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Charge Type Setting Price  
Service Code MSDRG 882
Min. Negotiated Rate $9,098.07
Max. Negotiated Rate $25,293.00
Rate for Payer: Aetna Managed Medicare $9,098.07
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $19,721.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $15,116.14
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $14,361.32
Rate for Payer: Anthem Medicare Advantage $9,098.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $9,098.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $9,098.07
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $9,098.07
Rate for Payer: Dean Health DHI/DHP/ASO $15,942.38
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $9,098.07
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $18,316.35
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $9,098.07
Rate for Payer: Independent Care Health Plan Medicare $9,098.07
Rate for Payer: Managed Health Services Medicare Advantage $9,098.07
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $9,098.07
Rate for Payer: NAPHCARE Commercial $13,647.10
Rate for Payer: Quartz Medicare Advantage $9,098.07
Rate for Payer: The Alliance Commercial $25,293.00
Rate for Payer: United Healthcare Medicare Advantage $9,098.07
Rate for Payer: United Healthcare PPO $14,259.51
Rate for Payer: Wellcare Medicare $9,098.07
Hospital Charge Code 2960249
Hospital Revenue Code 360
Min. Negotiated Rate $1,210.72
Max. Negotiated Rate $17,296.00
Rate for Payer: Aetna Commercial $3,891.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,718.64
Rate for Payer: Aetna Managed Medicare $1,210.72
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $2,810.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,162.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,075.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,291.72
Rate for Payer: Cash Price $1,297.20
Rate for Payer: Cigna Commercial $3,978.08
Rate for Payer: Dean Health DHI/DHP/ASO $2,419.71
Rate for Payer: Health EOS Commercial $3,848.36
Rate for Payer: HFN Commercial $3,978.08
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,243.00
Rate for Payer: Multiplan Commercial $3,459.20
Rate for Payer: NAPHCARE Commercial $2,594.40
Rate for Payer: Preferred Network Access Commercial $3,978.08
Rate for Payer: Quartz Beloit One Network $2,118.76
Rate for Payer: Quartz Commercial $2,810.60
Rate for Payer: Quartz Medicare Advantage $2,594.40
Rate for Payer: The Alliance Commercial $17,296.00
Rate for Payer: WEA Trust Commercial $2,378.20
Rate for Payer: WPS Commercial $3,202.79
Hospital Charge Code 2960249
Hospital Revenue Code 360
Min. Negotiated Rate $2,118.76
Max. Negotiated Rate $3,978.08
Rate for Payer: Aetna Commercial $3,891.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,718.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,291.72
Rate for Payer: Cash Price $1,297.20
Rate for Payer: Cigna Commercial $3,978.08
Rate for Payer: Health EOS Commercial $3,848.36
Rate for Payer: HFN Commercial $3,978.08
Rate for Payer: Multiplan Commercial $3,459.20
Rate for Payer: NAPHCARE Commercial $2,594.40
Rate for Payer: Preferred Network Access Commercial $3,978.08
Rate for Payer: Quartz Beloit One Network $2,118.76
Rate for Payer: Quartz Commercial $2,594.40
Rate for Payer: WEA Trust Commercial $2,378.20
Rate for Payer: WPS Commercial $3,202.79
Service Code HCPCS C1767
Hospital Charge Code 5349493
Hospital Revenue Code 278
Min. Negotiated Rate $19,913.60
Max. Negotiated Rate $284,480.00
Rate for Payer: Aetna Commercial $64,008.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $61,163.20
Rate for Payer: Aetna Managed Medicare $19,913.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $46,228.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $35,560.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $34,137.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $37,693.60
Rate for Payer: Cash Price $21,336.00
Rate for Payer: Cigna Commercial $65,430.40
Rate for Payer: Dean Health DHI/DHP/ASO $39,798.75
Rate for Payer: Health EOS Commercial $63,296.80
Rate for Payer: HFN Commercial $65,430.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $53,340.00
Rate for Payer: Multiplan Commercial $56,896.00
Rate for Payer: NAPHCARE Commercial $42,672.00
Rate for Payer: Preferred Network Access Commercial $65,430.40
Rate for Payer: Quartz Beloit One Network $34,848.80
Rate for Payer: Quartz Commercial $46,228.00
Rate for Payer: Quartz Medicare Advantage $42,672.00
Rate for Payer: The Alliance Commercial $284,480.00
Rate for Payer: WEA Trust Commercial $39,116.00
Rate for Payer: WPS Commercial $52,678.58
Service Code HCPCS C1767
Hospital Charge Code 5349493
Hospital Revenue Code 278
Min. Negotiated Rate $34,848.80
Max. Negotiated Rate $65,430.40
Rate for Payer: Aetna Commercial $64,008.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $61,163.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $37,693.60
Rate for Payer: Cash Price $21,336.00
Rate for Payer: Cigna Commercial $65,430.40
Rate for Payer: Health EOS Commercial $63,296.80
Rate for Payer: HFN Commercial $65,430.40
Rate for Payer: Multiplan Commercial $56,896.00
Rate for Payer: NAPHCARE Commercial $42,672.00
Rate for Payer: Preferred Network Access Commercial $65,430.40
Rate for Payer: Quartz Beloit One Network $34,848.80
Rate for Payer: Quartz Commercial $42,672.00
Rate for Payer: WEA Trust Commercial $39,116.00
Rate for Payer: WPS Commercial $52,678.58
Hospital Charge Code 6049662
Hospital Revenue Code 278
Min. Negotiated Rate $14,119.00
Max. Negotiated Rate $201,700.00
Rate for Payer: Aetna Commercial $45,382.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $43,365.50
Rate for Payer: Aetna Managed Medicare $14,119.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $32,776.25
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $25,212.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24,204.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $26,725.25
Rate for Payer: Cash Price $15,127.50
Rate for Payer: Cigna Commercial $46,391.00
Rate for Payer: Dean Health DHI/DHP/ASO $28,217.83
Rate for Payer: Health EOS Commercial $44,878.25
Rate for Payer: HFN Commercial $46,391.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $37,818.75
Rate for Payer: Multiplan Commercial $40,340.00
Rate for Payer: NAPHCARE Commercial $30,255.00
Rate for Payer: Preferred Network Access Commercial $46,391.00
Rate for Payer: Quartz Beloit One Network $24,708.25
Rate for Payer: Quartz Commercial $32,776.25
Rate for Payer: Quartz Medicare Advantage $30,255.00
Rate for Payer: The Alliance Commercial $201,700.00
Rate for Payer: WEA Trust Commercial $27,733.75
Rate for Payer: WPS Commercial $37,349.80
Hospital Charge Code 6049662
Hospital Revenue Code 278
Min. Negotiated Rate $24,708.25
Max. Negotiated Rate $46,391.00
Rate for Payer: Aetna Commercial $45,382.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $43,365.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $26,725.25
Rate for Payer: Cash Price $15,127.50
Rate for Payer: Cigna Commercial $46,391.00
Rate for Payer: Health EOS Commercial $44,878.25
Rate for Payer: HFN Commercial $46,391.00
Rate for Payer: Multiplan Commercial $40,340.00
Rate for Payer: NAPHCARE Commercial $30,255.00
Rate for Payer: Preferred Network Access Commercial $46,391.00
Rate for Payer: Quartz Beloit One Network $24,708.25
Rate for Payer: Quartz Commercial $30,255.00
Rate for Payer: WEA Trust Commercial $27,733.75
Rate for Payer: WPS Commercial $37,349.80
Service Code CPT 82657
Hospital Charge Code 3579519
Hospital Revenue Code 300
Min. Negotiated Rate $22.17
Max. Negotiated Rate $265.88
Rate for Payer: Aetna Commercial $260.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $248.54
Rate for Payer: Aetna Managed Medicare $22.17
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $83.14
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $38.80
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $36.80
Rate for Payer: Anthem Medicaid $22.91
Rate for Payer: Anthem Medicare Advantage $22.17
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $153.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $22.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $22.17
Rate for Payer: Cash Price $86.70
Rate for Payer: Cash Price $86.70
Rate for Payer: Cigna Commercial $265.88
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $22.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $22.91
Rate for Payer: Dean Health DHI/DHP/ASO $161.72
Rate for Payer: Dean Health Medicaid $22.91
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $22.17
Rate for Payer: Health EOS Commercial $257.21
Rate for Payer: HFN Commercial $265.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $82.47
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $22.17
Rate for Payer: Independent Care Health Plan Medicaid $22.91
Rate for Payer: Independent Care Health Plan Medicare $22.17
Rate for Payer: Managed Health Services Medicaid $23.83
Rate for Payer: Managed Health Services Medicare Advantage $22.17
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $22.17
Rate for Payer: Multiplan Commercial $231.20
Rate for Payer: NAPHCARE Commercial $33.26
Rate for Payer: Preferred Network Access Commercial $265.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $22.91
Rate for Payer: Quartz Beloit One Network $141.61
Rate for Payer: Quartz Commercial $187.85
Rate for Payer: Quartz Medicare Advantage $22.17
Rate for Payer: The Alliance Commercial $88.68
Rate for Payer: United Healthcare Medicaid $22.91
Rate for Payer: United Healthcare Medicare Advantage $22.17
Rate for Payer: United Healthcare PPO $216.75
Rate for Payer: WEA Trust Commercial $158.95
Rate for Payer: Wellcare Medicare $22.17
Rate for Payer: WMAP Medicaid $22.91
Rate for Payer: WPS Commercial $214.06
Service Code CPT 82657
Hospital Charge Code 3579519
Hospital Revenue Code 300
Min. Negotiated Rate $78.26
Max. Negotiated Rate $274.55
Rate for Payer: Aetna Commercial $274.55
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $248.54
Rate for Payer: Cash Price $86.70
Rate for Payer: Cash Price $86.70
Rate for Payer: Cigna Commercial $274.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $144.50
Rate for Payer: Dean Health DHI/DHP/ASO $173.40
Rate for Payer: Health EOS Commercial $262.99
Rate for Payer: HFN Commercial $274.55
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $78.26
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $78.26
Rate for Payer: Multiplan Commercial $231.20
Rate for Payer: Preferred Network Access Commercial $274.55
Rate for Payer: Quartz Beloit One Network $127.16
Rate for Payer: Quartz Commercial $164.73
Rate for Payer: The Alliance Commercial $144.50
Rate for Payer: WEA Trust Commercial $158.95
Rate for Payer: WPS Commercial $214.06
Service Code CPT 82657
Hospital Charge Code 3579519
Hospital Revenue Code 300
Min. Negotiated Rate $141.61
Max. Negotiated Rate $265.88
Rate for Payer: Aetna Commercial $260.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $248.54
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $153.17
Rate for Payer: Cash Price $86.70
Rate for Payer: Cigna Commercial $265.88
Rate for Payer: Health EOS Commercial $257.21
Rate for Payer: HFN Commercial $265.88
Rate for Payer: Multiplan Commercial $231.20
Rate for Payer: NAPHCARE Commercial $173.40
Rate for Payer: Preferred Network Access Commercial $265.88
Rate for Payer: Quartz Beloit One Network $141.61
Rate for Payer: Quartz Commercial $173.40
Rate for Payer: WEA Trust Commercial $158.95
Rate for Payer: WPS Commercial $214.06
Service Code CPT 99211
Hospital Charge Code 3000436
Hospital Revenue Code 514
Min. Negotiated Rate $35.84
Max. Negotiated Rate $512.00
Rate for Payer: Aetna Commercial $115.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $110.08
Rate for Payer: Aetna Managed Medicare $35.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $83.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $64.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $61.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $67.84
Rate for Payer: Cash Price $38.40
Rate for Payer: Cigna Commercial $117.76
Rate for Payer: Dean Health DHI/DHP/ASO $71.63
Rate for Payer: Health EOS Commercial $113.92
Rate for Payer: HFN Commercial $117.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $96.00
Rate for Payer: Multiplan Commercial $102.40
Rate for Payer: NAPHCARE Commercial $76.80
Rate for Payer: Preferred Network Access Commercial $117.76
Rate for Payer: Quartz Beloit One Network $62.72
Rate for Payer: Quartz Commercial $83.20
Rate for Payer: Quartz Medicare Advantage $76.80
Rate for Payer: The Alliance Commercial $512.00
Rate for Payer: WEA Trust Commercial $70.40
Rate for Payer: WPS Commercial $94.81
Service Code CPT 99211
Hospital Charge Code 3000436
Hospital Revenue Code 514
Min. Negotiated Rate $62.72
Max. Negotiated Rate $117.76
Rate for Payer: Aetna Commercial $115.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $110.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $67.84
Rate for Payer: Cash Price $38.40
Rate for Payer: Cigna Commercial $117.76
Rate for Payer: Health EOS Commercial $113.92
Rate for Payer: HFN Commercial $117.76
Rate for Payer: Multiplan Commercial $102.40
Rate for Payer: NAPHCARE Commercial $76.80
Rate for Payer: Preferred Network Access Commercial $117.76
Rate for Payer: Quartz Beloit One Network $62.72
Rate for Payer: Quartz Commercial $76.80
Rate for Payer: WEA Trust Commercial $70.40
Rate for Payer: WPS Commercial $94.81
Service Code CPT 99211
Hospital Charge Code 5356647
Hospital Revenue Code 510
Min. Negotiated Rate $44.24
Max. Negotiated Rate $632.00
Rate for Payer: Aetna Commercial $142.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $135.88
Rate for Payer: Aetna Managed Medicare $44.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $102.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $79.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $75.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $83.74
Rate for Payer: Cash Price $47.40
Rate for Payer: Cigna Commercial $145.36
Rate for Payer: Dean Health DHI/DHP/ASO $88.42
Rate for Payer: Health EOS Commercial $140.62
Rate for Payer: HFN Commercial $145.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $118.50
Rate for Payer: Multiplan Commercial $126.40
Rate for Payer: NAPHCARE Commercial $94.80
Rate for Payer: Preferred Network Access Commercial $145.36
Rate for Payer: Quartz Beloit One Network $77.42
Rate for Payer: Quartz Commercial $102.70
Rate for Payer: Quartz Medicare Advantage $94.80
Rate for Payer: The Alliance Commercial $632.00
Rate for Payer: WEA Trust Commercial $86.90
Rate for Payer: WPS Commercial $117.03
Service Code CPT 99211
Hospital Charge Code 5356647
Hospital Revenue Code 510
Min. Negotiated Rate $77.42
Max. Negotiated Rate $145.36
Rate for Payer: Aetna Commercial $142.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $135.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $83.74
Rate for Payer: Cash Price $47.40
Rate for Payer: Cigna Commercial $145.36
Rate for Payer: Health EOS Commercial $140.62
Rate for Payer: HFN Commercial $145.36
Rate for Payer: Multiplan Commercial $126.40
Rate for Payer: NAPHCARE Commercial $94.80
Rate for Payer: Preferred Network Access Commercial $145.36
Rate for Payer: Quartz Beloit One Network $77.42
Rate for Payer: Quartz Commercial $94.80
Rate for Payer: WEA Trust Commercial $86.90
Rate for Payer: WPS Commercial $117.03
Service Code CPT 99211
Hospital Charge Code 5356646
Hospital Revenue Code 514
Min. Negotiated Rate $54.32
Max. Negotiated Rate $776.00
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Aetna Managed Medicare $54.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $126.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $97.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $93.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Dean Health DHI/DHP/ASO $108.56
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $145.50
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $116.40
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $126.10
Rate for Payer: Quartz Medicare Advantage $116.40
Rate for Payer: The Alliance Commercial $776.00
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Service Code CPT 99211
Hospital Charge Code 5356646
Hospital Revenue Code 514
Min. Negotiated Rate $95.06
Max. Negotiated Rate $178.48
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $116.40
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $116.40
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Service Code CPT 99211
Hospital Charge Code 5356648
Hospital Revenue Code 514
Min. Negotiated Rate $35.84
Max. Negotiated Rate $512.00
Rate for Payer: Aetna Commercial $115.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $110.08
Rate for Payer: Aetna Managed Medicare $35.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $83.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $64.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $61.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $67.84
Rate for Payer: Cash Price $38.40
Rate for Payer: Cigna Commercial $117.76
Rate for Payer: Dean Health DHI/DHP/ASO $71.63
Rate for Payer: Health EOS Commercial $113.92
Rate for Payer: HFN Commercial $117.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $96.00
Rate for Payer: Multiplan Commercial $102.40
Rate for Payer: NAPHCARE Commercial $76.80
Rate for Payer: Preferred Network Access Commercial $117.76
Rate for Payer: Quartz Beloit One Network $62.72
Rate for Payer: Quartz Commercial $83.20
Rate for Payer: Quartz Medicare Advantage $76.80
Rate for Payer: The Alliance Commercial $512.00
Rate for Payer: WEA Trust Commercial $70.40
Rate for Payer: WPS Commercial $94.81
Service Code CPT 99211
Hospital Charge Code 5356648
Hospital Revenue Code 514
Min. Negotiated Rate $62.72
Max. Negotiated Rate $117.76
Rate for Payer: Aetna Commercial $115.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $110.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $67.84
Rate for Payer: Cash Price $38.40
Rate for Payer: Cigna Commercial $117.76
Rate for Payer: Health EOS Commercial $113.92
Rate for Payer: HFN Commercial $117.76
Rate for Payer: Multiplan Commercial $102.40
Rate for Payer: NAPHCARE Commercial $76.80
Rate for Payer: Preferred Network Access Commercial $117.76
Rate for Payer: Quartz Beloit One Network $62.72
Rate for Payer: Quartz Commercial $76.80
Rate for Payer: WEA Trust Commercial $70.40
Rate for Payer: WPS Commercial $94.81
Service Code CPT 99202
Hospital Charge Code 3228203
Hospital Revenue Code 272
Min. Negotiated Rate $54.88
Max. Negotiated Rate $784.00
Rate for Payer: Aetna Commercial $176.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $168.56
Rate for Payer: Aetna Managed Medicare $54.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $127.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $98.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $94.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $103.88
Rate for Payer: Cash Price $58.80
Rate for Payer: Cigna Commercial $180.32
Rate for Payer: Dean Health DHI/DHP/ASO $109.68
Rate for Payer: Health EOS Commercial $174.44
Rate for Payer: HFN Commercial $180.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $147.00
Rate for Payer: Multiplan Commercial $156.80
Rate for Payer: NAPHCARE Commercial $117.60
Rate for Payer: Preferred Network Access Commercial $180.32
Rate for Payer: Quartz Beloit One Network $96.04
Rate for Payer: Quartz Commercial $127.40
Rate for Payer: Quartz Medicare Advantage $117.60
Rate for Payer: The Alliance Commercial $784.00
Rate for Payer: WEA Trust Commercial $107.80
Rate for Payer: WPS Commercial $145.18
Service Code CPT 99202
Hospital Charge Code 3228203
Hospital Revenue Code 272
Min. Negotiated Rate $96.04
Max. Negotiated Rate $180.32
Rate for Payer: Aetna Commercial $176.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $168.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $103.88
Rate for Payer: Cash Price $58.80
Rate for Payer: Cigna Commercial $180.32
Rate for Payer: Health EOS Commercial $174.44
Rate for Payer: HFN Commercial $180.32
Rate for Payer: Multiplan Commercial $156.80
Rate for Payer: NAPHCARE Commercial $117.60
Rate for Payer: Preferred Network Access Commercial $180.32
Rate for Payer: Quartz Beloit One Network $96.04
Rate for Payer: Quartz Commercial $117.60
Rate for Payer: WEA Trust Commercial $107.80
Rate for Payer: WPS Commercial $145.18
Hospital Charge Code 2967757
Hospital Revenue Code 278
Min. Negotiated Rate $1,337.84
Max. Negotiated Rate $19,112.00
Rate for Payer: Aetna Commercial $4,300.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,109.08
Rate for Payer: Aetna Managed Medicare $1,337.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,105.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,389.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,293.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,532.34
Rate for Payer: Cash Price $1,433.40
Rate for Payer: Cigna Commercial $4,395.76
Rate for Payer: Dean Health DHI/DHP/ASO $2,673.77
Rate for Payer: Health EOS Commercial $4,252.42
Rate for Payer: HFN Commercial $4,395.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,583.50
Rate for Payer: Multiplan Commercial $3,822.40
Rate for Payer: NAPHCARE Commercial $2,866.80
Rate for Payer: Preferred Network Access Commercial $4,395.76
Rate for Payer: Quartz Beloit One Network $2,341.22
Rate for Payer: Quartz Commercial $3,105.70
Rate for Payer: Quartz Medicare Advantage $2,866.80
Rate for Payer: The Alliance Commercial $19,112.00
Rate for Payer: WEA Trust Commercial $2,627.90
Rate for Payer: WPS Commercial $3,539.06
Hospital Charge Code 2967757
Hospital Revenue Code 278
Min. Negotiated Rate $2,341.22
Max. Negotiated Rate $4,395.76
Rate for Payer: Aetna Commercial $4,300.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,109.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,532.34
Rate for Payer: Cash Price $1,433.40
Rate for Payer: Cigna Commercial $4,395.76
Rate for Payer: Health EOS Commercial $4,252.42
Rate for Payer: HFN Commercial $4,395.76
Rate for Payer: Multiplan Commercial $3,822.40
Rate for Payer: NAPHCARE Commercial $2,866.80
Rate for Payer: Preferred Network Access Commercial $4,395.76
Rate for Payer: Quartz Beloit One Network $2,341.22
Rate for Payer: Quartz Commercial $2,866.80
Rate for Payer: WEA Trust Commercial $2,627.90
Rate for Payer: WPS Commercial $3,539.06
Service Code HCPCS J7307
Hospital Charge Code 2958857
Hospital Revenue Code 636
Min. Negotiated Rate $771.75
Max. Negotiated Rate $1,449.00
Rate for Payer: Aetna Commercial $1,417.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,354.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $834.75
Rate for Payer: Cash Price $472.50
Rate for Payer: Cigna Commercial $1,449.00
Rate for Payer: Health EOS Commercial $1,401.75
Rate for Payer: HFN Commercial $1,449.00
Rate for Payer: Multiplan Commercial $1,260.00
Rate for Payer: NAPHCARE Commercial $945.00
Rate for Payer: Preferred Network Access Commercial $1,449.00
Rate for Payer: Quartz Beloit One Network $771.75
Rate for Payer: Quartz Commercial $945.00
Rate for Payer: WEA Trust Commercial $866.25
Rate for Payer: WPS Commercial $1,166.60
Service Code HCPCS J7307
Hospital Charge Code 2958857
Hospital Revenue Code 636
Min. Negotiated Rate $693.00
Max. Negotiated Rate $1,496.25
Rate for Payer: Aetna Commercial $1,496.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,354.50
Rate for Payer: Anthem Commercial $981.56
Rate for Payer: Cash Price $472.50
Rate for Payer: Cash Price $472.50
Rate for Payer: Cigna Commercial $1,496.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $1,156.28
Rate for Payer: Dean Health DHI/DHP/ASO $945.00
Rate for Payer: Health EOS Commercial $1,433.25
Rate for Payer: HFN Commercial $1,496.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,468.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,468.91
Rate for Payer: Multiplan Commercial $1,260.00
Rate for Payer: Preferred Network Access Commercial $1,496.25
Rate for Payer: Quartz Beloit One Network $693.00
Rate for Payer: Quartz Commercial $897.75
Rate for Payer: The Alliance Commercial $787.50
Rate for Payer: United Healthcare Medicaid $1,156.28
Rate for Payer: WEA Trust Commercial $866.25
Rate for Payer: WPS Commercial $1,166.60
Service Code HCPCS J7307
Hospital Charge Code 2958857
Hospital Revenue Code 636
Min. Negotiated Rate $441.00
Max. Negotiated Rate $6,300.00
Rate for Payer: Aetna Commercial $1,417.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,354.50
Rate for Payer: Aetna Managed Medicare $441.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,023.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $787.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $756.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $834.75
Rate for Payer: Cash Price $472.50
Rate for Payer: Cigna Commercial $1,449.00
Rate for Payer: Dean Health DHI/DHP/ASO $881.37
Rate for Payer: Health EOS Commercial $1,401.75
Rate for Payer: HFN Commercial $1,449.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,181.25
Rate for Payer: Multiplan Commercial $1,260.00
Rate for Payer: NAPHCARE Commercial $945.00
Rate for Payer: Preferred Network Access Commercial $1,449.00
Rate for Payer: Quartz Beloit One Network $771.75
Rate for Payer: Quartz Commercial $1,023.75
Rate for Payer: Quartz Medicare Advantage $945.00
Rate for Payer: The Alliance Commercial $6,300.00
Rate for Payer: WEA Trust Commercial $866.25
Rate for Payer: WPS Commercial $1,166.60