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Service Code CPT 87147
Hospital Charge Code 297691
Hospital Revenue Code 300
Min. Negotiated Rate $19.60
Max. Negotiated Rate $36.80
Rate for Payer: Aetna Commercial $36.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $34.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21.20
Rate for Payer: Cash Price $12.00
Rate for Payer: Cigna Commercial $36.80
Rate for Payer: Health EOS Commercial $35.60
Rate for Payer: HFN Commercial $36.80
Rate for Payer: Multiplan Commercial $32.00
Rate for Payer: NAPHCARE Commercial $24.00
Rate for Payer: Preferred Network Access Commercial $36.80
Rate for Payer: Quartz Beloit One Network $19.60
Rate for Payer: Quartz Commercial $24.00
Rate for Payer: WEA Trust Commercial $22.00
Rate for Payer: WPS Commercial $29.63
Service Code CPT 87147
Hospital Charge Code 297691
Hospital Revenue Code 300
Min. Negotiated Rate $5.18
Max. Negotiated Rate $36.80
Rate for Payer: Aetna Commercial $36.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $34.40
Rate for Payer: Aetna Managed Medicare $5.18
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $19.42
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $9.06
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $8.60
Rate for Payer: Anthem Medicaid $5.35
Rate for Payer: Anthem Medicare Advantage $5.18
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21.20
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5.18
Rate for Payer: Cash Price $12.00
Rate for Payer: Cash Price $12.00
Rate for Payer: Cigna Commercial $36.80
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $5.35
Rate for Payer: Dean Health DHI/DHP/ASO $22.38
Rate for Payer: Dean Health Medicaid $5.35
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5.18
Rate for Payer: Health EOS Commercial $35.60
Rate for Payer: HFN Commercial $36.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $19.27
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5.18
Rate for Payer: Independent Care Health Plan Medicaid $5.35
Rate for Payer: Independent Care Health Plan Medicare $5.18
Rate for Payer: Managed Health Services Medicaid $5.56
Rate for Payer: Managed Health Services Medicare Advantage $5.18
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5.18
Rate for Payer: Multiplan Commercial $32.00
Rate for Payer: NAPHCARE Commercial $7.77
Rate for Payer: Preferred Network Access Commercial $36.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $5.35
Rate for Payer: Quartz Beloit One Network $19.60
Rate for Payer: Quartz Commercial $26.00
Rate for Payer: Quartz Medicare Advantage $5.18
Rate for Payer: The Alliance Commercial $20.72
Rate for Payer: United Healthcare Medicaid $5.35
Rate for Payer: United Healthcare Medicare Advantage $5.18
Rate for Payer: United Healthcare PPO $30.00
Rate for Payer: WEA Trust Commercial $22.00
Rate for Payer: Wellcare Medicare $5.18
Rate for Payer: WMAP Medicaid $5.35
Rate for Payer: WPS Commercial $29.63
Service Code CPT 96376
Hospital Charge Code 3023769
Hospital Revenue Code 260
Min. Negotiated Rate $24.16
Max. Negotiated Rate $75.05
Rate for Payer: Aetna Commercial $75.05
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $67.94
Rate for Payer: Cash Price $23.70
Rate for Payer: Cash Price $23.70
Rate for Payer: Cigna Commercial $75.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $24.16
Rate for Payer: Dean Health DHI/DHP/ASO $47.40
Rate for Payer: Health EOS Commercial $71.89
Rate for Payer: HFN Commercial $75.05
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $34.66
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $34.66
Rate for Payer: Multiplan Commercial $63.20
Rate for Payer: Preferred Network Access Commercial $75.05
Rate for Payer: Quartz Beloit One Network $34.76
Rate for Payer: Quartz Commercial $45.03
Rate for Payer: The Alliance Commercial $39.50
Rate for Payer: United Healthcare Medicaid $24.16
Rate for Payer: WEA Trust Commercial $43.45
Rate for Payer: WPS Commercial $58.52
Service Code CPT 96376
Hospital Charge Code 3023769
Hospital Revenue Code 260
Min. Negotiated Rate $38.71
Max. Negotiated Rate $72.68
Rate for Payer: Aetna Commercial $71.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $67.94
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $41.87
Rate for Payer: Cash Price $23.70
Rate for Payer: Cigna Commercial $72.68
Rate for Payer: Health EOS Commercial $70.31
Rate for Payer: HFN Commercial $72.68
Rate for Payer: Multiplan Commercial $63.20
Rate for Payer: NAPHCARE Commercial $47.40
Rate for Payer: Preferred Network Access Commercial $72.68
Rate for Payer: Quartz Beloit One Network $38.71
Rate for Payer: Quartz Commercial $47.40
Rate for Payer: WEA Trust Commercial $43.45
Rate for Payer: WPS Commercial $58.52
Service Code CPT 96376
Hospital Charge Code 3023769
Hospital Revenue Code 260
Min. Negotiated Rate $22.12
Max. Negotiated Rate $316.00
Rate for Payer: Aetna Commercial $71.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $67.94
Rate for Payer: Aetna Managed Medicare $22.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $51.35
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $39.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $37.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $41.87
Rate for Payer: Cash Price $23.70
Rate for Payer: Cigna Commercial $72.68
Rate for Payer: Dean Health DHI/DHP/ASO $44.21
Rate for Payer: Health EOS Commercial $70.31
Rate for Payer: HFN Commercial $72.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $59.25
Rate for Payer: Multiplan Commercial $63.20
Rate for Payer: NAPHCARE Commercial $47.40
Rate for Payer: Preferred Network Access Commercial $72.68
Rate for Payer: Quartz Beloit One Network $38.71
Rate for Payer: Quartz Commercial $51.35
Rate for Payer: Quartz Medicare Advantage $47.40
Rate for Payer: The Alliance Commercial $316.00
Rate for Payer: United Healthcare PPO $59.25
Rate for Payer: WEA Trust Commercial $43.45
Rate for Payer: WPS Commercial $58.52
Service Code CPT 87640
Hospital Charge Code 4254037
Hospital Revenue Code 300
Min. Negotiated Rate $66.64
Max. Negotiated Rate $125.12
Rate for Payer: Aetna Commercial $122.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $116.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $72.08
Rate for Payer: Cash Price $40.80
Rate for Payer: Cigna Commercial $125.12
Rate for Payer: Health EOS Commercial $121.04
Rate for Payer: HFN Commercial $125.12
Rate for Payer: Multiplan Commercial $108.80
Rate for Payer: NAPHCARE Commercial $81.60
Rate for Payer: Preferred Network Access Commercial $125.12
Rate for Payer: Quartz Beloit One Network $66.64
Rate for Payer: Quartz Commercial $81.60
Rate for Payer: WEA Trust Commercial $74.80
Rate for Payer: WPS Commercial $100.74
Service Code CPT 87640
Hospital Charge Code 4254037
Hospital Revenue Code 300
Min. Negotiated Rate $35.09
Max. Negotiated Rate $140.36
Rate for Payer: Aetna Commercial $122.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $116.96
Rate for Payer: Aetna Managed Medicare $35.09
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $131.59
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $61.41
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $58.25
Rate for Payer: Anthem Medicaid $36.26
Rate for Payer: Anthem Medicare Advantage $35.09
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $72.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $35.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $35.09
Rate for Payer: Cash Price $40.80
Rate for Payer: Cash Price $40.80
Rate for Payer: Cigna Commercial $125.12
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $35.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $36.26
Rate for Payer: Dean Health DHI/DHP/ASO $76.11
Rate for Payer: Dean Health Medicaid $36.26
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $35.09
Rate for Payer: Health EOS Commercial $121.04
Rate for Payer: HFN Commercial $125.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $130.53
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $35.09
Rate for Payer: Independent Care Health Plan Medicaid $36.26
Rate for Payer: Independent Care Health Plan Medicare $35.09
Rate for Payer: Managed Health Services Medicaid $37.71
Rate for Payer: Managed Health Services Medicare Advantage $35.09
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $35.09
Rate for Payer: Multiplan Commercial $108.80
Rate for Payer: NAPHCARE Commercial $52.64
Rate for Payer: Preferred Network Access Commercial $125.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $36.26
Rate for Payer: Quartz Beloit One Network $66.64
Rate for Payer: Quartz Commercial $88.40
Rate for Payer: Quartz Medicare Advantage $35.09
Rate for Payer: The Alliance Commercial $140.36
Rate for Payer: United Healthcare Medicaid $36.26
Rate for Payer: United Healthcare Medicare Advantage $35.09
Rate for Payer: United Healthcare PPO $102.00
Rate for Payer: WEA Trust Commercial $74.80
Rate for Payer: Wellcare Medicare $35.09
Rate for Payer: WMAP Medicaid $36.26
Rate for Payer: WPS Commercial $100.74
Service Code CPT 87640
Hospital Charge Code 4254037
Hospital Revenue Code 300
Min. Negotiated Rate $59.84
Max. Negotiated Rate $129.20
Rate for Payer: Aetna Commercial $129.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $116.96
Rate for Payer: Cash Price $40.80
Rate for Payer: Cash Price $40.80
Rate for Payer: Cigna Commercial $129.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $68.00
Rate for Payer: Dean Health DHI/DHP/ASO $81.60
Rate for Payer: Health EOS Commercial $123.76
Rate for Payer: HFN Commercial $129.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $123.87
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $123.87
Rate for Payer: Multiplan Commercial $108.80
Rate for Payer: Preferred Network Access Commercial $129.20
Rate for Payer: Quartz Beloit One Network $59.84
Rate for Payer: Quartz Commercial $77.52
Rate for Payer: The Alliance Commercial $68.00
Rate for Payer: WEA Trust Commercial $74.80
Rate for Payer: WPS Commercial $100.74
Service Code HCPCS J2353
Hospital Charge Code 2958936
Hospital Revenue Code 636
Min. Negotiated Rate $201.96
Max. Negotiated Rate $526.40
Rate for Payer: Aetna Commercial $436.05
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $394.74
Rate for Payer: Cash Price $137.70
Rate for Payer: Cash Price $137.70
Rate for Payer: Cigna Commercial $436.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $210.56
Rate for Payer: Dean Health DHI/DHP/ASO $210.56
Rate for Payer: Health EOS Commercial $417.69
Rate for Payer: HFN Commercial $436.05
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $299.36
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $299.36
Rate for Payer: Multiplan Commercial $367.20
Rate for Payer: Preferred Network Access Commercial $436.05
Rate for Payer: Quartz Beloit One Network $201.96
Rate for Payer: Quartz Commercial $261.63
Rate for Payer: The Alliance Commercial $229.50
Rate for Payer: United Healthcare Medicaid $210.56
Rate for Payer: WEA Trust Commercial $252.45
Rate for Payer: WPS Commercial $526.40
Service Code HCPCS J2353
Hospital Charge Code 2958936
Hospital Revenue Code 636
Min. Negotiated Rate $224.91
Max. Negotiated Rate $422.28
Rate for Payer: Aetna Commercial $413.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $394.74
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $243.27
Rate for Payer: Cash Price $137.70
Rate for Payer: Cigna Commercial $422.28
Rate for Payer: Health EOS Commercial $408.51
Rate for Payer: HFN Commercial $422.28
Rate for Payer: Multiplan Commercial $367.20
Rate for Payer: NAPHCARE Commercial $275.40
Rate for Payer: Preferred Network Access Commercial $422.28
Rate for Payer: Quartz Beloit One Network $224.91
Rate for Payer: Quartz Commercial $275.40
Rate for Payer: WEA Trust Commercial $252.45
Rate for Payer: WPS Commercial $339.98
Service Code HCPCS J2353
Hospital Charge Code 2958936
Hospital Revenue Code 636
Min. Negotiated Rate $210.56
Max. Negotiated Rate $843.32
Rate for Payer: Aetna Commercial $413.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $394.74
Rate for Payer: Aetna Managed Medicare $210.83
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $210.56
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $210.56
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $210.56
Rate for Payer: Anthem Medicare Advantage $210.83
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $243.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $210.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $210.83
Rate for Payer: Cash Price $137.70
Rate for Payer: Cash Price $137.70
Rate for Payer: Cigna Commercial $422.28
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $210.83
Rate for Payer: Dean Health DHI/DHP/ASO $278.57
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $210.83
Rate for Payer: Health EOS Commercial $408.51
Rate for Payer: HFN Commercial $422.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $784.28
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $210.83
Rate for Payer: Independent Care Health Plan Medicare $210.83
Rate for Payer: Managed Health Services Medicare Advantage $210.83
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $210.83
Rate for Payer: Multiplan Commercial $367.20
Rate for Payer: NAPHCARE Commercial $316.24
Rate for Payer: Preferred Network Access Commercial $422.28
Rate for Payer: Quartz Beloit One Network $224.91
Rate for Payer: Quartz Commercial $298.35
Rate for Payer: Quartz Medicare Advantage $210.83
Rate for Payer: The Alliance Commercial $843.32
Rate for Payer: United Healthcare Medicare Advantage $210.83
Rate for Payer: WEA Trust Commercial $252.45
Rate for Payer: Wellcare Medicare $210.83
Rate for Payer: WPS Commercial $526.40
Service Code HCPCS J2353
Hospital Charge Code 5516859
Hospital Revenue Code 636
Min. Negotiated Rate $205.92
Max. Negotiated Rate $526.40
Rate for Payer: Aetna Commercial $444.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $402.48
Rate for Payer: Cash Price $140.40
Rate for Payer: Cash Price $140.40
Rate for Payer: Cigna Commercial $444.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $210.56
Rate for Payer: Dean Health DHI/DHP/ASO $210.56
Rate for Payer: Health EOS Commercial $425.88
Rate for Payer: HFN Commercial $444.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $299.36
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $299.36
Rate for Payer: Multiplan Commercial $374.40
Rate for Payer: Preferred Network Access Commercial $444.60
Rate for Payer: Quartz Beloit One Network $205.92
Rate for Payer: Quartz Commercial $266.76
Rate for Payer: The Alliance Commercial $234.00
Rate for Payer: United Healthcare Medicaid $210.56
Rate for Payer: WEA Trust Commercial $257.40
Rate for Payer: WPS Commercial $526.40
Service Code HCPCS J2353
Hospital Charge Code 5516859
Hospital Revenue Code 636
Min. Negotiated Rate $210.56
Max. Negotiated Rate $843.32
Rate for Payer: Aetna Commercial $421.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $402.48
Rate for Payer: Aetna Managed Medicare $210.83
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $210.56
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $210.56
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $210.56
Rate for Payer: Anthem Medicare Advantage $210.83
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $248.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $210.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $210.83
Rate for Payer: Cash Price $140.40
Rate for Payer: Cash Price $140.40
Rate for Payer: Cigna Commercial $430.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $210.83
Rate for Payer: Dean Health DHI/DHP/ASO $278.57
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $210.83
Rate for Payer: Health EOS Commercial $416.52
Rate for Payer: HFN Commercial $430.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $784.28
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $210.83
Rate for Payer: Independent Care Health Plan Medicare $210.83
Rate for Payer: Managed Health Services Medicare Advantage $210.83
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $210.83
Rate for Payer: Multiplan Commercial $374.40
Rate for Payer: NAPHCARE Commercial $316.24
Rate for Payer: Preferred Network Access Commercial $430.56
Rate for Payer: Quartz Beloit One Network $229.32
Rate for Payer: Quartz Commercial $304.20
Rate for Payer: Quartz Medicare Advantage $210.83
Rate for Payer: The Alliance Commercial $843.32
Rate for Payer: United Healthcare Medicare Advantage $210.83
Rate for Payer: WEA Trust Commercial $257.40
Rate for Payer: Wellcare Medicare $210.83
Rate for Payer: WPS Commercial $526.40
Service Code HCPCS J2353
Hospital Charge Code 5516859
Hospital Revenue Code 636
Min. Negotiated Rate $229.32
Max. Negotiated Rate $430.56
Rate for Payer: Aetna Commercial $421.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $402.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $248.04
Rate for Payer: Cash Price $140.40
Rate for Payer: Cigna Commercial $430.56
Rate for Payer: Health EOS Commercial $416.52
Rate for Payer: HFN Commercial $430.56
Rate for Payer: Multiplan Commercial $374.40
Rate for Payer: NAPHCARE Commercial $280.80
Rate for Payer: Preferred Network Access Commercial $430.56
Rate for Payer: Quartz Beloit One Network $229.32
Rate for Payer: Quartz Commercial $280.80
Rate for Payer: WEA Trust Commercial $257.40
Rate for Payer: WPS Commercial $346.65
Service Code CPT 87640
Hospital Charge Code 4125437
Hospital Revenue Code 300
Min. Negotiated Rate $35.09
Max. Negotiated Rate $154.56
Rate for Payer: Aetna Commercial $151.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $144.48
Rate for Payer: Aetna Managed Medicare $35.09
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $131.59
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $61.41
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $58.25
Rate for Payer: Anthem Medicaid $36.26
Rate for Payer: Anthem Medicare Advantage $35.09
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $89.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $35.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $35.09
Rate for Payer: Cash Price $50.40
Rate for Payer: Cash Price $50.40
Rate for Payer: Cigna Commercial $154.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $35.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $36.26
Rate for Payer: Dean Health DHI/DHP/ASO $94.01
Rate for Payer: Dean Health Medicaid $36.26
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $35.09
Rate for Payer: Health EOS Commercial $149.52
Rate for Payer: HFN Commercial $154.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $130.53
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $35.09
Rate for Payer: Independent Care Health Plan Medicaid $36.26
Rate for Payer: Independent Care Health Plan Medicare $35.09
Rate for Payer: Managed Health Services Medicaid $37.71
Rate for Payer: Managed Health Services Medicare Advantage $35.09
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $35.09
Rate for Payer: Multiplan Commercial $134.40
Rate for Payer: NAPHCARE Commercial $52.64
Rate for Payer: Preferred Network Access Commercial $154.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $36.26
Rate for Payer: Quartz Beloit One Network $82.32
Rate for Payer: Quartz Commercial $109.20
Rate for Payer: Quartz Medicare Advantage $35.09
Rate for Payer: The Alliance Commercial $140.36
Rate for Payer: United Healthcare Medicaid $36.26
Rate for Payer: United Healthcare Medicare Advantage $35.09
Rate for Payer: United Healthcare PPO $126.00
Rate for Payer: WEA Trust Commercial $92.40
Rate for Payer: Wellcare Medicare $35.09
Rate for Payer: WMAP Medicaid $36.26
Rate for Payer: WPS Commercial $124.44
Service Code CPT 87640
Hospital Charge Code 4125437
Hospital Revenue Code 300
Min. Negotiated Rate $82.32
Max. Negotiated Rate $154.56
Rate for Payer: Aetna Commercial $151.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $144.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $89.04
Rate for Payer: Cash Price $50.40
Rate for Payer: Cigna Commercial $154.56
Rate for Payer: Health EOS Commercial $149.52
Rate for Payer: HFN Commercial $154.56
Rate for Payer: Multiplan Commercial $134.40
Rate for Payer: NAPHCARE Commercial $100.80
Rate for Payer: Preferred Network Access Commercial $154.56
Rate for Payer: Quartz Beloit One Network $82.32
Rate for Payer: Quartz Commercial $100.80
Rate for Payer: WEA Trust Commercial $92.40
Rate for Payer: WPS Commercial $124.44
Service Code CPT 87640
Hospital Charge Code 4125437
Hospital Revenue Code 300
Min. Negotiated Rate $73.92
Max. Negotiated Rate $159.60
Rate for Payer: Aetna Commercial $159.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $144.48
Rate for Payer: Cash Price $50.40
Rate for Payer: Cash Price $50.40
Rate for Payer: Cigna Commercial $159.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $84.00
Rate for Payer: Dean Health DHI/DHP/ASO $100.80
Rate for Payer: Health EOS Commercial $152.88
Rate for Payer: HFN Commercial $159.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $123.87
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $123.87
Rate for Payer: Multiplan Commercial $134.40
Rate for Payer: Preferred Network Access Commercial $159.60
Rate for Payer: Quartz Beloit One Network $73.92
Rate for Payer: Quartz Commercial $95.76
Rate for Payer: The Alliance Commercial $84.00
Rate for Payer: WEA Trust Commercial $92.40
Rate for Payer: WPS Commercial $124.44
Hospital Charge Code 2971918
Hospital Revenue Code 271
Min. Negotiated Rate $492.94
Max. Negotiated Rate $925.52
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $603.60
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Hospital Charge Code 2971918
Hospital Revenue Code 271
Min. Negotiated Rate $281.68
Max. Negotiated Rate $4,024.00
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Aetna Managed Medicare $281.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $653.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $503.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $482.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Dean Health DHI/DHP/ASO $562.96
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $754.50
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $653.90
Rate for Payer: Quartz Medicare Advantage $603.60
Rate for Payer: The Alliance Commercial $4,024.00
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Hospital Charge Code 2971917
Hospital Revenue Code 271
Min. Negotiated Rate $281.68
Max. Negotiated Rate $4,024.00
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Aetna Managed Medicare $281.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $653.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $503.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $482.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Dean Health DHI/DHP/ASO $562.96
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $754.50
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $653.90
Rate for Payer: Quartz Medicare Advantage $603.60
Rate for Payer: The Alliance Commercial $4,024.00
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Hospital Charge Code 2971917
Hospital Revenue Code 271
Min. Negotiated Rate $492.94
Max. Negotiated Rate $925.52
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $603.60
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Hospital Charge Code 2960362
Hospital Revenue Code 360
Min. Negotiated Rate $1,167.60
Max. Negotiated Rate $16,680.00
Rate for Payer: Aetna Commercial $3,753.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,586.20
Rate for Payer: Aetna Managed Medicare $1,167.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $2,710.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,085.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,001.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,210.10
Rate for Payer: Cash Price $1,251.00
Rate for Payer: Cigna Commercial $3,836.40
Rate for Payer: Dean Health DHI/DHP/ASO $2,333.53
Rate for Payer: Health EOS Commercial $3,711.30
Rate for Payer: HFN Commercial $3,836.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,127.50
Rate for Payer: Multiplan Commercial $3,336.00
Rate for Payer: NAPHCARE Commercial $2,502.00
Rate for Payer: Preferred Network Access Commercial $3,836.40
Rate for Payer: Quartz Beloit One Network $2,043.30
Rate for Payer: Quartz Commercial $2,710.50
Rate for Payer: Quartz Medicare Advantage $2,502.00
Rate for Payer: The Alliance Commercial $16,680.00
Rate for Payer: WEA Trust Commercial $2,293.50
Rate for Payer: WPS Commercial $3,088.72
Hospital Charge Code 2960362
Hospital Revenue Code 360
Min. Negotiated Rate $2,043.30
Max. Negotiated Rate $3,836.40
Rate for Payer: Aetna Commercial $3,753.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,586.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,210.10
Rate for Payer: Cash Price $1,251.00
Rate for Payer: Cigna Commercial $3,836.40
Rate for Payer: Health EOS Commercial $3,711.30
Rate for Payer: HFN Commercial $3,836.40
Rate for Payer: Multiplan Commercial $3,336.00
Rate for Payer: NAPHCARE Commercial $2,502.00
Rate for Payer: Preferred Network Access Commercial $3,836.40
Rate for Payer: Quartz Beloit One Network $2,043.30
Rate for Payer: Quartz Commercial $2,502.00
Rate for Payer: WEA Trust Commercial $2,293.50
Rate for Payer: WPS Commercial $3,088.72
Hospital Charge Code 5831721
Hospital Revenue Code 272
Min. Negotiated Rate $667.52
Max. Negotiated Rate $9,536.00
Rate for Payer: Aetna Commercial $2,145.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,050.24
Rate for Payer: Aetna Managed Medicare $667.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,549.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,192.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,144.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,263.52
Rate for Payer: Cash Price $715.20
Rate for Payer: Cigna Commercial $2,193.28
Rate for Payer: Dean Health DHI/DHP/ASO $1,334.09
Rate for Payer: Health EOS Commercial $2,121.76
Rate for Payer: HFN Commercial $2,193.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,788.00
Rate for Payer: Multiplan Commercial $1,907.20
Rate for Payer: NAPHCARE Commercial $1,430.40
Rate for Payer: Preferred Network Access Commercial $2,193.28
Rate for Payer: Quartz Beloit One Network $1,168.16
Rate for Payer: Quartz Commercial $1,549.60
Rate for Payer: Quartz Medicare Advantage $1,430.40
Rate for Payer: The Alliance Commercial $9,536.00
Rate for Payer: WEA Trust Commercial $1,311.20
Rate for Payer: WPS Commercial $1,765.83
Hospital Charge Code 5831721
Hospital Revenue Code 272
Min. Negotiated Rate $1,168.16
Max. Negotiated Rate $2,193.28
Rate for Payer: Aetna Commercial $2,145.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,050.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,263.52
Rate for Payer: Cash Price $715.20
Rate for Payer: Cigna Commercial $2,193.28
Rate for Payer: Health EOS Commercial $2,121.76
Rate for Payer: HFN Commercial $2,193.28
Rate for Payer: Multiplan Commercial $1,907.20
Rate for Payer: NAPHCARE Commercial $1,430.40
Rate for Payer: Preferred Network Access Commercial $2,193.28
Rate for Payer: Quartz Beloit One Network $1,168.16
Rate for Payer: Quartz Commercial $1,430.40
Rate for Payer: WEA Trust Commercial $1,311.20
Rate for Payer: WPS Commercial $1,765.83