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Service Code CPT 84100
Hospital Charge Code 633803
Hospital Revenue Code 300
Min. Negotiated Rate $16.73
Max. Negotiated Rate $77.90
Rate for Payer: Aetna Commercial $77.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $70.52
Rate for Payer: Cash Price $24.60
Rate for Payer: Cash Price $24.60
Rate for Payer: Cigna Commercial $77.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $41.00
Rate for Payer: Dean Health DHI/DHP/ASO $49.20
Rate for Payer: Health EOS Commercial $74.62
Rate for Payer: HFN Commercial $77.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $16.73
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $16.73
Rate for Payer: Multiplan Commercial $65.60
Rate for Payer: Preferred Network Access Commercial $77.90
Rate for Payer: Quartz Beloit One Network $36.08
Rate for Payer: Quartz Commercial $46.74
Rate for Payer: The Alliance Commercial $41.00
Rate for Payer: WEA Trust Commercial $45.10
Rate for Payer: WPS Commercial $60.74
Service Code CPT 84100
Hospital Charge Code 633803
Hospital Revenue Code 300
Min. Negotiated Rate $4.74
Max. Negotiated Rate $75.44
Rate for Payer: Aetna Commercial $73.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $70.52
Rate for Payer: Aetna Managed Medicare $4.74
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $17.78
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $8.30
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $7.87
Rate for Payer: Anthem Medicaid $4.90
Rate for Payer: Anthem Medicare Advantage $4.74
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $43.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $4.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $4.74
Rate for Payer: Cash Price $24.60
Rate for Payer: Cash Price $24.60
Rate for Payer: Cigna Commercial $75.44
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $4.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $4.90
Rate for Payer: Dean Health DHI/DHP/ASO $45.89
Rate for Payer: Dean Health Medicaid $4.90
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $4.74
Rate for Payer: Health EOS Commercial $72.98
Rate for Payer: HFN Commercial $75.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $17.63
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $4.74
Rate for Payer: Independent Care Health Plan Medicaid $4.90
Rate for Payer: Independent Care Health Plan Medicare $4.74
Rate for Payer: Managed Health Services Medicaid $5.10
Rate for Payer: Managed Health Services Medicare Advantage $4.74
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $4.74
Rate for Payer: Multiplan Commercial $65.60
Rate for Payer: NAPHCARE Commercial $7.11
Rate for Payer: Preferred Network Access Commercial $75.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $4.90
Rate for Payer: Quartz Beloit One Network $40.18
Rate for Payer: Quartz Commercial $53.30
Rate for Payer: Quartz Medicare Advantage $4.74
Rate for Payer: The Alliance Commercial $18.96
Rate for Payer: United Healthcare Medicaid $4.90
Rate for Payer: United Healthcare Medicare Advantage $4.74
Rate for Payer: United Healthcare PPO $61.50
Rate for Payer: WEA Trust Commercial $45.10
Rate for Payer: Wellcare Medicare $4.74
Rate for Payer: WMAP Medicaid $4.90
Rate for Payer: WPS Commercial $60.74
Service Code CPT 84100
Hospital Charge Code 633803
Hospital Revenue Code 300
Min. Negotiated Rate $40.18
Max. Negotiated Rate $75.44
Rate for Payer: Aetna Commercial $73.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $70.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $43.46
Rate for Payer: Cash Price $24.60
Rate for Payer: Cigna Commercial $75.44
Rate for Payer: Health EOS Commercial $72.98
Rate for Payer: HFN Commercial $75.44
Rate for Payer: Multiplan Commercial $65.60
Rate for Payer: NAPHCARE Commercial $49.20
Rate for Payer: Preferred Network Access Commercial $75.44
Rate for Payer: Quartz Beloit One Network $40.18
Rate for Payer: Quartz Commercial $49.20
Rate for Payer: WEA Trust Commercial $45.10
Rate for Payer: WPS Commercial $60.74
Service Code CPT 84105
Hospital Charge Code 5474690
Hospital Revenue Code 300
Min. Negotiated Rate $13.64
Max. Negotiated Rate $29.45
Rate for Payer: Aetna Commercial $29.45
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $26.66
Rate for Payer: Cash Price $9.30
Rate for Payer: Cash Price $9.30
Rate for Payer: Cigna Commercial $29.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $15.50
Rate for Payer: Dean Health DHI/DHP/ASO $18.60
Rate for Payer: Health EOS Commercial $28.21
Rate for Payer: HFN Commercial $29.45
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $20.40
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $20.40
Rate for Payer: Multiplan Commercial $24.80
Rate for Payer: Preferred Network Access Commercial $29.45
Rate for Payer: Quartz Beloit One Network $13.64
Rate for Payer: Quartz Commercial $17.67
Rate for Payer: The Alliance Commercial $15.50
Rate for Payer: WEA Trust Commercial $17.05
Rate for Payer: WPS Commercial $22.96
Service Code CPT 84105
Hospital Charge Code 5474690
Hospital Revenue Code 300
Min. Negotiated Rate $5.78
Max. Negotiated Rate $28.52
Rate for Payer: Aetna Commercial $27.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $26.66
Rate for Payer: Aetna Managed Medicare $5.78
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $21.68
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $10.12
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $9.59
Rate for Payer: Anthem Medicaid $5.97
Rate for Payer: Anthem Medicare Advantage $5.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5.78
Rate for Payer: Cash Price $9.30
Rate for Payer: Cash Price $9.30
Rate for Payer: Cigna Commercial $28.52
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $5.97
Rate for Payer: Dean Health DHI/DHP/ASO $17.35
Rate for Payer: Dean Health Medicaid $5.97
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5.78
Rate for Payer: Health EOS Commercial $27.59
Rate for Payer: HFN Commercial $28.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21.50
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5.78
Rate for Payer: Independent Care Health Plan Medicaid $5.97
Rate for Payer: Independent Care Health Plan Medicare $5.78
Rate for Payer: Managed Health Services Medicaid $6.21
Rate for Payer: Managed Health Services Medicare Advantage $5.78
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5.78
Rate for Payer: Multiplan Commercial $24.80
Rate for Payer: NAPHCARE Commercial $8.67
Rate for Payer: Preferred Network Access Commercial $28.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $5.97
Rate for Payer: Quartz Beloit One Network $15.19
Rate for Payer: Quartz Commercial $20.15
Rate for Payer: Quartz Medicare Advantage $5.78
Rate for Payer: The Alliance Commercial $23.12
Rate for Payer: United Healthcare Medicaid $5.97
Rate for Payer: United Healthcare Medicare Advantage $5.78
Rate for Payer: United Healthcare PPO $23.25
Rate for Payer: WEA Trust Commercial $17.05
Rate for Payer: Wellcare Medicare $5.78
Rate for Payer: WMAP Medicaid $5.97
Rate for Payer: WPS Commercial $22.96
Service Code CPT 84105
Hospital Charge Code 5474690
Hospital Revenue Code 300
Min. Negotiated Rate $15.19
Max. Negotiated Rate $28.52
Rate for Payer: Aetna Commercial $27.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $26.66
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $16.43
Rate for Payer: Cash Price $9.30
Rate for Payer: Cigna Commercial $28.52
Rate for Payer: Health EOS Commercial $27.59
Rate for Payer: HFN Commercial $28.52
Rate for Payer: Multiplan Commercial $24.80
Rate for Payer: NAPHCARE Commercial $18.60
Rate for Payer: Preferred Network Access Commercial $28.52
Rate for Payer: Quartz Beloit One Network $15.19
Rate for Payer: Quartz Commercial $18.60
Rate for Payer: WEA Trust Commercial $17.05
Rate for Payer: WPS Commercial $22.96
Service Code CPT 67145
Hospital Charge Code 1188906
Hospital Revenue Code 510
Min. Negotiated Rate $411.53
Max. Negotiated Rate $2,006.40
Rate for Payer: Aetna Commercial $2,006.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,816.32
Rate for Payer: Cash Price $633.60
Rate for Payer: Cash Price $633.60
Rate for Payer: Cigna Commercial $2,006.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $411.53
Rate for Payer: Dean Health DHI/DHP/ASO $1,267.20
Rate for Payer: Health EOS Commercial $1,921.92
Rate for Payer: HFN Commercial $2,006.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,668.14
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,668.14
Rate for Payer: Multiplan Commercial $1,689.60
Rate for Payer: Preferred Network Access Commercial $2,006.40
Rate for Payer: Quartz Beloit One Network $929.28
Rate for Payer: Quartz Commercial $1,203.84
Rate for Payer: The Alliance Commercial $1,056.00
Rate for Payer: United Healthcare Medicaid $411.53
Rate for Payer: WEA Trust Commercial $1,161.60
Rate for Payer: WPS Commercial $1,564.36
Hospital Charge Code 3003959
Hospital Revenue Code 230
Min. Negotiated Rate $168.56
Max. Negotiated Rate $2,408.00
Rate for Payer: Aetna Commercial $541.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $517.72
Rate for Payer: Aetna Managed Medicare $168.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $391.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $301.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $288.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $319.06
Rate for Payer: Cash Price $180.60
Rate for Payer: Cigna Commercial $553.84
Rate for Payer: Dean Health DHI/DHP/ASO $336.88
Rate for Payer: Health EOS Commercial $535.78
Rate for Payer: HFN Commercial $553.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $451.50
Rate for Payer: Multiplan Commercial $481.60
Rate for Payer: NAPHCARE Commercial $361.20
Rate for Payer: Preferred Network Access Commercial $553.84
Rate for Payer: Quartz Beloit One Network $294.98
Rate for Payer: Quartz Commercial $391.30
Rate for Payer: Quartz Medicare Advantage $361.20
Rate for Payer: The Alliance Commercial $2,408.00
Rate for Payer: WEA Trust Commercial $331.10
Rate for Payer: WPS Commercial $445.90
Hospital Charge Code 3003959
Hospital Revenue Code 230
Min. Negotiated Rate $294.98
Max. Negotiated Rate $553.84
Rate for Payer: Aetna Commercial $541.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $517.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $319.06
Rate for Payer: Cash Price $180.60
Rate for Payer: Cigna Commercial $553.84
Rate for Payer: Health EOS Commercial $535.78
Rate for Payer: HFN Commercial $553.84
Rate for Payer: Multiplan Commercial $481.60
Rate for Payer: NAPHCARE Commercial $361.20
Rate for Payer: Preferred Network Access Commercial $553.84
Rate for Payer: Quartz Beloit One Network $294.98
Rate for Payer: Quartz Commercial $361.20
Rate for Payer: WEA Trust Commercial $331.10
Rate for Payer: WPS Commercial $445.90
Hospital Charge Code 3003951
Hospital Revenue Code 230
Min. Negotiated Rate $168.56
Max. Negotiated Rate $2,408.00
Rate for Payer: Aetna Commercial $541.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $517.72
Rate for Payer: Aetna Managed Medicare $168.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $391.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $301.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $288.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $319.06
Rate for Payer: Cash Price $180.60
Rate for Payer: Cigna Commercial $553.84
Rate for Payer: Dean Health DHI/DHP/ASO $336.88
Rate for Payer: Health EOS Commercial $535.78
Rate for Payer: HFN Commercial $553.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $451.50
Rate for Payer: Multiplan Commercial $481.60
Rate for Payer: NAPHCARE Commercial $361.20
Rate for Payer: Preferred Network Access Commercial $553.84
Rate for Payer: Quartz Beloit One Network $294.98
Rate for Payer: Quartz Commercial $391.30
Rate for Payer: Quartz Medicare Advantage $361.20
Rate for Payer: The Alliance Commercial $2,408.00
Rate for Payer: WEA Trust Commercial $331.10
Rate for Payer: WPS Commercial $445.90
Hospital Charge Code 3003951
Hospital Revenue Code 230
Min. Negotiated Rate $294.98
Max. Negotiated Rate $553.84
Rate for Payer: Aetna Commercial $541.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $517.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $319.06
Rate for Payer: Cash Price $180.60
Rate for Payer: Cigna Commercial $553.84
Rate for Payer: Health EOS Commercial $535.78
Rate for Payer: HFN Commercial $553.84
Rate for Payer: Multiplan Commercial $481.60
Rate for Payer: NAPHCARE Commercial $361.20
Rate for Payer: Preferred Network Access Commercial $553.84
Rate for Payer: Quartz Beloit One Network $294.98
Rate for Payer: Quartz Commercial $361.20
Rate for Payer: WEA Trust Commercial $331.10
Rate for Payer: WPS Commercial $445.90
Hospital Charge Code 3003958
Hospital Revenue Code 121
Min. Negotiated Rate $126.91
Max. Negotiated Rate $238.28
Rate for Payer: Aetna Commercial $233.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $222.74
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $137.27
Rate for Payer: Cash Price $77.70
Rate for Payer: Cigna Commercial $238.28
Rate for Payer: Health EOS Commercial $230.51
Rate for Payer: HFN Commercial $238.28
Rate for Payer: Multiplan Commercial $207.20
Rate for Payer: NAPHCARE Commercial $155.40
Rate for Payer: Preferred Network Access Commercial $238.28
Rate for Payer: Quartz Beloit One Network $126.91
Rate for Payer: Quartz Commercial $155.40
Rate for Payer: WEA Trust Commercial $142.45
Rate for Payer: WPS Commercial $191.84
Hospital Charge Code 3003950
Hospital Revenue Code 231
Min. Negotiated Rate $77.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Aetna Commercial $247.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $236.50
Rate for Payer: Aetna Managed Medicare $77.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $178.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $137.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $132.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $145.75
Rate for Payer: Cash Price $82.50
Rate for Payer: Cigna Commercial $253.00
Rate for Payer: Dean Health DHI/DHP/ASO $153.89
Rate for Payer: Health EOS Commercial $244.75
Rate for Payer: HFN Commercial $253.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $206.25
Rate for Payer: Multiplan Commercial $220.00
Rate for Payer: NAPHCARE Commercial $165.00
Rate for Payer: Preferred Network Access Commercial $253.00
Rate for Payer: Quartz Beloit One Network $134.75
Rate for Payer: Quartz Commercial $178.75
Rate for Payer: Quartz Medicare Advantage $165.00
Rate for Payer: The Alliance Commercial $1,100.00
Rate for Payer: WEA Trust Commercial $151.25
Rate for Payer: WPS Commercial $203.69
Hospital Charge Code 3003950
Hospital Revenue Code 231
Min. Negotiated Rate $134.75
Max. Negotiated Rate $253.00
Rate for Payer: Aetna Commercial $247.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $236.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $145.75
Rate for Payer: Cash Price $82.50
Rate for Payer: Cigna Commercial $253.00
Rate for Payer: Health EOS Commercial $244.75
Rate for Payer: HFN Commercial $253.00
Rate for Payer: Multiplan Commercial $220.00
Rate for Payer: NAPHCARE Commercial $165.00
Rate for Payer: Preferred Network Access Commercial $253.00
Rate for Payer: Quartz Beloit One Network $134.75
Rate for Payer: Quartz Commercial $165.00
Rate for Payer: WEA Trust Commercial $151.25
Rate for Payer: WPS Commercial $203.69
Hospital Charge Code 3003957
Hospital Revenue Code 230
Min. Negotiated Rate $253.12
Max. Negotiated Rate $3,616.00
Rate for Payer: Aetna Commercial $813.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $777.44
Rate for Payer: Aetna Managed Medicare $253.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $587.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $452.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $433.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $479.12
Rate for Payer: Cash Price $271.20
Rate for Payer: Cigna Commercial $831.68
Rate for Payer: Dean Health DHI/DHP/ASO $505.88
Rate for Payer: Health EOS Commercial $804.56
Rate for Payer: HFN Commercial $831.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $678.00
Rate for Payer: Multiplan Commercial $723.20
Rate for Payer: NAPHCARE Commercial $542.40
Rate for Payer: Preferred Network Access Commercial $831.68
Rate for Payer: Quartz Beloit One Network $442.96
Rate for Payer: Quartz Commercial $587.60
Rate for Payer: Quartz Medicare Advantage $542.40
Rate for Payer: The Alliance Commercial $3,616.00
Rate for Payer: WEA Trust Commercial $497.20
Rate for Payer: WPS Commercial $669.59
Hospital Charge Code 3003957
Hospital Revenue Code 230
Min. Negotiated Rate $442.96
Max. Negotiated Rate $831.68
Rate for Payer: Aetna Commercial $813.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $777.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $479.12
Rate for Payer: Cash Price $271.20
Rate for Payer: Cigna Commercial $831.68
Rate for Payer: Health EOS Commercial $804.56
Rate for Payer: HFN Commercial $831.68
Rate for Payer: Multiplan Commercial $723.20
Rate for Payer: NAPHCARE Commercial $542.40
Rate for Payer: Preferred Network Access Commercial $831.68
Rate for Payer: Quartz Beloit One Network $442.96
Rate for Payer: Quartz Commercial $542.40
Rate for Payer: WEA Trust Commercial $497.20
Rate for Payer: WPS Commercial $669.59
Hospital Charge Code 3003949
Hospital Revenue Code 230
Min. Negotiated Rate $253.12
Max. Negotiated Rate $3,616.00
Rate for Payer: Aetna Commercial $813.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $777.44
Rate for Payer: Aetna Managed Medicare $253.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $587.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $452.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $433.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $479.12
Rate for Payer: Cash Price $271.20
Rate for Payer: Cigna Commercial $831.68
Rate for Payer: Dean Health DHI/DHP/ASO $505.88
Rate for Payer: Health EOS Commercial $804.56
Rate for Payer: HFN Commercial $831.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $678.00
Rate for Payer: Multiplan Commercial $723.20
Rate for Payer: NAPHCARE Commercial $542.40
Rate for Payer: Preferred Network Access Commercial $831.68
Rate for Payer: Quartz Beloit One Network $442.96
Rate for Payer: Quartz Commercial $587.60
Rate for Payer: Quartz Medicare Advantage $542.40
Rate for Payer: The Alliance Commercial $3,616.00
Rate for Payer: WEA Trust Commercial $497.20
Rate for Payer: WPS Commercial $669.59
Hospital Charge Code 3003949
Hospital Revenue Code 230
Min. Negotiated Rate $442.96
Max. Negotiated Rate $831.68
Rate for Payer: Aetna Commercial $813.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $777.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $479.12
Rate for Payer: Cash Price $271.20
Rate for Payer: Cigna Commercial $831.68
Rate for Payer: Health EOS Commercial $804.56
Rate for Payer: HFN Commercial $831.68
Rate for Payer: Multiplan Commercial $723.20
Rate for Payer: NAPHCARE Commercial $542.40
Rate for Payer: Preferred Network Access Commercial $831.68
Rate for Payer: Quartz Beloit One Network $442.96
Rate for Payer: Quartz Commercial $542.40
Rate for Payer: WEA Trust Commercial $497.20
Rate for Payer: WPS Commercial $669.59
Service Code CPT 52648
Hospital Charge Code 2960194
Hospital Revenue Code 360
Min. Negotiated Rate $5,961.83
Max. Negotiated Rate $11,193.64
Rate for Payer: Aetna Commercial $10,950.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10,463.62
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,448.51
Rate for Payer: Cash Price $3,650.10
Rate for Payer: Cigna Commercial $11,193.64
Rate for Payer: Health EOS Commercial $10,828.63
Rate for Payer: HFN Commercial $11,193.64
Rate for Payer: Multiplan Commercial $9,733.60
Rate for Payer: NAPHCARE Commercial $7,300.20
Rate for Payer: Preferred Network Access Commercial $11,193.64
Rate for Payer: Quartz Beloit One Network $5,961.83
Rate for Payer: Quartz Commercial $7,300.20
Rate for Payer: WEA Trust Commercial $6,691.85
Rate for Payer: WPS Commercial $9,012.10
Service Code CPT 52648
Hospital Charge Code 2960194
Hospital Revenue Code 360
Min. Negotiated Rate $4,240.00
Max. Negotiated Rate $20,457.48
Rate for Payer: Aetna Commercial $10,950.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10,463.62
Rate for Payer: Aetna Managed Medicare $5,114.37
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $12,238.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $10,914.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $10,367.00
Rate for Payer: Anthem Medicare Advantage $5,114.37
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,448.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,114.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,114.37
Rate for Payer: Cash Price $3,650.10
Rate for Payer: Cash Price $3,650.10
Rate for Payer: Cash Price $3,650.10
Rate for Payer: Cigna Commercial $11,193.64
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,114.37
Rate for Payer: Dean Health DHI/DHP/ASO $7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,114.37
Rate for Payer: Health EOS Commercial $10,828.63
Rate for Payer: HFN Commercial $11,193.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $19,025.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,114.37
Rate for Payer: Independent Care Health Plan Medicare $5,114.37
Rate for Payer: Managed Health Services Medicare Advantage $5,114.37
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,114.37
Rate for Payer: Multiplan Commercial $9,733.60
Rate for Payer: NAPHCARE Commercial $7,671.56
Rate for Payer: Preferred Network Access Commercial $11,193.64
Rate for Payer: Quartz Beloit One Network $5,961.83
Rate for Payer: Quartz Commercial $7,908.55
Rate for Payer: Quartz Medicare Advantage $5,114.37
Rate for Payer: The Alliance Commercial $20,457.48
Rate for Payer: United Healthcare Medicare Advantage $5,114.37
Rate for Payer: United Healthcare PPO $4,240.00
Rate for Payer: WEA Trust Commercial $6,691.85
Rate for Payer: Wellcare Medicare $5,114.37
Rate for Payer: WPS Commercial $9,012.10
Service Code CPT 83986
Hospital Charge Code 5455093
Hospital Revenue Code 300
Min. Negotiated Rate $28.42
Max. Negotiated Rate $53.36
Rate for Payer: Aetna Commercial $52.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $49.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $30.74
Rate for Payer: Cash Price $17.40
Rate for Payer: Cigna Commercial $53.36
Rate for Payer: Health EOS Commercial $51.62
Rate for Payer: HFN Commercial $53.36
Rate for Payer: Multiplan Commercial $46.40
Rate for Payer: NAPHCARE Commercial $34.80
Rate for Payer: Preferred Network Access Commercial $53.36
Rate for Payer: Quartz Beloit One Network $28.42
Rate for Payer: Quartz Commercial $34.80
Rate for Payer: WEA Trust Commercial $31.90
Rate for Payer: WPS Commercial $42.96
Service Code CPT 83986
Hospital Charge Code 5455093
Hospital Revenue Code 300
Min. Negotiated Rate $3.58
Max. Negotiated Rate $53.36
Rate for Payer: Aetna Commercial $52.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $49.88
Rate for Payer: Aetna Managed Medicare $3.58
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $13.42
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $6.26
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5.94
Rate for Payer: Anthem Medicaid $3.70
Rate for Payer: Anthem Medicare Advantage $3.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $30.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3.58
Rate for Payer: Cash Price $17.40
Rate for Payer: Cash Price $17.40
Rate for Payer: Cigna Commercial $53.36
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $3.70
Rate for Payer: Dean Health DHI/DHP/ASO $32.46
Rate for Payer: Dean Health Medicaid $3.70
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3.58
Rate for Payer: Health EOS Commercial $51.62
Rate for Payer: HFN Commercial $53.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13.32
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3.58
Rate for Payer: Independent Care Health Plan Medicaid $3.70
Rate for Payer: Independent Care Health Plan Medicare $3.58
Rate for Payer: Managed Health Services Medicaid $3.85
Rate for Payer: Managed Health Services Medicare Advantage $3.58
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3.58
Rate for Payer: Multiplan Commercial $46.40
Rate for Payer: NAPHCARE Commercial $5.37
Rate for Payer: Preferred Network Access Commercial $53.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $3.70
Rate for Payer: Quartz Beloit One Network $28.42
Rate for Payer: Quartz Commercial $37.70
Rate for Payer: Quartz Medicare Advantage $3.58
Rate for Payer: The Alliance Commercial $14.32
Rate for Payer: United Healthcare Medicaid $3.70
Rate for Payer: United Healthcare Medicare Advantage $3.58
Rate for Payer: United Healthcare PPO $43.50
Rate for Payer: WEA Trust Commercial $31.90
Rate for Payer: Wellcare Medicare $3.58
Rate for Payer: WMAP Medicaid $3.70
Rate for Payer: WPS Commercial $42.96
Service Code CPT 83986
Hospital Charge Code 5455093
Hospital Revenue Code 300
Min. Negotiated Rate $12.64
Max. Negotiated Rate $55.10
Rate for Payer: Aetna Commercial $55.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $49.88
Rate for Payer: Cash Price $17.40
Rate for Payer: Cash Price $17.40
Rate for Payer: Cigna Commercial $55.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $29.00
Rate for Payer: Dean Health DHI/DHP/ASO $34.80
Rate for Payer: Health EOS Commercial $52.78
Rate for Payer: HFN Commercial $55.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12.64
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $12.64
Rate for Payer: Multiplan Commercial $46.40
Rate for Payer: Preferred Network Access Commercial $55.10
Rate for Payer: Quartz Beloit One Network $25.52
Rate for Payer: Quartz Commercial $33.06
Rate for Payer: The Alliance Commercial $29.00
Rate for Payer: WEA Trust Commercial $31.90
Rate for Payer: WPS Commercial $42.96
Service Code CPT 83986
Hospital Charge Code 5474694
Hospital Revenue Code 300
Min. Negotiated Rate $10.78
Max. Negotiated Rate $20.24
Rate for Payer: Aetna Commercial $19.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $18.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $11.66
Rate for Payer: Cash Price $6.60
Rate for Payer: Cigna Commercial $20.24
Rate for Payer: Health EOS Commercial $19.58
Rate for Payer: HFN Commercial $20.24
Rate for Payer: Multiplan Commercial $17.60
Rate for Payer: NAPHCARE Commercial $13.20
Rate for Payer: Preferred Network Access Commercial $20.24
Rate for Payer: Quartz Beloit One Network $10.78
Rate for Payer: Quartz Commercial $13.20
Rate for Payer: WEA Trust Commercial $12.10
Rate for Payer: WPS Commercial $16.30
Service Code CPT 83986
Hospital Charge Code 5474694
Hospital Revenue Code 300
Min. Negotiated Rate $9.68
Max. Negotiated Rate $20.90
Rate for Payer: Aetna Commercial $20.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $18.92
Rate for Payer: Cash Price $6.60
Rate for Payer: Cash Price $6.60
Rate for Payer: Cigna Commercial $20.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $11.00
Rate for Payer: Dean Health DHI/DHP/ASO $13.20
Rate for Payer: Health EOS Commercial $20.02
Rate for Payer: HFN Commercial $20.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12.64
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $12.64
Rate for Payer: Multiplan Commercial $17.60
Rate for Payer: Preferred Network Access Commercial $20.90
Rate for Payer: Quartz Beloit One Network $9.68
Rate for Payer: Quartz Commercial $12.54
Rate for Payer: The Alliance Commercial $11.00
Rate for Payer: WEA Trust Commercial $12.10
Rate for Payer: WPS Commercial $16.30