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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
Service Code CPT 82800
Hospital Charge Code 633795
Hospital Revenue Code 300
Min. Negotiated Rate $38.83
Max. Negotiated Rate $698.25
Rate for Payer: Aetna Commercial $698.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $632.10
Rate for Payer: Cash Price $220.50
Rate for Payer: Cash Price $220.50
Rate for Payer: Cigna Commercial $698.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $367.50
Rate for Payer: Dean Health DHI/DHP/ASO $441.00
Rate for Payer: Health EOS Commercial $668.85
Rate for Payer: HFN Commercial $698.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $38.83
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $38.83
Rate for Payer: Multiplan Commercial $588.00
Rate for Payer: Preferred Network Access Commercial $698.25
Rate for Payer: Quartz Beloit One Network $323.40
Rate for Payer: Quartz Commercial $418.95
Rate for Payer: The Alliance Commercial $367.50
Rate for Payer: WEA Trust Commercial $404.25
Rate for Payer: WPS Commercial $544.41
Service Code CPT 82800
Hospital Charge Code 633795
Hospital Revenue Code 300
Min. Negotiated Rate $360.15
Max. Negotiated Rate $676.20
Rate for Payer: Aetna Commercial $661.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $632.10
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $389.55
Rate for Payer: Cash Price $220.50
Rate for Payer: Cigna Commercial $676.20
Rate for Payer: Health EOS Commercial $654.15
Rate for Payer: HFN Commercial $676.20
Rate for Payer: Multiplan Commercial $588.00
Rate for Payer: NAPHCARE Commercial $441.00
Rate for Payer: Preferred Network Access Commercial $676.20
Rate for Payer: Quartz Beloit One Network $360.15
Rate for Payer: Quartz Commercial $441.00
Rate for Payer: WEA Trust Commercial $404.25
Rate for Payer: WPS Commercial $544.41
Service Code CPT 82800
Hospital Charge Code 633795
Hospital Revenue Code 300
Min. Negotiated Rate $11.00
Max. Negotiated Rate $676.20
Rate for Payer: Aetna Commercial $661.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $632.10
Rate for Payer: Aetna Managed Medicare $11.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $41.25
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $19.25
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $18.26
Rate for Payer: Anthem Medicaid $11.37
Rate for Payer: Anthem Medicare Advantage $11.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $389.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $11.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $11.00
Rate for Payer: Cash Price $220.50
Rate for Payer: Cash Price $220.50
Rate for Payer: Cigna Commercial $676.20
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $11.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $11.37
Rate for Payer: Dean Health DHI/DHP/ASO $411.31
Rate for Payer: Dean Health Medicaid $11.37
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $11.00
Rate for Payer: Health EOS Commercial $654.15
Rate for Payer: HFN Commercial $676.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $40.92
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $11.00
Rate for Payer: Independent Care Health Plan Medicaid $11.37
Rate for Payer: Independent Care Health Plan Medicare $11.00
Rate for Payer: Managed Health Services Medicaid $11.82
Rate for Payer: Managed Health Services Medicare Advantage $11.00
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $11.00
Rate for Payer: Multiplan Commercial $588.00
Rate for Payer: NAPHCARE Commercial $16.50
Rate for Payer: Preferred Network Access Commercial $676.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $11.37
Rate for Payer: Quartz Beloit One Network $360.15
Rate for Payer: Quartz Commercial $477.75
Rate for Payer: Quartz Medicare Advantage $11.00
Rate for Payer: The Alliance Commercial $44.00
Rate for Payer: United Healthcare Medicaid $11.37
Rate for Payer: United Healthcare Medicare Advantage $11.00
Rate for Payer: United Healthcare PPO $551.25
Rate for Payer: WEA Trust Commercial $404.25
Rate for Payer: Wellcare Medicare $11.00
Rate for Payer: WMAP Medicaid $11.37
Rate for Payer: WPS Commercial $544.41
Service Code CPT 97750 GP
Hospital Charge Code 2472554
Hospital Revenue Code 420
Min. Negotiated Rate $89.88
Max. Negotiated Rate $1,284.00
Rate for Payer: Aetna Commercial $288.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $276.06
Rate for Payer: Aetna Managed Medicare $89.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $170.13
Rate for Payer: Cash Price $96.30
Rate for Payer: Cash Price $96.30
Rate for Payer: Cigna Commercial $295.32
Rate for Payer: Dean Health DHI/DHP/ASO $179.63
Rate for Payer: Health EOS Commercial $285.69
Rate for Payer: HFN Commercial $295.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $256.80
Rate for Payer: NAPHCARE Commercial $192.60
Rate for Payer: Preferred Network Access Commercial $295.32
Rate for Payer: Quartz Beloit One Network $157.29
Rate for Payer: Quartz Commercial $208.65
Rate for Payer: Quartz Medicare Advantage $192.60
Rate for Payer: The Alliance Commercial $1,284.00
Rate for Payer: United Healthcare PPO $240.75
Rate for Payer: WEA Trust Commercial $176.55
Rate for Payer: WPS Commercial $237.76
Service Code CPT 97750 GP
Hospital Charge Code 2472554
Hospital Revenue Code 420
Min. Negotiated Rate $157.29
Max. Negotiated Rate $295.32
Rate for Payer: Aetna Commercial $288.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $276.06
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $170.13
Rate for Payer: Cash Price $96.30
Rate for Payer: Cigna Commercial $295.32
Rate for Payer: Health EOS Commercial $285.69
Rate for Payer: HFN Commercial $295.32
Rate for Payer: Multiplan Commercial $256.80
Rate for Payer: NAPHCARE Commercial $192.60
Rate for Payer: Preferred Network Access Commercial $295.32
Rate for Payer: Quartz Beloit One Network $157.29
Rate for Payer: Quartz Commercial $192.60
Rate for Payer: WEA Trust Commercial $176.55
Rate for Payer: WPS Commercial $237.76
Service Code CPT 97750 GO,CO
Hospital Charge Code 3007746
Hospital Revenue Code 430
Min. Negotiated Rate $68.11
Max. Negotiated Rate $127.88
Rate for Payer: Aetna Commercial $125.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $119.54
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $73.67
Rate for Payer: Cash Price $41.70
Rate for Payer: Cigna Commercial $127.88
Rate for Payer: Health EOS Commercial $123.71
Rate for Payer: HFN Commercial $127.88
Rate for Payer: Multiplan Commercial $111.20
Rate for Payer: NAPHCARE Commercial $83.40
Rate for Payer: Preferred Network Access Commercial $127.88
Rate for Payer: Quartz Beloit One Network $68.11
Rate for Payer: Quartz Commercial $83.40
Rate for Payer: WEA Trust Commercial $76.45
Rate for Payer: WPS Commercial $102.96
Service Code CPT 97750 GO,CO
Hospital Charge Code 3007746
Hospital Revenue Code 430
Min. Negotiated Rate $38.92
Max. Negotiated Rate $556.00
Rate for Payer: Aetna Commercial $125.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $119.54
Rate for Payer: Aetna Managed Medicare $38.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $73.67
Rate for Payer: Cash Price $41.70
Rate for Payer: Cash Price $41.70
Rate for Payer: Cigna Commercial $127.88
Rate for Payer: Dean Health DHI/DHP/ASO $77.78
Rate for Payer: Health EOS Commercial $123.71
Rate for Payer: HFN Commercial $127.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $111.20
Rate for Payer: NAPHCARE Commercial $83.40
Rate for Payer: Preferred Network Access Commercial $127.88
Rate for Payer: Quartz Beloit One Network $68.11
Rate for Payer: Quartz Commercial $90.35
Rate for Payer: Quartz Medicare Advantage $83.40
Rate for Payer: The Alliance Commercial $556.00
Rate for Payer: United Healthcare PPO $104.25
Rate for Payer: WEA Trust Commercial $76.45
Rate for Payer: WPS Commercial $102.96
Service Code CPT 97750 GO
Hospital Charge Code 3007750
Hospital Revenue Code 430
Min. Negotiated Rate $164.36
Max. Negotiated Rate $2,348.00
Rate for Payer: Aetna Commercial $528.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $504.82
Rate for Payer: Aetna Managed Medicare $164.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $311.11
Rate for Payer: Cash Price $176.10
Rate for Payer: Cash Price $176.10
Rate for Payer: Cigna Commercial $540.04
Rate for Payer: Dean Health DHI/DHP/ASO $328.49
Rate for Payer: Health EOS Commercial $522.43
Rate for Payer: HFN Commercial $540.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $469.60
Rate for Payer: NAPHCARE Commercial $352.20
Rate for Payer: Preferred Network Access Commercial $540.04
Rate for Payer: Quartz Beloit One Network $287.63
Rate for Payer: Quartz Commercial $381.55
Rate for Payer: Quartz Medicare Advantage $352.20
Rate for Payer: The Alliance Commercial $2,348.00
Rate for Payer: United Healthcare PPO $440.25
Rate for Payer: WEA Trust Commercial $322.85
Rate for Payer: WPS Commercial $434.79
Service Code CPT 97750 GO
Hospital Charge Code 3007750
Hospital Revenue Code 430
Min. Negotiated Rate $287.63
Max. Negotiated Rate $540.04
Rate for Payer: Aetna Commercial $528.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $504.82
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $311.11
Rate for Payer: Cash Price $176.10
Rate for Payer: Cigna Commercial $540.04
Rate for Payer: Health EOS Commercial $522.43
Rate for Payer: HFN Commercial $540.04
Rate for Payer: Multiplan Commercial $469.60
Rate for Payer: NAPHCARE Commercial $352.20
Rate for Payer: Preferred Network Access Commercial $540.04
Rate for Payer: Quartz Beloit One Network $287.63
Rate for Payer: Quartz Commercial $352.20
Rate for Payer: WEA Trust Commercial $322.85
Rate for Payer: WPS Commercial $434.79
Service Code CPT 97750 GO
Hospital Charge Code 3007748
Hospital Revenue Code 430
Min. Negotiated Rate $79.87
Max. Negotiated Rate $149.96
Rate for Payer: Aetna Commercial $146.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $140.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $86.39
Rate for Payer: Cash Price $48.90
Rate for Payer: Cigna Commercial $149.96
Rate for Payer: Health EOS Commercial $145.07
Rate for Payer: HFN Commercial $149.96
Rate for Payer: Multiplan Commercial $130.40
Rate for Payer: NAPHCARE Commercial $97.80
Rate for Payer: Preferred Network Access Commercial $149.96
Rate for Payer: Quartz Beloit One Network $79.87
Rate for Payer: Quartz Commercial $97.80
Rate for Payer: WEA Trust Commercial $89.65
Rate for Payer: WPS Commercial $120.73
Service Code CPT 97750 GO
Hospital Charge Code 3007748
Hospital Revenue Code 430
Min. Negotiated Rate $45.64
Max. Negotiated Rate $652.00
Rate for Payer: Aetna Commercial $146.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $140.18
Rate for Payer: Aetna Managed Medicare $45.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $86.39
Rate for Payer: Cash Price $48.90
Rate for Payer: Cash Price $48.90
Rate for Payer: Cigna Commercial $149.96
Rate for Payer: Dean Health DHI/DHP/ASO $91.21
Rate for Payer: Health EOS Commercial $145.07
Rate for Payer: HFN Commercial $149.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $130.40
Rate for Payer: NAPHCARE Commercial $97.80
Rate for Payer: Preferred Network Access Commercial $149.96
Rate for Payer: Quartz Beloit One Network $79.87
Rate for Payer: Quartz Commercial $105.95
Rate for Payer: Quartz Medicare Advantage $97.80
Rate for Payer: The Alliance Commercial $652.00
Rate for Payer: United Healthcare PPO $122.25
Rate for Payer: WEA Trust Commercial $89.65
Rate for Payer: WPS Commercial $120.73
Service Code CPT 97750 GO
Hospital Charge Code 2564919
Hospital Revenue Code 430
Min. Negotiated Rate $96.53
Max. Negotiated Rate $181.24
Rate for Payer: Aetna Commercial $177.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $169.42
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $104.41
Rate for Payer: Cash Price $59.10
Rate for Payer: Cigna Commercial $181.24
Rate for Payer: Health EOS Commercial $175.33
Rate for Payer: HFN Commercial $181.24
Rate for Payer: Multiplan Commercial $157.60
Rate for Payer: NAPHCARE Commercial $118.20
Rate for Payer: Preferred Network Access Commercial $181.24
Rate for Payer: Quartz Beloit One Network $96.53
Rate for Payer: Quartz Commercial $118.20
Rate for Payer: WEA Trust Commercial $108.35
Rate for Payer: WPS Commercial $145.92
Service Code CPT 97750 GO
Hospital Charge Code 2564919
Hospital Revenue Code 430
Min. Negotiated Rate $55.16
Max. Negotiated Rate $788.00
Rate for Payer: Aetna Commercial $177.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $169.42
Rate for Payer: Aetna Managed Medicare $55.16
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $104.41
Rate for Payer: Cash Price $59.10
Rate for Payer: Cash Price $59.10
Rate for Payer: Cigna Commercial $181.24
Rate for Payer: Dean Health DHI/DHP/ASO $110.24
Rate for Payer: Health EOS Commercial $175.33
Rate for Payer: HFN Commercial $181.24
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $157.60
Rate for Payer: NAPHCARE Commercial $118.20
Rate for Payer: Preferred Network Access Commercial $181.24
Rate for Payer: Quartz Beloit One Network $96.53
Rate for Payer: Quartz Commercial $128.05
Rate for Payer: Quartz Medicare Advantage $118.20
Rate for Payer: The Alliance Commercial $788.00
Rate for Payer: United Healthcare PPO $147.75
Rate for Payer: WEA Trust Commercial $108.35
Rate for Payer: WPS Commercial $145.92
Service Code CPT 97750 GO
Hospital Charge Code 5294653
Hospital Revenue Code 430
Min. Negotiated Rate $84.77
Max. Negotiated Rate $159.16
Rate for Payer: Aetna Commercial $155.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $148.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $91.69
Rate for Payer: Cash Price $51.90
Rate for Payer: Cigna Commercial $159.16
Rate for Payer: Health EOS Commercial $153.97
Rate for Payer: HFN Commercial $159.16
Rate for Payer: Multiplan Commercial $138.40
Rate for Payer: NAPHCARE Commercial $103.80
Rate for Payer: Preferred Network Access Commercial $159.16
Rate for Payer: Quartz Beloit One Network $84.77
Rate for Payer: Quartz Commercial $103.80
Rate for Payer: WEA Trust Commercial $95.15
Rate for Payer: WPS Commercial $128.14
Service Code CPT 97750 GO
Hospital Charge Code 5294653
Hospital Revenue Code 430
Min. Negotiated Rate $48.44
Max. Negotiated Rate $692.00
Rate for Payer: Aetna Commercial $155.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $148.78
Rate for Payer: Aetna Managed Medicare $48.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $349.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $287.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $272.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $91.69
Rate for Payer: Cash Price $51.90
Rate for Payer: Cash Price $51.90
Rate for Payer: Cigna Commercial $159.16
Rate for Payer: Dean Health DHI/DHP/ASO $96.81
Rate for Payer: Health EOS Commercial $153.97
Rate for Payer: HFN Commercial $159.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $202.00
Rate for Payer: Multiplan Commercial $138.40
Rate for Payer: NAPHCARE Commercial $103.80
Rate for Payer: Preferred Network Access Commercial $159.16
Rate for Payer: Quartz Beloit One Network $84.77
Rate for Payer: Quartz Commercial $112.45
Rate for Payer: Quartz Medicare Advantage $103.80
Rate for Payer: The Alliance Commercial $692.00
Rate for Payer: United Healthcare PPO $129.75
Rate for Payer: WEA Trust Commercial $95.15
Rate for Payer: WPS Commercial $128.14
Service Code HCPCS G0180
Hospital Charge Code 2957678
Hospital Revenue Code 510
Min. Negotiated Rate $85.36
Max. Negotiated Rate $184.30
Rate for Payer: Aetna Commercial $184.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Cash Price $58.20
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $184.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $97.00
Rate for Payer: Dean Health DHI/DHP/ASO $116.40
Rate for Payer: Health EOS Commercial $176.54
Rate for Payer: HFN Commercial $184.30
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $178.34
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $178.34
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: Preferred Network Access Commercial $184.30
Rate for Payer: Quartz Beloit One Network $85.36
Rate for Payer: Quartz Commercial $110.58
Rate for Payer: The Alliance Commercial $97.00
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Service Code HCPCS G0179
Hospital Charge Code 2957677
Hospital Revenue Code 510
Min. Negotiated Rate $31.68
Max. Negotiated Rate $138.09
Rate for Payer: Aetna Commercial $68.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $61.92
Rate for Payer: Cash Price $21.60
Rate for Payer: Cash Price $21.60
Rate for Payer: Cigna Commercial $68.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $36.00
Rate for Payer: Dean Health DHI/DHP/ASO $43.20
Rate for Payer: Health EOS Commercial $65.52
Rate for Payer: HFN Commercial $68.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $138.09
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $138.09
Rate for Payer: Multiplan Commercial $57.60
Rate for Payer: Preferred Network Access Commercial $68.40
Rate for Payer: Quartz Beloit One Network $31.68
Rate for Payer: Quartz Commercial $41.04
Rate for Payer: The Alliance Commercial $36.00
Rate for Payer: WEA Trust Commercial $39.60
Rate for Payer: WPS Commercial $53.33
Hospital Charge Code 2965105
Hospital Revenue Code 278
Min. Negotiated Rate $12,138.28
Max. Negotiated Rate $22,790.24
Rate for Payer: Aetna Commercial $22,294.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $21,303.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $13,129.16
Rate for Payer: Cash Price $7,431.60
Rate for Payer: Cigna Commercial $22,790.24
Rate for Payer: Health EOS Commercial $22,047.08
Rate for Payer: HFN Commercial $22,790.24
Rate for Payer: Multiplan Commercial $19,817.60
Rate for Payer: NAPHCARE Commercial $14,863.20
Rate for Payer: Preferred Network Access Commercial $22,790.24
Rate for Payer: Quartz Beloit One Network $12,138.28
Rate for Payer: Quartz Commercial $14,863.20
Rate for Payer: WEA Trust Commercial $13,624.60
Rate for Payer: WPS Commercial $18,348.62
Hospital Charge Code 2965105
Hospital Revenue Code 278
Min. Negotiated Rate $6,936.16
Max. Negotiated Rate $99,088.00
Rate for Payer: Aetna Commercial $22,294.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $21,303.92
Rate for Payer: Aetna Managed Medicare $6,936.16
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $16,101.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $12,386.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $11,890.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $13,129.16
Rate for Payer: Cash Price $7,431.60
Rate for Payer: Cigna Commercial $22,790.24
Rate for Payer: Dean Health DHI/DHP/ASO $13,862.41
Rate for Payer: Health EOS Commercial $22,047.08
Rate for Payer: HFN Commercial $22,790.24
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $18,579.00
Rate for Payer: Multiplan Commercial $19,817.60
Rate for Payer: NAPHCARE Commercial $14,863.20
Rate for Payer: Preferred Network Access Commercial $22,790.24
Rate for Payer: Quartz Beloit One Network $12,138.28
Rate for Payer: Quartz Commercial $16,101.80
Rate for Payer: Quartz Medicare Advantage $14,863.20
Rate for Payer: The Alliance Commercial $99,088.00
Rate for Payer: WEA Trust Commercial $13,624.60
Rate for Payer: WPS Commercial $18,348.62
Service Code HCPCS J3430 JW
Hospital Charge Code 5266686
Hospital Revenue Code 636
Min. Negotiated Rate $15.84
Max. Negotiated Rate $34.20
Rate for Payer: Aetna Commercial $34.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $30.96
Rate for Payer: Cash Price $10.80
Rate for Payer: Cigna Commercial $34.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $18.00
Rate for Payer: Dean Health DHI/DHP/ASO $21.60
Rate for Payer: Health EOS Commercial $32.76
Rate for Payer: HFN Commercial $34.20
Rate for Payer: Multiplan Commercial $28.80
Rate for Payer: Preferred Network Access Commercial $34.20
Rate for Payer: Quartz Beloit One Network $15.84
Rate for Payer: Quartz Commercial $20.52
Rate for Payer: The Alliance Commercial $18.00
Rate for Payer: WEA Trust Commercial $19.80
Rate for Payer: WPS Commercial $26.67
Service Code HCPCS J3430 JW
Hospital Charge Code 5266686
Hospital Revenue Code 636
Min. Negotiated Rate $17.64
Max. Negotiated Rate $33.12
Rate for Payer: Aetna Commercial $32.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $30.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $19.08
Rate for Payer: Cash Price $10.80
Rate for Payer: Cigna Commercial $33.12
Rate for Payer: Health EOS Commercial $32.04
Rate for Payer: HFN Commercial $33.12
Rate for Payer: Multiplan Commercial $28.80
Rate for Payer: NAPHCARE Commercial $21.60
Rate for Payer: Preferred Network Access Commercial $33.12
Rate for Payer: Quartz Beloit One Network $17.64
Rate for Payer: Quartz Commercial $21.60
Rate for Payer: WEA Trust Commercial $19.80
Rate for Payer: WPS Commercial $26.67
Service Code HCPCS J3430 JW
Hospital Charge Code 5266686
Hospital Revenue Code 636
Min. Negotiated Rate $10.08
Max. Negotiated Rate $144.00
Rate for Payer: Aetna Commercial $32.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $30.96
Rate for Payer: Aetna Managed Medicare $10.08
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $23.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $18.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $17.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $19.08
Rate for Payer: Cash Price $10.80
Rate for Payer: Cigna Commercial $33.12
Rate for Payer: Dean Health DHI/DHP/ASO $20.15
Rate for Payer: Health EOS Commercial $32.04
Rate for Payer: HFN Commercial $33.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27.00
Rate for Payer: Multiplan Commercial $28.80
Rate for Payer: NAPHCARE Commercial $21.60
Rate for Payer: Preferred Network Access Commercial $33.12
Rate for Payer: Quartz Beloit One Network $17.64
Rate for Payer: Quartz Commercial $23.40
Rate for Payer: Quartz Medicare Advantage $21.60
Rate for Payer: The Alliance Commercial $144.00
Rate for Payer: WEA Trust Commercial $19.80
Rate for Payer: WPS Commercial $26.67
Service Code CPT 36592
Hospital Charge Code 4558646
Hospital Revenue Code 300
Min. Negotiated Rate $102.24
Max. Negotiated Rate $505.04
Rate for Payer: Aetna Commercial $191.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $183.18
Rate for Payer: Aetna Managed Medicare $126.26
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $138.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $106.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $102.24
Rate for Payer: Anthem Medicare Advantage $126.26
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $112.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $126.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $126.26
Rate for Payer: Cash Price $63.90
Rate for Payer: Cash Price $63.90
Rate for Payer: Cigna Commercial $195.96
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $126.26
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $126.26
Rate for Payer: Health EOS Commercial $189.57
Rate for Payer: HFN Commercial $195.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $469.69
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $126.26
Rate for Payer: Independent Care Health Plan Medicare $126.26
Rate for Payer: Managed Health Services Medicare Advantage $126.26
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $126.26
Rate for Payer: Multiplan Commercial $170.40
Rate for Payer: NAPHCARE Commercial $189.39
Rate for Payer: Preferred Network Access Commercial $195.96
Rate for Payer: Quartz Beloit One Network $104.37
Rate for Payer: Quartz Commercial $138.45
Rate for Payer: Quartz Medicare Advantage $126.26
Rate for Payer: The Alliance Commercial $505.04
Rate for Payer: United Healthcare Medicare Advantage $126.26
Rate for Payer: United Healthcare PPO $159.75
Rate for Payer: WEA Trust Commercial $117.15
Rate for Payer: Wellcare Medicare $126.26
Rate for Payer: WPS Commercial $157.77
Service Code CPT 36592
Hospital Charge Code 4558646
Hospital Revenue Code 300
Min. Negotiated Rate $104.37
Max. Negotiated Rate $195.96
Rate for Payer: Aetna Commercial $191.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $183.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $112.89
Rate for Payer: Cash Price $63.90
Rate for Payer: Cigna Commercial $195.96
Rate for Payer: Health EOS Commercial $189.57
Rate for Payer: HFN Commercial $195.96
Rate for Payer: Multiplan Commercial $170.40
Rate for Payer: NAPHCARE Commercial $127.80
Rate for Payer: Preferred Network Access Commercial $195.96
Rate for Payer: Quartz Beloit One Network $104.37
Rate for Payer: Quartz Commercial $127.80
Rate for Payer: WEA Trust Commercial $117.15
Rate for Payer: WPS Commercial $157.77