $647.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $341.00
Rate for Payer: Dean Health DHI/DHP/ASO $11.85
Rate for Payer: Health EOS Commercial $620.62
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $41.83
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $41.83
Rate for Payer: Independent Care Health Plan Medicare $11.85
Rate for Payer: Multiplan Commercial $545.60
Rate for Payer: Preferred Network Access Commercial $647.90
Rate for Payer: Quartz Beloit One Network $300.08
Rate for Payer: Quartz Commercial $388.74
Rate for Payer: Quartz Medicare Advantage $11.85
Rate for Payer: The Alliance Commercial $46.81
Rate for Payer: United Healthcare Medicare Advantage $11.85
Rate for Payer: WEA Trust Commercial $375.10
Rate for Payer: WPS Commercial $52.14
Service Code CPT 85300
Hospital Charge Code 980026
Hospital Revenue Code 300
Min. Negotiated Rate $11.85
Max. Negotiated Rate $2,728.00
Rate for Payer: Aetna Commercial $613.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $586.52
Rate for Payer: Aetna Managed Medicare $11.85
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $44.44
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $20.74
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $19.67
Rate for Payer: Anthem Medicaid $12.24
Rate for Payer: Anthem Medicare Advantage $11.85
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $361.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $11.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $11.85
Rate for Payer: Cash Price $204.60
Rate for Payer: Cash Price $204.60
Rate for Payer: Cigna Commercial $627.44
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $11.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $12.24
Rate for Payer: Dean Health Medicaid $12.24
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $11.85
Rate for Payer: Health EOS Commercial $606.98
Rate for Payer: HFN Commercial $627.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $44.08
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $11.85
Rate for Payer: Independent Care Health Plan Medicaid $12.24
Rate for Payer: Independent Care Health Plan Medicare $11.85
Rate for Payer: Managed Health Services Medicaid $12.73
Rate for Payer: Managed Health Services Medicare Advantage $11.85
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $11.85
Rate for Payer: Multiplan Commercial $545.60
Rate for Payer: NAPHCARE Commercial $17.78
Rate for Payer: Preferred Network Access Commercial $627.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $12.24
Rate for Payer: Quartz Beloit One Network $334.18
Rate for Payer: Quartz Commercial $443.30
Rate for Payer: Quartz Medicare Advantage $11.85
Rate for Payer: The Alliance Commercial $2,728.00
Rate for Payer: United Healthcare Medicaid $12.24
Rate for Payer: United Healthcare Medicare Advantage $11.85
Rate for Payer: United Healthcare PPO $511.50
Rate for Payer: WEA Trust Commercial $375.10
Rate for Payer: Wellcare Medicare $11.85
Rate for Payer: WMAP Medicaid $12.24
Rate for Payer: WPS Commercial $505.16
Service Code CPT 85300
Hospital Charge Code 980026
Hospital Revenue Code 300
Min. Negotiated Rate $334.18
Max. Negotiated Rate $627.44
Rate for Payer: Aetna Commercial $613.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $361.46
Rate for Payer: Cash Price $204.60
Rate for Payer: Cigna Commercial $627.44
Rate for Payer: Health EOS Commercial $606.98
Rate for Payer: HFN Commercial $627.44
Rate for Payer: Multiplan Commercial $545.60
Rate for Payer: NAPHCARE Commercial $409.20
Rate for Payer: Preferred Network Access Commercial $627.44
Rate for Payer: Quartz Beloit One Network $334.18
Rate for Payer: Quartz Commercial $409.20
Rate for Payer: WEA Trust Commercial $375.10
Rate for Payer: WPS Commercial $505.16
Service Code CPT 85301
Hospital Charge Code 980027
Hospital Revenue Code 300
Min. Negotiated Rate $478.24
Max. Negotiated Rate $897.92
Rate for Payer: Aetna Commercial $878.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $517.28
Rate for Payer: Cash Price $292.80
Rate for Payer: Cigna Commercial $897.92
Rate for Payer: Health EOS Commercial $868.64
Rate for Payer: HFN Commercial $897.92
Rate for Payer: Multiplan Commercial $780.80
Rate for Payer: NAPHCARE Commercial $585.60
Rate for Payer: Preferred Network Access Commercial $897.92
Rate for Payer: Quartz Beloit One Network $478.24
Rate for Payer: Quartz Commercial $585.60
Rate for Payer: WEA Trust Commercial $536.80
Rate for Payer: WPS Commercial $722.92
Service Code CPT 85301
Hospital Charge Code 980027
Hospital Revenue Code 300
Min. Negotiated Rate $10.81
Max. Negotiated Rate $927.20
Rate for Payer: Aetna Commercial $927.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $839.36
Rate for Payer: Aetna Managed Medicare $10.81
Rate for Payer: Anthem Medicare Advantage $10.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $10.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $10.81
Rate for Payer: Cash Price $292.80
Rate for Payer: Cash Price $292.80
Rate for Payer: Cigna Commercial $927.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $488.00
Rate for Payer: Dean Health DHI/DHP/ASO $10.81
Rate for Payer: Health EOS Commercial $888.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $38.16
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $38.16
Rate for Payer: Independent Care Health Plan Medicare $10.81
Rate for Payer: Multiplan Commercial $780.80
Rate for Payer: Preferred Network Access Commercial $927.20
Rate for Payer: Quartz Beloit One Network $429.44
Rate for Payer: Quartz Commercial $556.32
Rate for Payer: Quartz Medicare Advantage $10.81
Rate for Payer: The Alliance Commercial $42.70
Rate for Payer: United Healthcare Medicare Advantage $10.81
Rate for Payer: WEA Trust Commercial $536.80
Rate for Payer: WPS Commercial $47.56
Service Code CPT 85301
Hospital Charge Code 980027
Hospital Revenue Code 300
Min. Negotiated Rate $10.81
Max. Negotiated Rate $3,904.00
Rate for Payer: Aetna Commercial $878.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $839.36
Rate for Payer: Aetna Managed Medicare $10.81
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $40.54
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $18.92
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $17.94
Rate for Payer: Anthem Medicaid $11.17
Rate for Payer: Anthem Medicare Advantage $10.81
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $517.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $10.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $10.81
Rate for Payer: Cash Price $292.80
Rate for Payer: Cash Price $292.80
Rate for Payer: Cigna Commercial $897.92
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $10.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $11.17
Rate for Payer: Dean Health Medicaid $11.17
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $10.81
Rate for Payer: Health EOS Commercial $868.64
Rate for Payer: HFN Commercial $897.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $40.21
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $10.81
Rate for Payer: Independent Care Health Plan Medicaid $11.17
Rate for Payer: Independent Care Health Plan Medicare $10.81
Rate for Payer: Managed Health Services Medicaid $11.62
Rate for Payer: Managed Health Services Medicare Advantage $10.81
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $10.81
Rate for Payer: Multiplan Commercial $780.80
Rate for Payer: NAPHCARE Commercial $16.22
Rate for Payer: Preferred Network Access Commercial $897.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $11.17
Rate for Payer: Quartz Beloit One Network $478.24
Rate for Payer: Quartz Commercial $634.40
Rate for Payer: Quartz Medicare Advantage $10.81
Rate for Payer: The Alliance Commercial $3,904.00
Rate for Payer: United Healthcare Medicaid $11.17
Rate for Payer: United Healthcare Medicare Advantage $10.81
Rate for Payer: United Healthcare PPO $732.00
Rate for Payer: WEA Trust Commercial $536.80
Rate for Payer: Wellcare Medicare $10.81
Rate for Payer: WMAP Medicaid $11.17
Rate for Payer: WPS Commercial $722.92
Service Code CPT 83520
Hospital Charge Code 5542921
Hospital Revenue Code 300
Min. Negotiated Rate $123.48
Max. Negotiated Rate $231.84
Rate for Payer: Aetna Commercial $226.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $133.56
Rate for Payer: Cash Price $75.60
Rate for Payer: Cigna Commercial $231.84
Rate for Payer: Health EOS Commercial $224.28
Rate for Payer: HFN Commercial $231.84
Rate for Payer: Multiplan Commercial $201.60
Rate for Payer: NAPHCARE Commercial $151.20
Rate for Payer: Preferred Network Access Commercial $231.84
Rate for Payer: Quartz Beloit One Network $123.48
Rate for Payer: Quartz Commercial $151.20
Rate for Payer: WEA Trust Commercial $138.60
Rate for Payer: WPS Commercial $186.66
Service Code CPT 83520
Hospital Charge Code 5542921
Hospital Revenue Code 300
Min. Negotiated Rate $17.27
Max. Negotiated Rate $239.40
Rate for Payer: Aetna Commercial $239.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $216.72
Rate for Payer: Aetna Managed Medicare $17.27
Rate for Payer: Anthem Medicare Advantage $17.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $17.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $17.27
Rate for Payer: Cash Price $75.60
Rate for Payer: Cash Price $75.60
Rate for Payer: Cigna Commercial $239.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $126.00
Rate for Payer: Dean Health DHI/DHP/ASO $17.27
Rate for Payer: Health EOS Commercial $229.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $60.96
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $60.96
Rate for Payer: Independent Care Health Plan Medicare $17.27
Rate for Payer: Multiplan Commercial $201.60
Rate for Payer: Preferred Network Access Commercial $239.40
Rate for Payer: Quartz Beloit One Network $110.88
Rate for Payer: Quartz Commercial $143.64
Rate for Payer: Quartz Medicare Advantage $17.27
Rate for Payer: The Alliance Commercial $68.22
Rate for Payer: United Healthcare Medicare Advantage $17.27
Rate for Payer: WEA Trust Commercial $138.60
Rate for Payer: WPS Commercial $75.99
Service Code CPT 83520
Hospital Charge Code 5542921
Hospital Revenue Code 300
Min. Negotiated Rate $17.27
Max. Negotiated Rate $1,008.00
Rate for Payer: Aetna Commercial $226.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $216.72
Rate for Payer: Aetna Managed Medicare $17.27
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $64.76
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $30.22
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $28.67
Rate for Payer: Anthem Medicaid $17.85
Rate for Payer: Anthem Medicare Advantage $17.27
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $133.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $17.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $17.27
Rate for Payer: Cash Price $75.60
Rate for Payer: Cash Price $75.60
Rate for Payer: Cigna Commercial $231.84
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $17.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $17.85
Rate for Payer: Dean Health Medicaid $17.85
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $17.27
Rate for Payer: Health EOS Commercial $224.28
Rate for Payer: HFN Commercial $231.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $64.24
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $17.27
Rate for Payer: Independent Care Health Plan Medicaid $17.85
Rate for Payer: Independent Care Health Plan Medicare $17.27
Rate for Payer: Managed Health Services Medicaid $18.56
Rate for Payer: Managed Health Services Medicare Advantage $17.27
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $17.27
Rate for Payer: Multiplan Commercial $201.60
Rate for Payer: NAPHCARE Commercial $25.90
Rate for Payer: Preferred Network Access Commercial $231.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $17.85
Rate for Payer: Quartz Beloit One Network $123.48
Rate for Payer: Quartz Commercial $163.80
Rate for Payer: Quartz Medicare Advantage $17.27
Rate for Payer: The Alliance Commercial $1,008.00
Rate for Payer: United Healthcare Medicaid $17.85
Rate for Payer: United Healthcare Medicare Advantage $17.27
Rate for Payer: United Healthcare PPO $189.00
Rate for Payer: WEA Trust Commercial $138.60
Rate for Payer: Wellcare Medicare $17.27
Rate for Payer: WMAP Medicaid $17.85
Rate for Payer: WPS Commercial $186.66
Service Code MS-DRG 268
Min. Negotiated Rate $65,668.77
Max. Negotiated Rate $182,559.00
Rate for Payer: Aetna Managed Medicare $65,668.77
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $143,713.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $110,154.85
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $104,654.30
Rate for Payer: Anthem Medicare Advantage $65,668.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $65,668.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $65,668.77
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $65,668.77
Rate for Payer: Dean Health DHI/DHP/ASO $116,175.86
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $65,668.77
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $133,666.70
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $65,668.77
Rate for Payer: Independent Care Health Plan Medicare $65,668.77
Rate for Payer: Managed Health Services Medicare Advantage $65,668.77
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $65,668.77
Rate for Payer: NAPHCARE Commercial $98,503.16
Rate for Payer: Quartz Medicare Advantage $65,668.77
Rate for Payer: The Alliance Commercial $182,559.00
Rate for Payer: United Healthcare Medicare Advantage $65,668.77
Rate for Payer: United Healthcare PPO $104,061.20
Rate for Payer: Wellcare Medicare $65,668.77
Service Code MS-DRG 269
Min. Negotiated Rate $39,885.18
Max. Negotiated Rate $110,881.00
Rate for Payer: Aetna Managed Medicare $39,885.18
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $87,276.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $66,896.96
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $63,556.48
Rate for Payer: Anthem Medicare Advantage $39,885.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $39,885.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $39,885.18
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $39,885.18
Rate for Payer: Dean Health DHI/DHP/ASO $70,553.52
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $39,885.18
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $81,092.70
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $39,885.18
Rate for Payer: Independent Care Health Plan Medicare $39,885.18
Rate for Payer: Managed Health Services Medicare Advantage $39,885.18
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $39,885.18
Rate for Payer: NAPHCARE Commercial $59,827.77
Rate for Payer: Quartz Medicare Advantage $39,885.18
Rate for Payer: The Alliance Commercial $110,881.00
Rate for Payer: United Healthcare Medicare Advantage $39,885.18
Rate for Payer: United Healthcare PPO $63,131.71
Rate for Payer: Wellcare Medicare $39,885.18
Service Code HCPCS L8699
Hospital Charge Code 2973948
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $29,909.08
Rate for Payer: Aetna Managed Medicare $9,737.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $22,605.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $17,389.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $16,693.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Dean Health DHI/DHP/ASO $19,461.77
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $26,083.50
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $22,605.70
Rate for Payer: Quartz Medicare Advantage $20,866.80
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973948
Hospital Revenue Code 278
Min. Negotiated Rate $17,041.22
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $20,866.80
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973947
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $29,909.08
Rate for Payer: Aetna Managed Medicare $9,737.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $22,605.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $17,389.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $16,693.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Dean Health DHI/DHP/ASO $19,461.77
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $26,083.50
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $22,605.70
Rate for Payer: Quartz Medicare Advantage $20,866.80
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973947
Hospital Revenue Code 278
Min. Negotiated Rate $17,041.22
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $20,866.80
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973954
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $35,363.88
Rate for Payer: Aetna Commercial $34,595.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $33,057.54
Rate for Payer: Aetna Managed Medicare $10,762.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $24,985.35
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $19,219.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $18,450.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $20,372.67
Rate for Payer: Cash Price $11,531.70
Rate for Payer: Cash Price $11,531.70
Rate for Payer: Cigna Commercial $35,363.88
Rate for Payer: Dean Health DHI/DHP/ASO $21,510.46
Rate for Payer: Health EOS Commercial $34,210.71
Rate for Payer: HFN Commercial $35,363.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $28,829.25
Rate for Payer: Multiplan Commercial $30,751.20
Rate for Payer: NAPHCARE Commercial $23,063.40
Rate for Payer: Preferred Network Access Commercial $35,363.88
Rate for Payer: Quartz Beloit One Network $18,835.11
Rate for Payer: Quartz Commercial $24,985.35
Rate for Payer: Quartz Medicare Advantage $23,063.40
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $21,141.45
Rate for Payer: WPS Commercial $28,471.77
Service Code HCPCS L8699
Hospital Charge Code 2973954
Hospital Revenue Code 278
Min. Negotiated Rate $18,835.11
Max. Negotiated Rate $35,363.88
Rate for Payer: Aetna Commercial $34,595.10
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $20,372.67
Rate for Payer: Cash Price $11,531.70
Rate for Payer: Cigna Commercial $35,363.88
Rate for Payer: Health EOS Commercial $34,210.71
Rate for Payer: HFN Commercial $35,363.88
Rate for Payer: Multiplan Commercial $30,751.20
Rate for Payer: NAPHCARE Commercial $23,063.40
Rate for Payer: Preferred Network Access Commercial $35,363.88
Rate for Payer: Quartz Beloit One Network $18,835.11
Rate for Payer: Quartz Commercial $23,063.40
Rate for Payer: WEA Trust Commercial $21,141.45
Rate for Payer: WPS Commercial $28,471.77
Service Code HCPCS L8699
Hospital Charge Code 2966066
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $49,567.76
Rate for Payer: Aetna Commercial $48,490.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $46,335.08
Rate for Payer: Aetna Managed Medicare $15,085.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $35,020.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,939.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,861.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $28,555.34
Rate for Payer: Cash Price $16,163.40
Rate for Payer: Cash Price $16,163.40
Rate for Payer: Cigna Commercial $49,567.76
Rate for Payer: Dean Health DHI/DHP/ASO $30,150.13
Rate for Payer: Health EOS Commercial $47,951.42
Rate for Payer: HFN Commercial $49,567.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $40,408.50
Rate for Payer: Multiplan Commercial $43,102.40
Rate for Payer: NAPHCARE Commercial $32,326.80
Rate for Payer: Preferred Network Access Commercial $49,567.76
Rate for Payer: Quartz Beloit One Network $26,400.22
Rate for Payer: Quartz Commercial $35,020.70
Rate for Payer: Quartz Medicare Advantage $32,326.80
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $29,632.90
Rate for Payer: WPS Commercial $39,907.43
Service Code HCPCS L8699
Hospital Charge Code 2966066
Hospital Revenue Code 278
Min. Negotiated Rate $26,400.22
Max. Negotiated Rate $49,567.76
Rate for Payer: Aetna Commercial $48,490.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $28,555.34
Rate for Payer: Cash Price $16,163.40
Rate for Payer: Cigna Commercial $49,567.76
Rate for Payer: Health EOS Commercial $47,951.42
Rate for Payer: HFN Commercial $49,567.76
Rate for Payer: Multiplan Commercial $43,102.40
Rate for Payer: NAPHCARE Commercial $32,326.80
Rate for Payer: Preferred Network Access Commercial $49,567.76
Rate for Payer: Quartz Beloit One Network $26,400.22
Rate for Payer: Quartz Commercial $32,326.80
Rate for Payer: WEA Trust Commercial $29,632.90
Rate for Payer: WPS Commercial $39,907.43
Service Code HCPCS L8699
Hospital Charge Code 5074608
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $25,806.00
Rate for Payer: Aetna Commercial $25,245.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24,123.00
Rate for Payer: Aetna Managed Medicare $7,854.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $18,232.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $14,025.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $13,464.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14,866.50
Rate for Payer: Cash Price $8,415.00
Rate for Payer: Cash Price $8,415.00
Rate for Payer: Cigna Commercial $25,806.00
Rate for Payer: Dean Health DHI/DHP/ASO $15,696.78
Rate for Payer: Health EOS Commercial $24,964.50
Rate for Payer: HFN Commercial $25,806.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,037.50
Rate for Payer: Multiplan Commercial $22,440.00
Rate for Payer: NAPHCARE Commercial $16,830.00
Rate for Payer: Preferred Network Access Commercial $25,806.00
Rate for Payer: Quartz Beloit One Network $13,744.50
Rate for Payer: Quartz Commercial $18,232.50
Rate for Payer: Quartz Medicare Advantage $16,830.00
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $15,427.50
Rate for Payer: WPS Commercial $20,776.64
Service Code HCPCS L8699
Hospital Charge Code 5074608
Hospital Revenue Code 278
Min. Negotiated Rate $13,744.50
Max. Negotiated Rate $25,806.00
Rate for Payer: Aetna Commercial $25,245.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14,866.50
Rate for Payer: Cash Price $8,415.00
Rate for Payer: Cigna Commercial $25,806.00
Rate for Payer: Health EOS Commercial $24,964.50
Rate for Payer: HFN Commercial $25,806.00
Rate for Payer: Multiplan Commercial $22,440.00
Rate for Payer: NAPHCARE Commercial $16,830.00
Rate for Payer: Preferred Network Access Commercial $25,806.00
Rate for Payer: Quartz Beloit One Network $13,744.50
Rate for Payer: Quartz Commercial $16,830.00
Rate for Payer: WEA Trust Commercial $15,427.50
Rate for Payer: WPS Commercial $20,776.64
Service Code HCPCS L8699
Hospital Charge Code 2973949
Hospital Revenue Code 278
Min. Negotiated Rate $17,041.22
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $20,866.80
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973949
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $31,995.76
Rate for Payer: Aetna Commercial $31,300.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $29,909.08
Rate for Payer: Aetna Managed Medicare $9,737.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $22,605.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $17,389.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $16,693.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $18,432.34
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cash Price $10,433.40
Rate for Payer: Cigna Commercial $31,995.76
Rate for Payer: Dean Health DHI/DHP/ASO $19,461.77
Rate for Payer: Health EOS Commercial $30,952.42
Rate for Payer: HFN Commercial $31,995.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $26,083.50
Rate for Payer: Multiplan Commercial $27,822.40
Rate for Payer: NAPHCARE Commercial $20,866.80
Rate for Payer: Preferred Network Access Commercial $31,995.76
Rate for Payer: Quartz Beloit One Network $17,041.22
Rate for Payer: Quartz Commercial $22,605.70
Rate for Payer: Quartz Medicare Advantage $20,866.80
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $19,127.90
Rate for Payer: WPS Commercial $25,760.06
Service Code HCPCS L8699
Hospital Charge Code 2973955
Hospital Revenue Code 278
Min. Negotiated Rate $19,559.33
Max. Negotiated Rate $36,723.64
Rate for Payer: Aetna Commercial $35,925.30
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21,156.01
Rate for Payer: Cash Price $11,975.10
Rate for Payer: Cigna Commercial $36,723.64
Rate for Payer: Health EOS Commercial $35,526.13
Rate for Payer: HFN Commercial $36,723.64
Rate for Payer: Multiplan Commercial $31,933.60
Rate for Payer: NAPHCARE Commercial $23,950.20
Rate for Payer: Preferred Network Access Commercial $36,723.64
Rate for Payer: Quartz Beloit One Network $19,559.33
Rate for Payer: Quartz Commercial $23,950.20
Rate for Payer: WEA Trust Commercial $21,954.35
Rate for Payer: WPS Commercial $29,566.52
Service Code HCPCS L8699
Hospital Charge Code 2973955
Hospital Revenue Code 278
Min. Negotiated Rate $1,196.24
Max. Negotiated Rate $36,723.64
Rate for Payer: Aetna Commercial $35,925.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $34,328.62
Rate for Payer: Aetna Managed Medicare $11,176.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $25,946.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $19,958.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $19,160.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21,156.01
Rate for Payer: Cash Price $11,975.10
Rate for Payer: Cash Price $11,975.10
Rate for Payer: Cigna Commercial $36,723.64
Rate for Payer: Dean Health DHI/DHP/ASO $22,337.55
Rate for Payer: Health EOS Commercial $35,526.13
Rate for Payer: HFN Commercial $36,723.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $29,937.75
Rate for Payer: Multiplan Commercial $31,933.60
Rate for Payer: NAPHCARE Commercial $23,950.20
Rate for Payer: Preferred Network Access Commercial $36,723.64
Rate for Payer: Quartz Beloit One Network $19,559.33
Rate for Payer: Quartz Commercial $25,946.05
Rate for Payer: Quartz Medicare Advantage $23,950.20
Rate for Payer: The Alliance Commercial $1,196.24
Rate for Payer: WEA Trust Commercial $21,954.35
Rate for Payer: WPS Commercial $29,566.52