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Charge Type Setting Price  
Service Code MSDRG 301
Min. Negotiated Rate $6,903.29
Max. Negotiated Rate $19,191.00
Rate for Payer: Aetna Managed Medicare $6,903.29
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $14,895.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $11,417.51
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $10,847.38
Rate for Payer: Anthem Medicare Advantage $6,903.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $6,903.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $6,903.29
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $6,903.29
Rate for Payer: Dean Health DHI/DHP/ASO $12,041.59
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $6,903.29
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13,841.10
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $6,903.29
Rate for Payer: Independent Care Health Plan Medicare $6,903.29
Rate for Payer: Managed Health Services Medicare Advantage $6,903.29
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $6,903.29
Rate for Payer: NAPHCARE Commercial $10,354.94
Rate for Payer: Quartz Medicare Advantage $6,903.29
Rate for Payer: The Alliance Commercial $19,191.00
Rate for Payer: United Healthcare Medicare Advantage $6,903.29
Rate for Payer: United Healthcare PPO $10,775.47
Rate for Payer: Wellcare Medicare $6,903.29
Service Code CPT 93286 26
Hospital Charge Code 3015360
Hospital Revenue Code 510
Min. Negotiated Rate $52.39
Max. Negotiated Rate $202.35
Rate for Payer: Aetna Commercial $202.35
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $183.18
Rate for Payer: Cash Price $63.90
Rate for Payer: Cash Price $63.90
Rate for Payer: Cigna Commercial $202.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $106.50
Rate for Payer: Dean Health DHI/DHP/ASO $127.80
Rate for Payer: Health EOS Commercial $193.83
Rate for Payer: HFN Commercial $202.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $52.39
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $52.39
Rate for Payer: Multiplan Commercial $170.40
Rate for Payer: Preferred Network Access Commercial $202.35
Rate for Payer: Quartz Beloit One Network $93.72
Rate for Payer: Quartz Commercial $121.41
Rate for Payer: The Alliance Commercial $106.50
Rate for Payer: WEA Trust Commercial $117.15
Rate for Payer: WPS Commercial $157.77
Service Code HCPCS Q4100
Hospital Charge Code 5917673
Hospital Revenue Code 278
Min. Negotiated Rate $715.96
Max. Negotiated Rate $10,228.00
Rate for Payer: Aetna Commercial $2,301.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,199.02
Rate for Payer: Aetna Managed Medicare $715.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,662.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,278.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,227.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,355.21
Rate for Payer: Cash Price $767.10
Rate for Payer: Cigna Commercial $2,352.44
Rate for Payer: Dean Health DHI/DHP/ASO $1,430.90
Rate for Payer: Health EOS Commercial $2,275.73
Rate for Payer: HFN Commercial $2,352.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,917.75
Rate for Payer: Multiplan Commercial $2,045.60
Rate for Payer: NAPHCARE Commercial $1,534.20
Rate for Payer: Preferred Network Access Commercial $2,352.44
Rate for Payer: Quartz Beloit One Network $1,252.93
Rate for Payer: Quartz Commercial $1,662.05
Rate for Payer: Quartz Medicare Advantage $1,534.20
Rate for Payer: The Alliance Commercial $10,228.00
Rate for Payer: WEA Trust Commercial $1,406.35
Rate for Payer: WPS Commercial $1,893.97
Service Code HCPCS Q4100
Hospital Charge Code 5917673
Hospital Revenue Code 278
Min. Negotiated Rate $1,252.93
Max. Negotiated Rate $2,352.44
Rate for Payer: Aetna Commercial $2,301.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,199.02
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,355.21
Rate for Payer: Cash Price $767.10
Rate for Payer: Cigna Commercial $2,352.44
Rate for Payer: Health EOS Commercial $2,275.73
Rate for Payer: HFN Commercial $2,352.44
Rate for Payer: Multiplan Commercial $2,045.60
Rate for Payer: NAPHCARE Commercial $1,534.20
Rate for Payer: Preferred Network Access Commercial $2,352.44
Rate for Payer: Quartz Beloit One Network $1,252.93
Rate for Payer: Quartz Commercial $1,534.20
Rate for Payer: WEA Trust Commercial $1,406.35
Rate for Payer: WPS Commercial $1,893.97
Service Code MSDRG 336
Min. Negotiated Rate $20,248.86
Max. Negotiated Rate $56,292.00
Rate for Payer: Aetna Managed Medicare $20,248.86
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $44,267.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $33,930.91
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $32,236.58
Rate for Payer: Anthem Medicare Advantage $20,248.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $20,248.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $20,248.86
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $20,248.86
Rate for Payer: Dean Health DHI/DHP/ASO $35,785.56
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $20,248.86
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $41,053.35
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $20,248.86
Rate for Payer: Independent Care Health Plan Medicare $20,248.86
Rate for Payer: Managed Health Services Medicare Advantage $20,248.86
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $20,248.86
Rate for Payer: NAPHCARE Commercial $30,373.29
Rate for Payer: Quartz Medicare Advantage $20,248.86
Rate for Payer: The Alliance Commercial $56,292.00
Rate for Payer: United Healthcare Medicare Advantage $20,248.86
Rate for Payer: United Healthcare PPO $31,960.56
Rate for Payer: Wellcare Medicare $20,248.86
Service Code MSDRG 335
Min. Negotiated Rate $34,304.03
Max. Negotiated Rate $95,365.00
Rate for Payer: Aetna Managed Medicare $34,304.03
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $75,108.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $57,569.98
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $54,695.24
Rate for Payer: Anthem Medicare Advantage $34,304.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $34,304.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $34,304.03
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $34,304.03
Rate for Payer: Dean Health DHI/DHP/ASO $60,716.73
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $34,304.03
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $69,712.50
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $34,304.03
Rate for Payer: Independent Care Health Plan Medicare $34,304.03
Rate for Payer: Managed Health Services Medicare Advantage $34,304.03
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $34,304.03
Rate for Payer: NAPHCARE Commercial $51,456.04
Rate for Payer: Quartz Medicare Advantage $34,304.03
Rate for Payer: The Alliance Commercial $95,365.00
Rate for Payer: United Healthcare Medicare Advantage $34,304.03
Rate for Payer: United Healthcare PPO $54,272.08
Rate for Payer: Wellcare Medicare $34,304.03
Service Code MSDRG 337
Min. Negotiated Rate $14,425.77
Max. Negotiated Rate $40,104.00
Rate for Payer: Aetna Managed Medicare $14,425.77
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $31,470.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $24,121.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $22,917.00
Rate for Payer: Anthem Medicare Advantage $14,425.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $14,425.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $14,425.77
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $14,425.77
Rate for Payer: Dean Health DHI/DHP/ASO $25,439.97
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $14,425.77
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $29,179.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $14,425.77
Rate for Payer: Independent Care Health Plan Medicare $14,425.77
Rate for Payer: Managed Health Services Medicare Advantage $14,425.77
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $14,425.77
Rate for Payer: NAPHCARE Commercial $21,638.66
Rate for Payer: Quartz Medicare Advantage $14,425.77
Rate for Payer: The Alliance Commercial $40,104.00
Rate for Payer: United Healthcare Medicare Advantage $14,425.77
Rate for Payer: United Healthcare PPO $22,716.85
Rate for Payer: Wellcare Medicare $14,425.77
Service Code HCPCS C1729
Hospital Charge Code 5364787
Hospital Revenue Code 621
Min. Negotiated Rate $1,227.60
Max. Negotiated Rate $2,650.50
Rate for Payer: Aetna Commercial $2,650.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,399.40
Rate for Payer: Cash Price $837.00
Rate for Payer: Cigna Commercial $2,650.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $1,395.00
Rate for Payer: Dean Health DHI/DHP/ASO $1,674.00
Rate for Payer: Health EOS Commercial $2,538.90
Rate for Payer: HFN Commercial $2,650.50
Rate for Payer: Multiplan Commercial $2,232.00
Rate for Payer: Preferred Network Access Commercial $2,650.50
Rate for Payer: Quartz Beloit One Network $1,227.60
Rate for Payer: Quartz Commercial $1,590.30
Rate for Payer: The Alliance Commercial $1,395.00
Rate for Payer: WEA Trust Commercial $1,534.50
Rate for Payer: WPS Commercial $2,066.55
Service Code HCPCS C1729
Hospital Charge Code 5364787
Hospital Revenue Code 621
Min. Negotiated Rate $1,367.10
Max. Negotiated Rate $2,566.80
Rate for Payer: Aetna Commercial $2,511.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,399.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,478.70
Rate for Payer: Cash Price $837.00
Rate for Payer: Cigna Commercial $2,566.80
Rate for Payer: Health EOS Commercial $2,483.10
Rate for Payer: HFN Commercial $2,566.80
Rate for Payer: Multiplan Commercial $2,232.00
Rate for Payer: NAPHCARE Commercial $1,674.00
Rate for Payer: Preferred Network Access Commercial $2,566.80
Rate for Payer: Quartz Beloit One Network $1,367.10
Rate for Payer: Quartz Commercial $1,674.00
Rate for Payer: WEA Trust Commercial $1,534.50
Rate for Payer: WPS Commercial $2,066.55
Service Code HCPCS C1729
Hospital Charge Code 5364787
Hospital Revenue Code 621
Min. Negotiated Rate $781.20
Max. Negotiated Rate $11,160.00
Rate for Payer: Aetna Commercial $2,511.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,399.40
Rate for Payer: Aetna Managed Medicare $781.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,813.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,395.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,339.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,478.70
Rate for Payer: Cash Price $837.00
Rate for Payer: Cigna Commercial $2,566.80
Rate for Payer: Dean Health DHI/DHP/ASO $1,561.28
Rate for Payer: Health EOS Commercial $2,483.10
Rate for Payer: HFN Commercial $2,566.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,092.50
Rate for Payer: Multiplan Commercial $2,232.00
Rate for Payer: NAPHCARE Commercial $1,674.00
Rate for Payer: Preferred Network Access Commercial $2,566.80
Rate for Payer: Quartz Beloit One Network $1,367.10
Rate for Payer: Quartz Commercial $1,813.50
Rate for Payer: Quartz Medicare Advantage $1,674.00
Rate for Payer: The Alliance Commercial $11,160.00
Rate for Payer: WEA Trust Commercial $1,534.50
Rate for Payer: WPS Commercial $2,066.55
Hospital Charge Code 3603568
Hospital Revenue Code 271
Min. Negotiated Rate $900.62
Max. Negotiated Rate $1,690.96
Rate for Payer: Aetna Commercial $1,654.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,580.68
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $974.14
Rate for Payer: Cash Price $551.40
Rate for Payer: Cigna Commercial $1,690.96
Rate for Payer: Health EOS Commercial $1,635.82
Rate for Payer: HFN Commercial $1,690.96
Rate for Payer: Multiplan Commercial $1,470.40
Rate for Payer: NAPHCARE Commercial $1,102.80
Rate for Payer: Preferred Network Access Commercial $1,690.96
Rate for Payer: Quartz Beloit One Network $900.62
Rate for Payer: Quartz Commercial $1,102.80
Rate for Payer: WEA Trust Commercial $1,010.90
Rate for Payer: WPS Commercial $1,361.41
Hospital Charge Code 3603568
Hospital Revenue Code 271
Min. Negotiated Rate $514.64
Max. Negotiated Rate $7,352.00
Rate for Payer: Aetna Commercial $1,654.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,580.68
Rate for Payer: Aetna Managed Medicare $514.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,194.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $919.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $882.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $974.14
Rate for Payer: Cash Price $551.40
Rate for Payer: Cigna Commercial $1,690.96
Rate for Payer: Dean Health DHI/DHP/ASO $1,028.54
Rate for Payer: Health EOS Commercial $1,635.82
Rate for Payer: HFN Commercial $1,690.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,378.50
Rate for Payer: Multiplan Commercial $1,470.40
Rate for Payer: NAPHCARE Commercial $1,102.80
Rate for Payer: Preferred Network Access Commercial $1,690.96
Rate for Payer: Quartz Beloit One Network $900.62
Rate for Payer: Quartz Commercial $1,194.70
Rate for Payer: Quartz Medicare Advantage $1,102.80
Rate for Payer: The Alliance Commercial $7,352.00
Rate for Payer: WEA Trust Commercial $1,010.90
Rate for Payer: WPS Commercial $1,361.41
Service Code CPT 49329
Hospital Charge Code 6178394
Hospital Revenue Code 510
Min. Negotiated Rate $294.80
Max. Negotiated Rate $636.50
Rate for Payer: Aetna Commercial $636.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $576.20
Rate for Payer: Cash Price $201.00
Rate for Payer: Cash Price $201.00
Rate for Payer: Cigna Commercial $636.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $335.00
Rate for Payer: Dean Health DHI/DHP/ASO $402.00
Rate for Payer: Health EOS Commercial $609.70
Rate for Payer: HFN Commercial $636.50
Rate for Payer: Multiplan Commercial $536.00
Rate for Payer: Preferred Network Access Commercial $636.50
Rate for Payer: Quartz Beloit One Network $294.80
Rate for Payer: Quartz Commercial $381.90
Rate for Payer: The Alliance Commercial $335.00
Rate for Payer: WEA Trust Commercial $368.50
Rate for Payer: WPS Commercial $496.27
Service Code HCPCS C1729
Hospital Charge Code 4538649
Hospital Revenue Code 272
Min. Negotiated Rate $561.12
Max. Negotiated Rate $8,016.00
Rate for Payer: Aetna Commercial $1,803.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,723.44
Rate for Payer: Aetna Managed Medicare $561.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,302.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,002.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $961.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,062.12
Rate for Payer: Cash Price $601.20
Rate for Payer: Cigna Commercial $1,843.68
Rate for Payer: Dean Health DHI/DHP/ASO $1,121.44
Rate for Payer: Health EOS Commercial $1,783.56
Rate for Payer: HFN Commercial $1,843.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,503.00
Rate for Payer: Multiplan Commercial $1,603.20
Rate for Payer: NAPHCARE Commercial $1,202.40
Rate for Payer: Preferred Network Access Commercial $1,843.68
Rate for Payer: Quartz Beloit One Network $981.96
Rate for Payer: Quartz Commercial $1,302.60
Rate for Payer: Quartz Medicare Advantage $1,202.40
Rate for Payer: The Alliance Commercial $8,016.00
Rate for Payer: WEA Trust Commercial $1,102.20
Rate for Payer: WPS Commercial $1,484.36
Service Code HCPCS C1729
Hospital Charge Code 4538649
Hospital Revenue Code 272
Min. Negotiated Rate $981.96
Max. Negotiated Rate $1,843.68
Rate for Payer: Aetna Commercial $1,803.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,723.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,062.12
Rate for Payer: Cash Price $601.20
Rate for Payer: Cigna Commercial $1,843.68
Rate for Payer: Health EOS Commercial $1,783.56
Rate for Payer: HFN Commercial $1,843.68
Rate for Payer: Multiplan Commercial $1,603.20
Rate for Payer: NAPHCARE Commercial $1,202.40
Rate for Payer: Preferred Network Access Commercial $1,843.68
Rate for Payer: Quartz Beloit One Network $981.96
Rate for Payer: Quartz Commercial $1,202.40
Rate for Payer: WEA Trust Commercial $1,102.20
Rate for Payer: WPS Commercial $1,484.36
Service Code MSDRG 243
Min. Negotiated Rate $21,896.63
Max. Negotiated Rate $60,873.00
Rate for Payer: Aetna Managed Medicare $21,896.63
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $47,834.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $36,664.68
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $34,833.84
Rate for Payer: Anthem Medicare Advantage $21,896.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $21,896.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $21,896.63
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $21,896.63
Rate for Payer: Dean Health DHI/DHP/ASO $38,668.75
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $21,896.63
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $44,413.20
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $21,896.63
Rate for Payer: Independent Care Health Plan Medicare $21,896.63
Rate for Payer: Managed Health Services Medicare Advantage $21,896.63
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $21,896.63
Rate for Payer: NAPHCARE Commercial $32,844.94
Rate for Payer: Quartz Medicare Advantage $21,896.63
Rate for Payer: The Alliance Commercial $60,873.00
Rate for Payer: United Healthcare Medicare Advantage $21,896.63
Rate for Payer: United Healthcare PPO $34,576.25
Rate for Payer: Wellcare Medicare $21,896.63
Service Code MSDRG 242
Min. Negotiated Rate $33,157.40
Max. Negotiated Rate $92,178.00
Rate for Payer: Aetna Managed Medicare $33,157.40
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $72,590.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $55,640.26
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $52,861.88
Rate for Payer: Anthem Medicare Advantage $33,157.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $33,157.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $33,157.40
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $33,157.40
Rate for Payer: Dean Health DHI/DHP/ASO $58,681.53
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $33,157.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $67,374.45
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $33,157.40
Rate for Payer: Independent Care Health Plan Medicare $33,157.40
Rate for Payer: Managed Health Services Medicare Advantage $33,157.40
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $33,157.40
Rate for Payer: NAPHCARE Commercial $49,736.10
Rate for Payer: Quartz Medicare Advantage $33,157.40
Rate for Payer: The Alliance Commercial $92,178.00
Rate for Payer: United Healthcare Medicare Advantage $33,157.40
Rate for Payer: United Healthcare PPO $52,451.87
Rate for Payer: Wellcare Medicare $33,157.40
Service Code MSDRG 244
Min. Negotiated Rate $17,611.32
Max. Negotiated Rate $48,959.00
Rate for Payer: Aetna Managed Medicare $17,611.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $38,393.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $29,428.23
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $27,958.74
Rate for Payer: Anthem Medicare Advantage $17,611.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $17,611.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $17,611.32
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $17,611.32
Rate for Payer: Dean Health DHI/DHP/ASO $31,036.76
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $17,611.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $35,675.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $17,611.32
Rate for Payer: Independent Care Health Plan Medicare $17,611.32
Rate for Payer: Managed Health Services Medicare Advantage $17,611.32
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $17,611.32
Rate for Payer: NAPHCARE Commercial $26,416.98
Rate for Payer: Quartz Medicare Advantage $17,611.32
Rate for Payer: The Alliance Commercial $48,959.00
Rate for Payer: United Healthcare Medicare Advantage $17,611.32
Rate for Payer: United Healthcare PPO $27,773.64
Rate for Payer: Wellcare Medicare $17,611.32
Service Code HCPCS A4263
Hospital Charge Code 3292171
Hospital Revenue Code 272
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 HCPCS A4263
Hospital Charge Code 3292171
Hospital Revenue Code 272
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 HCPCS A4263
Hospital Charge Code 3292171
Hospital Revenue Code 272
Min. Negotiated Rate $69.52
Max. Negotiated Rate $150.10
Rate for Payer: Aetna Commercial $150.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $135.88
Rate for Payer: Cash Price $47.40
Rate for Payer: Cash Price $47.40
Rate for Payer: Cigna Commercial $150.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $79.00
Rate for Payer: Dean Health DHI/DHP/ASO $94.80
Rate for Payer: Health EOS Commercial $143.78
Rate for Payer: HFN Commercial $150.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $92.84
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $92.84
Rate for Payer: Multiplan Commercial $126.40
Rate for Payer: Preferred Network Access Commercial $150.10
Rate for Payer: Quartz Beloit One Network $69.52
Rate for Payer: Quartz Commercial $90.06
Rate for Payer: The Alliance Commercial $79.00
Rate for Payer: WEA Trust Commercial $86.90
Rate for Payer: WPS Commercial $117.03
Service Code CPT 22510
Hospital Charge Code 6181378
Hospital Revenue Code 510
Min. Negotiated Rate $1,342.87
Max. Negotiated Rate $4,046.05
Rate for Payer: Aetna Commercial $4,046.05
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,662.74
Rate for Payer: Cash Price $1,277.70
Rate for Payer: Cash Price $1,277.70
Rate for Payer: Cigna Commercial $4,046.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $1,342.87
Rate for Payer: Dean Health DHI/DHP/ASO $2,555.40
Rate for Payer: Health EOS Commercial $3,875.69
Rate for Payer: HFN Commercial $4,046.05
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,438.90
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,438.90
Rate for Payer: Multiplan Commercial $3,407.20
Rate for Payer: Preferred Network Access Commercial $4,046.05
Rate for Payer: Quartz Beloit One Network $1,873.96
Rate for Payer: Quartz Commercial $2,427.63
Rate for Payer: The Alliance Commercial $2,129.50
Rate for Payer: United Healthcare Medicaid $1,342.87
Rate for Payer: WEA Trust Commercial $2,342.45
Rate for Payer: WPS Commercial $3,154.64
Service Code CPT 95018
Hospital Charge Code 3529576
Hospital Revenue Code 510
Min. Negotiated Rate $7.26
Max. Negotiated Rate $72.15
Rate for Payer: Aetna Commercial $47.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $43.00
Rate for Payer: Cash Price $15.00
Rate for Payer: Cash Price $15.00
Rate for Payer: Cigna Commercial $47.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $7.26
Rate for Payer: Dean Health DHI/DHP/ASO $30.00
Rate for Payer: Health EOS Commercial $45.50
Rate for Payer: HFN Commercial $47.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $72.15
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $72.15
Rate for Payer: Multiplan Commercial $40.00
Rate for Payer: Preferred Network Access Commercial $47.50
Rate for Payer: Quartz Beloit One Network $22.00
Rate for Payer: Quartz Commercial $28.50
Rate for Payer: The Alliance Commercial $25.00
Rate for Payer: United Healthcare Medicaid $7.26
Rate for Payer: WEA Trust Commercial $27.50
Rate for Payer: WPS Commercial $37.04
Service Code CPT 0201T
Hospital Charge Code 6181383
Hospital Revenue Code 510
Min. Negotiated Rate $1,981.32
Max. Negotiated Rate $6,426.22
Rate for Payer: Aetna Commercial $4,277.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,872.58
Rate for Payer: Cash Price $1,350.90
Rate for Payer: Cash Price $1,350.90
Rate for Payer: Cigna Commercial $4,277.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $2,251.50
Rate for Payer: Dean Health DHI/DHP/ASO $2,701.80
Rate for Payer: Health EOS Commercial $4,097.73
Rate for Payer: HFN Commercial $4,277.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,426.22
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $6,426.22
Rate for Payer: Multiplan Commercial $3,602.40
Rate for Payer: Preferred Network Access Commercial $4,277.85
Rate for Payer: Quartz Beloit One Network $1,981.32
Rate for Payer: Quartz Commercial $2,566.71
Rate for Payer: The Alliance Commercial $2,251.50
Rate for Payer: WEA Trust Commercial $2,476.65
Rate for Payer: WPS Commercial $3,335.37
Service Code CPT 0200T
Hospital Charge Code 6181382
Hospital Revenue Code 510
Min. Negotiated Rate $1,514.04
Max. Negotiated Rate $6,426.22
Rate for Payer: Aetna Commercial $3,268.95
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,959.26
Rate for Payer: Cash Price $1,032.30
Rate for Payer: Cash Price $1,032.30
Rate for Payer: Cigna Commercial $3,268.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $1,720.50
Rate for Payer: Dean Health DHI/DHP/ASO $2,064.60
Rate for Payer: Health EOS Commercial $3,131.31
Rate for Payer: HFN Commercial $3,268.95
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,426.22
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $6,426.22
Rate for Payer: Multiplan Commercial $2,752.80
Rate for Payer: Preferred Network Access Commercial $3,268.95
Rate for Payer: Quartz Beloit One Network $1,514.04
Rate for Payer: Quartz Commercial $1,961.37
Rate for Payer: The Alliance Commercial $1,720.50
Rate for Payer: WEA Trust Commercial $1,892.55
Rate for Payer: WPS Commercial $2,548.75