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Charge Type Setting Price  
Service Code HCPCS V5014
Hospital Charge Code 1230812
Hospital Revenue Code 470
Min. Negotiated Rate $55.44
Max. Negotiated Rate $792.00
Rate for Payer: Aetna Commercial $178.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $170.28
Rate for Payer: Aetna Managed Medicare $55.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $128.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $99.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $95.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $104.94
Rate for Payer: Cash Price $59.40
Rate for Payer: Cigna Commercial $182.16
Rate for Payer: Dean Health DHI/DHP/ASO $110.80
Rate for Payer: Health EOS Commercial $176.22
Rate for Payer: HFN Commercial $182.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $148.50
Rate for Payer: Multiplan Commercial $158.40
Rate for Payer: NAPHCARE Commercial $118.80
Rate for Payer: Preferred Network Access Commercial $182.16
Rate for Payer: Quartz Beloit One Network $97.02
Rate for Payer: Quartz Commercial $128.70
Rate for Payer: Quartz Medicare Advantage $118.80
Rate for Payer: The Alliance Commercial $792.00
Rate for Payer: United Healthcare PPO $148.50
Rate for Payer: WEA Trust Commercial $108.90
Rate for Payer: WPS Commercial $146.66
Service Code HCPCS V5014
Hospital Charge Code 1230812
Hospital Revenue Code 470
Min. Negotiated Rate $97.02
Max. Negotiated Rate $182.16
Rate for Payer: Aetna Commercial $178.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $170.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $104.94
Rate for Payer: Cash Price $59.40
Rate for Payer: Cigna Commercial $182.16
Rate for Payer: Health EOS Commercial $176.22
Rate for Payer: HFN Commercial $182.16
Rate for Payer: Multiplan Commercial $158.40
Rate for Payer: NAPHCARE Commercial $118.80
Rate for Payer: Preferred Network Access Commercial $182.16
Rate for Payer: Quartz Beloit One Network $97.02
Rate for Payer: Quartz Commercial $118.80
Rate for Payer: WEA Trust Commercial $108.90
Rate for Payer: WPS Commercial $146.66
Service Code HCPCS V5014
Hospital Charge Code 1230812
Hospital Revenue Code 470
Min. Negotiated Rate $87.12
Max. Negotiated Rate $323.74
Rate for Payer: Aetna Commercial $188.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $170.28
Rate for Payer: Cash Price $59.40
Rate for Payer: Cash Price $59.40
Rate for Payer: Cigna Commercial $188.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $99.00
Rate for Payer: Dean Health DHI/DHP/ASO $118.80
Rate for Payer: Health EOS Commercial $180.18
Rate for Payer: HFN Commercial $188.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $323.74
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $323.74
Rate for Payer: Multiplan Commercial $158.40
Rate for Payer: Preferred Network Access Commercial $188.10
Rate for Payer: Quartz Beloit One Network $87.12
Rate for Payer: Quartz Commercial $112.86
Rate for Payer: The Alliance Commercial $99.00
Rate for Payer: WEA Trust Commercial $108.90
Rate for Payer: WPS Commercial $146.66
Service Code CPT 49594
Hospital Revenue Code 360
Min. Negotiated Rate $5,703.09
Max. Negotiated Rate $22,812.36
Rate for Payer: Aetna Managed Medicare $5,703.09
Rate for Payer: Anthem Medicare Advantage $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,703.09
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,703.09
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,703.09
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,215.49
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,703.09
Rate for Payer: Independent Care Health Plan Medicare $5,703.09
Rate for Payer: Managed Health Services Medicare Advantage $5,703.09
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,703.09
Rate for Payer: NAPHCARE Commercial $8,554.64
Rate for Payer: Quartz Medicare Advantage $5,703.09
Rate for Payer: The Alliance Commercial $22,812.36
Rate for Payer: United Healthcare Medicare Advantage $5,703.09
Rate for Payer: Wellcare Medicare $5,703.09
Service Code CPT 49593
Hospital Revenue Code 360
Min. Negotiated Rate $3,419.56
Max. Negotiated Rate $13,678.24
Rate for Payer: Aetna Managed Medicare $3,419.56
Rate for Payer: Anthem Medicare Advantage $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3,419.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3,419.56
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3,419.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12,720.76
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3,419.56
Rate for Payer: Independent Care Health Plan Medicare $3,419.56
Rate for Payer: Managed Health Services Medicare Advantage $3,419.56
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3,419.56
Rate for Payer: NAPHCARE Commercial $5,129.34
Rate for Payer: Quartz Medicare Advantage $3,419.56
Rate for Payer: The Alliance Commercial $13,678.24
Rate for Payer: United Healthcare Medicare Advantage $3,419.56
Rate for Payer: Wellcare Medicare $3,419.56
Service Code CPT 49595
Hospital Revenue Code 360
Min. Negotiated Rate $3,419.56
Max. Negotiated Rate $13,678.24
Rate for Payer: Aetna Managed Medicare $3,419.56
Rate for Payer: Anthem Medicare Advantage $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3,419.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3,419.56
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3,419.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12,720.76
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3,419.56
Rate for Payer: Independent Care Health Plan Medicare $3,419.56
Rate for Payer: Managed Health Services Medicare Advantage $3,419.56
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3,419.56
Rate for Payer: NAPHCARE Commercial $5,129.34
Rate for Payer: Quartz Medicare Advantage $3,419.56
Rate for Payer: The Alliance Commercial $13,678.24
Rate for Payer: United Healthcare Medicare Advantage $3,419.56
Rate for Payer: Wellcare Medicare $3,419.56
Service Code CPT 49592
Hospital Revenue Code 360
Min. Negotiated Rate $5,703.09
Max. Negotiated Rate $22,812.36
Rate for Payer: Aetna Managed Medicare $5,703.09
Rate for Payer: Anthem Medicare Advantage $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,703.09
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,703.09
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,703.09
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,215.49
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,703.09
Rate for Payer: Independent Care Health Plan Medicare $5,703.09
Rate for Payer: Managed Health Services Medicare Advantage $5,703.09
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,703.09
Rate for Payer: NAPHCARE Commercial $8,554.64
Rate for Payer: Quartz Medicare Advantage $5,703.09
Rate for Payer: The Alliance Commercial $22,812.36
Rate for Payer: United Healthcare Medicare Advantage $5,703.09
Rate for Payer: Wellcare Medicare $5,703.09
Service Code CPT 49591
Hospital Revenue Code 360
Min. Negotiated Rate $3,419.56
Max. Negotiated Rate $13,678.24
Rate for Payer: Aetna Managed Medicare $3,419.56
Rate for Payer: Anthem Medicare Advantage $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3,419.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3,419.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3,419.56
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3,419.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $12,720.76
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3,419.56
Rate for Payer: Independent Care Health Plan Medicare $3,419.56
Rate for Payer: Managed Health Services Medicare Advantage $3,419.56
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3,419.56
Rate for Payer: NAPHCARE Commercial $5,129.34
Rate for Payer: Quartz Medicare Advantage $3,419.56
Rate for Payer: The Alliance Commercial $13,678.24
Rate for Payer: United Healthcare Medicare Advantage $3,419.56
Rate for Payer: Wellcare Medicare $3,419.56
Service Code CPT 49614
Hospital Revenue Code 360
Min. Negotiated Rate $5,703.09
Max. Negotiated Rate $22,812.36
Rate for Payer: Aetna Managed Medicare $5,703.09
Rate for Payer: Anthem Medicare Advantage $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,703.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,703.09
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,703.09
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,703.09
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,215.49
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,703.09
Rate for Payer: Independent Care Health Plan Medicare $5,703.09
Rate for Payer: Managed Health Services Medicare Advantage $5,703.09
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,703.09
Rate for Payer: NAPHCARE Commercial $8,554.64
Rate for Payer: Quartz Medicare Advantage $5,703.09
Rate for Payer: The Alliance Commercial $22,812.36
Rate for Payer: United Healthcare Medicare Advantage $5,703.09
Rate for Payer: Wellcare Medicare $5,703.09
Service Code CPT 67904
Hospital Charge Code 1188910
Hospital Revenue Code 510
Min. Negotiated Rate $576.78
Max. Negotiated Rate $5,519.50
Rate for Payer: Aetna Commercial $5,519.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,996.60
Rate for Payer: Cash Price $1,743.00
Rate for Payer: Cash Price $1,743.00
Rate for Payer: Cash Price $1,743.00
Rate for Payer: Cigna Commercial $5,519.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $576.78
Rate for Payer: Dean Health DHI/DHP/ASO $3,486.00
Rate for Payer: Health EOS Commercial $5,287.10
Rate for Payer: HFN Commercial $5,519.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,999.39
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,999.39
Rate for Payer: Multiplan Commercial $4,648.00
Rate for Payer: Preferred Network Access Commercial $5,519.50
Rate for Payer: Quartz Beloit One Network $2,556.40
Rate for Payer: Quartz Commercial $3,311.70
Rate for Payer: The Alliance Commercial $2,905.00
Rate for Payer: United Healthcare Medicaid $576.78
Rate for Payer: WEA Trust Commercial $3,195.50
Rate for Payer: WPS Commercial $4,303.47
Service Code CPT 29720
Hospital Charge Code 3014308
Hospital Revenue Code 510
Min. Negotiated Rate $25.40
Max. Negotiated Rate $142.22
Rate for Payer: Aetna Commercial $76.95
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $69.66
Rate for Payer: Cash Price $24.30
Rate for Payer: Cash Price $24.30
Rate for Payer: Cash Price $24.30
Rate for Payer: Cigna Commercial $76.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $25.40
Rate for Payer: Dean Health DHI/DHP/ASO $48.60
Rate for Payer: Health EOS Commercial $73.71
Rate for Payer: HFN Commercial $76.95
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $142.22
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $142.22
Rate for Payer: Multiplan Commercial $64.80
Rate for Payer: Preferred Network Access Commercial $76.95
Rate for Payer: Quartz Beloit One Network $35.64
Rate for Payer: Quartz Commercial $46.17
Rate for Payer: The Alliance Commercial $40.50
Rate for Payer: United Healthcare Medicaid $25.40
Rate for Payer: WEA Trust Commercial $44.55
Rate for Payer: WPS Commercial $60.00
Service Code CPT 69620
Hospital Charge Code 3015273
Hospital Revenue Code 510
Min. Negotiated Rate $583.72
Max. Negotiated Rate $3,725.90
Rate for Payer: Aetna Commercial $3,725.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,372.92
Rate for Payer: Cash Price $1,176.60
Rate for Payer: Cash Price $1,176.60
Rate for Payer: Cash Price $1,176.60
Rate for Payer: Cigna Commercial $3,725.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $583.72
Rate for Payer: Dean Health DHI/DHP/ASO $2,353.20
Rate for Payer: Health EOS Commercial $3,569.02
Rate for Payer: HFN Commercial $3,725.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,654.09
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,654.09
Rate for Payer: Multiplan Commercial $3,137.60
Rate for Payer: Preferred Network Access Commercial $3,725.90
Rate for Payer: Quartz Beloit One Network $1,725.68
Rate for Payer: Quartz Commercial $2,235.54
Rate for Payer: The Alliance Commercial $1,961.00
Rate for Payer: United Healthcare Medicaid $583.72
Rate for Payer: WEA Trust Commercial $2,157.10
Rate for Payer: WPS Commercial $2,905.03
Service Code CPT 67917
Hospital Charge Code 1188908
Hospital Revenue Code 510
Min. Negotiated Rate $466.09
Max. Negotiated Rate $3,328.80
Rate for Payer: Aetna Commercial $3,328.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,013.44
Rate for Payer: Cash Price $1,051.20
Rate for Payer: Cash Price $1,051.20
Rate for Payer: Cash Price $1,051.20
Rate for Payer: Cigna Commercial $3,328.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $466.09
Rate for Payer: Dean Health DHI/DHP/ASO $2,102.40
Rate for Payer: Health EOS Commercial $3,188.64
Rate for Payer: HFN Commercial $3,328.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,530.75
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,530.75
Rate for Payer: Multiplan Commercial $2,803.20
Rate for Payer: Preferred Network Access Commercial $3,328.80
Rate for Payer: Quartz Beloit One Network $1,541.76
Rate for Payer: Quartz Commercial $1,997.28
Rate for Payer: The Alliance Commercial $1,752.00
Rate for Payer: United Healthcare Medicaid $466.09
Rate for Payer: WEA Trust Commercial $1,927.20
Rate for Payer: WPS Commercial $2,595.41
Service Code CPT 67917
Hospital Revenue Code 360
Min. Negotiated Rate $2,309.71
Max. Negotiated Rate $9,238.84
Rate for Payer: Aetna Managed Medicare $2,309.71
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $2,309.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $2,309.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $2,309.71
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $2,309.71
Rate for Payer: Dean Health DHI/DHP/ASO $7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $2,309.71
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,592.12
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,309.71
Rate for Payer: Independent Care Health Plan Medicare $2,309.71
Rate for Payer: Managed Health Services Medicare Advantage $2,309.71
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $2,309.71
Rate for Payer: NAPHCARE Commercial $3,464.56
Rate for Payer: Quartz Medicare Advantage $2,309.71
Rate for Payer: The Alliance Commercial $9,238.84
Rate for Payer: United Healthcare Medicare Advantage $2,309.71
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $2,309.71
Service Code CPT 57268
Hospital Revenue Code 360
Min. Negotiated Rate $2,726.00
Max. Negotiated Rate $19,665.00
Rate for Payer: Aetna Managed Medicare $4,916.25
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $4,916.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $4,916.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $4,916.25
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $4,916.25
Rate for Payer: Dean Health DHI/DHP/ASO $6,546.14
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $4,916.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $18,288.45
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $4,916.25
Rate for Payer: Independent Care Health Plan Medicare $4,916.25
Rate for Payer: Managed Health Services Medicare Advantage $4,916.25
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $4,916.25
Rate for Payer: NAPHCARE Commercial $7,374.38
Rate for Payer: Quartz Medicare Advantage $4,916.25
Rate for Payer: The Alliance Commercial $19,665.00
Rate for Payer: United Healthcare Medicare Advantage $4,916.25
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $4,916.25
Service Code CPT 67924
Hospital Charge Code 1188909
Hospital Revenue Code 510
Min. Negotiated Rate $602.62
Max. Negotiated Rate $4,536.25
Rate for Payer: Aetna Commercial $4,536.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,106.50
Rate for Payer: Cash Price $1,432.50
Rate for Payer: Cash Price $1,432.50
Rate for Payer: Cash Price $1,432.50
Rate for Payer: Cigna Commercial $4,536.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $602.62
Rate for Payer: Dean Health DHI/DHP/ASO $2,865.00
Rate for Payer: Health EOS Commercial $4,345.25
Rate for Payer: HFN Commercial $4,536.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,531.53
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,531.53
Rate for Payer: Multiplan Commercial $3,820.00
Rate for Payer: Preferred Network Access Commercial $4,536.25
Rate for Payer: Quartz Beloit One Network $2,101.00
Rate for Payer: Quartz Commercial $2,721.75
Rate for Payer: The Alliance Commercial $2,387.50
Rate for Payer: United Healthcare Medicaid $602.62
Rate for Payer: WEA Trust Commercial $2,626.25
Rate for Payer: WPS Commercial $3,536.84
Service Code CPT 67924
Hospital Revenue Code 360
Min. Negotiated Rate $2,309.71
Max. Negotiated Rate $9,238.84
Rate for Payer: Aetna Managed Medicare $2,309.71
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $2,309.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $2,309.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $2,309.71
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $2,309.71
Rate for Payer: Dean Health DHI/DHP/ASO $7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $2,309.71
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,592.12
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,309.71
Rate for Payer: Independent Care Health Plan Medicare $2,309.71
Rate for Payer: Managed Health Services Medicare Advantage $2,309.71
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $2,309.71
Rate for Payer: NAPHCARE Commercial $3,464.56
Rate for Payer: Quartz Medicare Advantage $2,309.71
Rate for Payer: The Alliance Commercial $9,238.84
Rate for Payer: United Healthcare Medicare Advantage $2,309.71
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $2,309.71
Service Code CPT 65270
Hospital Charge Code 3015220
Hospital Revenue Code 510
Min. Negotiated Rate $75.33
Max. Negotiated Rate $749.55
Rate for Payer: Aetna Commercial $749.55
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $678.54
Rate for Payer: Cash Price $236.70
Rate for Payer: Cash Price $236.70
Rate for Payer: Cash Price $236.70
Rate for Payer: Cigna Commercial $749.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $75.33
Rate for Payer: Dean Health DHI/DHP/ASO $473.40
Rate for Payer: Health EOS Commercial $717.99
Rate for Payer: HFN Commercial $749.55
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $475.39
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $475.39
Rate for Payer: Multiplan Commercial $631.20
Rate for Payer: Preferred Network Access Commercial $749.55
Rate for Payer: Quartz Beloit One Network $347.16
Rate for Payer: Quartz Commercial $449.73
Rate for Payer: The Alliance Commercial $394.50
Rate for Payer: United Healthcare Medicaid $75.33
Rate for Payer: WEA Trust Commercial $433.95
Rate for Payer: WPS Commercial $584.41
Service Code CPT 28200
Hospital Charge Code 3014216
Hospital Revenue Code 510
Min. Negotiated Rate $452.00
Max. Negotiated Rate $2,099.50
Rate for Payer: Aetna Commercial $2,099.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,900.60
Rate for Payer: Cash Price $663.00
Rate for Payer: Cash Price $663.00
Rate for Payer: Cash Price $663.00
Rate for Payer: Cigna Commercial $2,099.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $452.00
Rate for Payer: Dean Health DHI/DHP/ASO $1,326.00
Rate for Payer: Health EOS Commercial $2,011.10
Rate for Payer: HFN Commercial $2,099.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,093.59
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,093.59
Rate for Payer: Multiplan Commercial $1,768.00
Rate for Payer: Preferred Network Access Commercial $2,099.50
Rate for Payer: Quartz Beloit One Network $972.40
Rate for Payer: Quartz Commercial $1,259.70
Rate for Payer: The Alliance Commercial $1,105.00
Rate for Payer: United Healthcare Medicaid $452.00
Rate for Payer: WEA Trust Commercial $1,215.50
Rate for Payer: WPS Commercial $1,636.95
Service Code CPT 28208
Hospital Charge Code 3014217
Hospital Revenue Code 510
Min. Negotiated Rate $180.80
Max. Negotiated Rate $1,069.91
Rate for Payer: Aetna Commercial $1,016.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $920.20
Rate for Payer: Cash Price $321.00
Rate for Payer: Cash Price $321.00
Rate for Payer: Cash Price $321.00
Rate for Payer: Cigna Commercial $1,016.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $180.80
Rate for Payer: Dean Health DHI/DHP/ASO $642.00
Rate for Payer: Health EOS Commercial $973.70
Rate for Payer: HFN Commercial $1,016.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,069.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,069.91
Rate for Payer: Multiplan Commercial $856.00
Rate for Payer: Preferred Network Access Commercial $1,016.50
Rate for Payer: Quartz Beloit One Network $470.80
Rate for Payer: Quartz Commercial $609.90
Rate for Payer: The Alliance Commercial $535.00
Rate for Payer: United Healthcare Medicaid $180.80
Rate for Payer: WEA Trust Commercial $588.50
Rate for Payer: WPS Commercial $792.55
Service Code CPT 28285
Hospital Charge Code 3014229
Hospital Revenue Code 510
Min. Negotiated Rate $274.92
Max. Negotiated Rate $2,171.70
Rate for Payer: Aetna Commercial $2,171.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,965.96
Rate for Payer: Cash Price $685.80
Rate for Payer: Cash Price $685.80
Rate for Payer: Cash Price $685.80
Rate for Payer: Cigna Commercial $2,171.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $274.92
Rate for Payer: Dean Health DHI/DHP/ASO $1,371.60
Rate for Payer: Health EOS Commercial $2,080.26
Rate for Payer: HFN Commercial $2,171.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,287.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,287.00
Rate for Payer: Multiplan Commercial $1,828.80
Rate for Payer: Preferred Network Access Commercial $2,171.70
Rate for Payer: Quartz Beloit One Network $1,005.84
Rate for Payer: Quartz Commercial $1,303.02
Rate for Payer: The Alliance Commercial $1,143.00
Rate for Payer: United Healthcare Medicaid $274.92
Rate for Payer: WEA Trust Commercial $1,257.30
Rate for Payer: WPS Commercial $1,693.24
Service Code CPT 28286
Hospital Charge Code 3014230
Hospital Revenue Code 510
Min. Negotiated Rate $226.00
Max. Negotiated Rate $1,789.80
Rate for Payer: Aetna Commercial $1,789.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,620.24
Rate for Payer: Cash Price $565.20
Rate for Payer: Cash Price $565.20
Rate for Payer: Cash Price $565.20
Rate for Payer: Cigna Commercial $1,789.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $226.00
Rate for Payer: Dean Health DHI/DHP/ASO $1,130.40
Rate for Payer: Health EOS Commercial $1,714.44
Rate for Payer: HFN Commercial $1,789.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,003.51
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,003.51
Rate for Payer: Multiplan Commercial $1,507.20
Rate for Payer: Preferred Network Access Commercial $1,789.80
Rate for Payer: Quartz Beloit One Network $828.96
Rate for Payer: Quartz Commercial $1,073.88
Rate for Payer: The Alliance Commercial $942.00
Rate for Payer: United Healthcare Medicaid $226.00
Rate for Payer: WEA Trust Commercial $1,036.20
Rate for Payer: WPS Commercial $1,395.48
Service Code CPT 28322
Hospital Charge Code 3014244
Hospital Revenue Code 510
Min. Negotiated Rate $376.66
Max. Negotiated Rate $1,925.83
Rate for Payer: Aetna Commercial $1,556.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,408.68
Rate for Payer: Cash Price $491.40
Rate for Payer: Cash Price $491.40
Rate for Payer: Cash Price $491.40
Rate for Payer: Cigna Commercial $1,556.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $376.66
Rate for Payer: Dean Health DHI/DHP/ASO $982.80
Rate for Payer: Health EOS Commercial $1,490.58
Rate for Payer: HFN Commercial $1,556.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,925.83
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,925.83
Rate for Payer: Multiplan Commercial $1,310.40
Rate for Payer: Preferred Network Access Commercial $1,556.10
Rate for Payer: Quartz Beloit One Network $720.72
Rate for Payer: Quartz Commercial $933.66
Rate for Payer: The Alliance Commercial $819.00
Rate for Payer: United Healthcare Medicaid $376.66
Rate for Payer: WEA Trust Commercial $900.90
Rate for Payer: WPS Commercial $1,213.27
Service Code CPT 11760
Hospital Charge Code 3013573
Hospital Revenue Code 510
Min. Negotiated Rate $41.87
Max. Negotiated Rate $731.50
Rate for Payer: Aetna Commercial $731.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $662.20
Rate for Payer: Cash Price $231.00
Rate for Payer: Cash Price $231.00
Rate for Payer: Cash Price $231.00
Rate for Payer: Cigna Commercial $731.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $41.87
Rate for Payer: Dean Health DHI/DHP/ASO $462.00
Rate for Payer: Health EOS Commercial $700.70
Rate for Payer: HFN Commercial $731.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $380.15
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $380.15
Rate for Payer: Multiplan Commercial $616.00
Rate for Payer: Preferred Network Access Commercial $731.50
Rate for Payer: Quartz Beloit One Network $338.80
Rate for Payer: Quartz Commercial $438.90
Rate for Payer: The Alliance Commercial $385.00
Rate for Payer: United Healthcare Medicaid $41.87
Rate for Payer: WEA Trust Commercial $423.50
Rate for Payer: WPS Commercial $570.34
Service Code CPT 30465
Hospital Revenue Code 360
Min. Negotiated Rate $4,240.00
Max. Negotiated Rate $23,153.12
Rate for Payer: Aetna Managed Medicare $5,788.28
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 $5,788.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,788.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,788.28
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,788.28
Rate for Payer: Dean Health DHI/DHP/ASO $7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,788.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,532.40
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,788.28
Rate for Payer: Independent Care Health Plan Medicare $5,788.28
Rate for Payer: Managed Health Services Medicare Advantage $5,788.28
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,788.28
Rate for Payer: NAPHCARE Commercial $8,682.42
Rate for Payer: Quartz Medicare Advantage $5,788.28
Rate for Payer: The Alliance Commercial $23,153.12
Rate for Payer: United Healthcare Medicare Advantage $5,788.28
Rate for Payer: United Healthcare PPO $4,240.00
Rate for Payer: Wellcare Medicare $5,788.28