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Service Code CPT 86317
Hospital Charge Code 2943012
Hospital Revenue Code 300
Min. Negotiated Rate $11.27
Max. Negotiated Rate $21.16
Rate for Payer: Aetna Commercial $20.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.19
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.16
Rate for Payer: Health EOS Commercial $20.47
Rate for Payer: HFN Commercial $21.16
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: NAPHCARE Commercial $13.80
Rate for Payer: Preferred Network Access Commercial $21.16
Rate for Payer: Quartz Beloit One Network $11.27
Rate for Payer: Quartz Commercial $13.80
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943003
Hospital Revenue Code 300
Min. Negotiated Rate $11.27
Max. Negotiated Rate $59.96
Rate for Payer: Aetna Commercial $20.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Aetna Managed Medicare $14.99
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $56.21
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26.23
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24.88
Rate for Payer: Anthem Medicaid $15.49
Rate for Payer: Anthem Medicare Advantage $14.99
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $14.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $14.99
Rate for Payer: Cash Price $6.90
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.16
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $14.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $15.49
Rate for Payer: Dean Health DHI/DHP/ASO $12.87
Rate for Payer: Dean Health Medicaid $15.49
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $14.99
Rate for Payer: Health EOS Commercial $20.47
Rate for Payer: HFN Commercial $21.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $55.76
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $14.99
Rate for Payer: Independent Care Health Plan Medicaid $15.49
Rate for Payer: Independent Care Health Plan Medicare $14.99
Rate for Payer: Managed Health Services Medicaid $16.11
Rate for Payer: Managed Health Services Medicare Advantage $14.99
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $14.99
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: NAPHCARE Commercial $22.48
Rate for Payer: Preferred Network Access Commercial $21.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $15.49
Rate for Payer: Quartz Beloit One Network $11.27
Rate for Payer: Quartz Commercial $14.95
Rate for Payer: Quartz Medicare Advantage $14.99
Rate for Payer: The Alliance Commercial $59.96
Rate for Payer: United Healthcare Medicaid $15.49
Rate for Payer: United Healthcare Medicare Advantage $14.99
Rate for Payer: United Healthcare PPO $17.25
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: Wellcare Medicare $14.99
Rate for Payer: WMAP Medicaid $15.49
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943003
Hospital Revenue Code 300
Min. Negotiated Rate $10.12
Max. Negotiated Rate $52.91
Rate for Payer: Aetna Commercial $21.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Cash Price $6.90
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $11.50
Rate for Payer: Dean Health DHI/DHP/ASO $13.80
Rate for Payer: Health EOS Commercial $20.93
Rate for Payer: HFN Commercial $21.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $52.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $52.91
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: Preferred Network Access Commercial $21.85
Rate for Payer: Quartz Beloit One Network $10.12
Rate for Payer: Quartz Commercial $13.11
Rate for Payer: The Alliance Commercial $11.50
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943003
Hospital Revenue Code 300
Min. Negotiated Rate $11.27
Max. Negotiated Rate $21.16
Rate for Payer: Aetna Commercial $20.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.19
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.16
Rate for Payer: Health EOS Commercial $20.47
Rate for Payer: HFN Commercial $21.16
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: NAPHCARE Commercial $13.80
Rate for Payer: Preferred Network Access Commercial $21.16
Rate for Payer: Quartz Beloit One Network $11.27
Rate for Payer: Quartz Commercial $13.80
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943004
Hospital Revenue Code 300
Min. Negotiated Rate $11.27
Max. Negotiated Rate $59.96
Rate for Payer: Aetna Commercial $20.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Aetna Managed Medicare $14.99
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $56.21
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26.23
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24.88
Rate for Payer: Anthem Medicaid $15.49
Rate for Payer: Anthem Medicare Advantage $14.99
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $14.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $14.99
Rate for Payer: Cash Price $6.90
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.16
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $14.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $15.49
Rate for Payer: Dean Health DHI/DHP/ASO $12.87
Rate for Payer: Dean Health Medicaid $15.49
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $14.99
Rate for Payer: Health EOS Commercial $20.47
Rate for Payer: HFN Commercial $21.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $55.76
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $14.99
Rate for Payer: Independent Care Health Plan Medicaid $15.49
Rate for Payer: Independent Care Health Plan Medicare $14.99
Rate for Payer: Managed Health Services Medicaid $16.11
Rate for Payer: Managed Health Services Medicare Advantage $14.99
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $14.99
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: NAPHCARE Commercial $22.48
Rate for Payer: Preferred Network Access Commercial $21.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $15.49
Rate for Payer: Quartz Beloit One Network $11.27
Rate for Payer: Quartz Commercial $14.95
Rate for Payer: Quartz Medicare Advantage $14.99
Rate for Payer: The Alliance Commercial $59.96
Rate for Payer: United Healthcare Medicaid $15.49
Rate for Payer: United Healthcare Medicare Advantage $14.99
Rate for Payer: United Healthcare PPO $17.25
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: Wellcare Medicare $14.99
Rate for Payer: WMAP Medicaid $15.49
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943004
Hospital Revenue Code 300
Min. Negotiated Rate $10.12
Max. Negotiated Rate $52.91
Rate for Payer: Aetna Commercial $21.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Cash Price $6.90
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $11.50
Rate for Payer: Dean Health DHI/DHP/ASO $13.80
Rate for Payer: Health EOS Commercial $20.93
Rate for Payer: HFN Commercial $21.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $52.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $52.91
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: Preferred Network Access Commercial $21.85
Rate for Payer: Quartz Beloit One Network $10.12
Rate for Payer: Quartz Commercial $13.11
Rate for Payer: The Alliance Commercial $11.50
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: WPS Commercial $17.04
Service Code CPT 86317
Hospital Charge Code 2943004
Hospital Revenue Code 300
Min. Negotiated Rate $11.27
Max. Negotiated Rate $21.16
Rate for Payer: Aetna Commercial $20.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $19.78
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.19
Rate for Payer: Cash Price $6.90
Rate for Payer: Cigna Commercial $21.16
Rate for Payer: Health EOS Commercial $20.47
Rate for Payer: HFN Commercial $21.16
Rate for Payer: Multiplan Commercial $18.40
Rate for Payer: NAPHCARE Commercial $13.80
Rate for Payer: Preferred Network Access Commercial $21.16
Rate for Payer: Quartz Beloit One Network $11.27
Rate for Payer: Quartz Commercial $13.80
Rate for Payer: WEA Trust Commercial $12.65
Rate for Payer: WPS Commercial $17.04
Service Code CPT 80332
Hospital Charge Code 983402
Hospital Revenue Code 300
Min. Negotiated Rate $77.00
Max. Negotiated Rate $166.25
Rate for Payer: Aetna Commercial $166.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $150.50
Rate for Payer: Cash Price $52.50
Rate for Payer: Cash Price $52.50
Rate for Payer: Cigna Commercial $166.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $87.50
Rate for Payer: Dean Health DHI/DHP/ASO $105.00
Rate for Payer: Health EOS Commercial $159.25
Rate for Payer: HFN Commercial $166.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $80.06
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $80.06
Rate for Payer: Multiplan Commercial $140.00
Rate for Payer: Preferred Network Access Commercial $166.25
Rate for Payer: Quartz Beloit One Network $77.00
Rate for Payer: Quartz Commercial $99.75
Rate for Payer: The Alliance Commercial $87.50
Rate for Payer: WEA Trust Commercial $96.25
Rate for Payer: WPS Commercial $129.62
Service Code CPT 80332
Hospital Charge Code 983402
Hospital Revenue Code 300
Min. Negotiated Rate $85.75
Max. Negotiated Rate $161.00
Rate for Payer: Aetna Commercial $157.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $150.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $92.75
Rate for Payer: Cash Price $52.50
Rate for Payer: Cigna Commercial $161.00
Rate for Payer: Health EOS Commercial $155.75
Rate for Payer: HFN Commercial $161.00
Rate for Payer: Multiplan Commercial $140.00
Rate for Payer: NAPHCARE Commercial $105.00
Rate for Payer: Preferred Network Access Commercial $161.00
Rate for Payer: Quartz Beloit One Network $85.75
Rate for Payer: Quartz Commercial $105.00
Rate for Payer: WEA Trust Commercial $96.25
Rate for Payer: WPS Commercial $129.62
Service Code CPT 80332
Hospital Charge Code 983402
Hospital Revenue Code 300
Min. Negotiated Rate $49.00
Max. Negotiated Rate $700.00
Rate for Payer: Aetna Commercial $157.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $150.50
Rate for Payer: Aetna Managed Medicare $49.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $113.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $87.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $84.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $92.75
Rate for Payer: Cash Price $52.50
Rate for Payer: Cigna Commercial $161.00
Rate for Payer: Dean Health DHI/DHP/ASO $97.93
Rate for Payer: Health EOS Commercial $155.75
Rate for Payer: HFN Commercial $161.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $131.25
Rate for Payer: Multiplan Commercial $140.00
Rate for Payer: NAPHCARE Commercial $105.00
Rate for Payer: Preferred Network Access Commercial $161.00
Rate for Payer: Quartz Beloit One Network $85.75
Rate for Payer: Quartz Commercial $113.75
Rate for Payer: Quartz Medicare Advantage $105.00
Rate for Payer: The Alliance Commercial $700.00
Rate for Payer: United Healthcare PPO $131.25
Rate for Payer: WEA Trust Commercial $96.25
Rate for Payer: WPS Commercial $129.62
Hospital Charge Code 6217082
Hospital Revenue Code 272
Min. Negotiated Rate $820.12
Max. Negotiated Rate $11,716.00
Rate for Payer: Aetna Commercial $2,636.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,518.94
Rate for Payer: Aetna Managed Medicare $820.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,903.85
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,464.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,405.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,552.37
Rate for Payer: Cash Price $878.70
Rate for Payer: Cigna Commercial $2,694.68
Rate for Payer: Dean Health DHI/DHP/ASO $1,639.07
Rate for Payer: Health EOS Commercial $2,606.81
Rate for Payer: HFN Commercial $2,694.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,196.75
Rate for Payer: Multiplan Commercial $2,343.20
Rate for Payer: NAPHCARE Commercial $1,757.40
Rate for Payer: Preferred Network Access Commercial $2,694.68
Rate for Payer: Quartz Beloit One Network $1,435.21
Rate for Payer: Quartz Commercial $1,903.85
Rate for Payer: Quartz Medicare Advantage $1,757.40
Rate for Payer: The Alliance Commercial $11,716.00
Rate for Payer: WEA Trust Commercial $1,610.95
Rate for Payer: WPS Commercial $2,169.51
Hospital Charge Code 6217082
Hospital Revenue Code 272
Min. Negotiated Rate $1,435.21
Max. Negotiated Rate $2,694.68
Rate for Payer: Aetna Commercial $2,636.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,518.94
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,552.37
Rate for Payer: Cash Price $878.70
Rate for Payer: Cigna Commercial $2,694.68
Rate for Payer: Health EOS Commercial $2,606.81
Rate for Payer: HFN Commercial $2,694.68
Rate for Payer: Multiplan Commercial $2,343.20
Rate for Payer: NAPHCARE Commercial $1,757.40
Rate for Payer: Preferred Network Access Commercial $2,694.68
Rate for Payer: Quartz Beloit One Network $1,435.21
Rate for Payer: Quartz Commercial $1,757.40
Rate for Payer: WEA Trust Commercial $1,610.95
Rate for Payer: WPS Commercial $2,169.51
Hospital Charge Code 2962912
Hospital Revenue Code 272
Min. Negotiated Rate $147.28
Max. Negotiated Rate $2,104.00
Rate for Payer: Aetna Commercial $473.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $452.36
Rate for Payer: Aetna Managed Medicare $147.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $341.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $263.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $252.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $278.78
Rate for Payer: Cash Price $157.80
Rate for Payer: Cigna Commercial $483.92
Rate for Payer: Dean Health DHI/DHP/ASO $294.35
Rate for Payer: Health EOS Commercial $468.14
Rate for Payer: HFN Commercial $483.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $394.50
Rate for Payer: Multiplan Commercial $420.80
Rate for Payer: NAPHCARE Commercial $315.60
Rate for Payer: Preferred Network Access Commercial $483.92
Rate for Payer: Quartz Beloit One Network $257.74
Rate for Payer: Quartz Commercial $341.90
Rate for Payer: Quartz Medicare Advantage $315.60
Rate for Payer: The Alliance Commercial $2,104.00
Rate for Payer: WEA Trust Commercial $289.30
Rate for Payer: WPS Commercial $389.61
Hospital Charge Code 2962912
Hospital Revenue Code 272
Min. Negotiated Rate $257.74
Max. Negotiated Rate $483.92
Rate for Payer: Aetna Commercial $473.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $452.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $278.78
Rate for Payer: Cash Price $157.80
Rate for Payer: Cigna Commercial $483.92
Rate for Payer: Health EOS Commercial $468.14
Rate for Payer: HFN Commercial $483.92
Rate for Payer: Multiplan Commercial $420.80
Rate for Payer: NAPHCARE Commercial $315.60
Rate for Payer: Preferred Network Access Commercial $483.92
Rate for Payer: Quartz Beloit One Network $257.74
Rate for Payer: Quartz Commercial $315.60
Rate for Payer: WEA Trust Commercial $289.30
Rate for Payer: WPS Commercial $389.61
Hospital Charge Code 4520507
Hospital Revenue Code 278
Min. Negotiated Rate $346.36
Max. Negotiated Rate $4,948.00
Rate for Payer: Aetna Commercial $1,113.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,063.82
Rate for Payer: Aetna Managed Medicare $346.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $804.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $618.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $593.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $655.61
Rate for Payer: Cash Price $371.10
Rate for Payer: Cigna Commercial $1,138.04
Rate for Payer: Dean Health DHI/DHP/ASO $692.23
Rate for Payer: Health EOS Commercial $1,100.93
Rate for Payer: HFN Commercial $1,138.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $927.75
Rate for Payer: Multiplan Commercial $989.60
Rate for Payer: NAPHCARE Commercial $742.20
Rate for Payer: Preferred Network Access Commercial $1,138.04
Rate for Payer: Quartz Beloit One Network $606.13
Rate for Payer: Quartz Commercial $804.05
Rate for Payer: Quartz Medicare Advantage $742.20
Rate for Payer: The Alliance Commercial $4,948.00
Rate for Payer: WEA Trust Commercial $680.35
Rate for Payer: WPS Commercial $916.25
Hospital Charge Code 4520507
Hospital Revenue Code 278
Min. Negotiated Rate $606.13
Max. Negotiated Rate $1,138.04
Rate for Payer: Aetna Commercial $1,113.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,063.82
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $655.61
Rate for Payer: Cash Price $371.10
Rate for Payer: Cigna Commercial $1,138.04
Rate for Payer: Health EOS Commercial $1,100.93
Rate for Payer: HFN Commercial $1,138.04
Rate for Payer: Multiplan Commercial $989.60
Rate for Payer: NAPHCARE Commercial $742.20
Rate for Payer: Preferred Network Access Commercial $1,138.04
Rate for Payer: Quartz Beloit One Network $606.13
Rate for Payer: Quartz Commercial $742.20
Rate for Payer: WEA Trust Commercial $680.35
Rate for Payer: WPS Commercial $916.25
Hospital Charge Code 2963558
Hospital Revenue Code 272
Min. Negotiated Rate $10.64
Max. Negotiated Rate $152.00
Rate for Payer: Aetna Commercial $34.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $32.68
Rate for Payer: Aetna Managed Medicare $10.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $24.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $19.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $18.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $20.14
Rate for Payer: Cash Price $11.40
Rate for Payer: Cigna Commercial $34.96
Rate for Payer: Dean Health DHI/DHP/ASO $21.26
Rate for Payer: Health EOS Commercial $33.82
Rate for Payer: HFN Commercial $34.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $28.50
Rate for Payer: Multiplan Commercial $30.40
Rate for Payer: NAPHCARE Commercial $22.80
Rate for Payer: Preferred Network Access Commercial $34.96
Rate for Payer: Quartz Beloit One Network $18.62
Rate for Payer: Quartz Commercial $24.70
Rate for Payer: Quartz Medicare Advantage $22.80
Rate for Payer: The Alliance Commercial $152.00
Rate for Payer: WEA Trust Commercial $20.90
Rate for Payer: WPS Commercial $28.15
Hospital Charge Code 2963558
Hospital Revenue Code 272
Min. Negotiated Rate $18.62
Max. Negotiated Rate $34.96
Rate for Payer: Aetna Commercial $34.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $32.68
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $20.14
Rate for Payer: Cash Price $11.40
Rate for Payer: Cigna Commercial $34.96
Rate for Payer: Health EOS Commercial $33.82
Rate for Payer: HFN Commercial $34.96
Rate for Payer: Multiplan Commercial $30.40
Rate for Payer: NAPHCARE Commercial $22.80
Rate for Payer: Preferred Network Access Commercial $34.96
Rate for Payer: Quartz Beloit One Network $18.62
Rate for Payer: Quartz Commercial $22.80
Rate for Payer: WEA Trust Commercial $20.90
Rate for Payer: WPS Commercial $28.15
Hospital Charge Code 4595219
Hospital Revenue Code 272
Min. Negotiated Rate $55.86
Max. Negotiated Rate $104.88
Rate for Payer: Aetna Commercial $102.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $98.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $60.42
Rate for Payer: Cash Price $34.20
Rate for Payer: Cigna Commercial $104.88
Rate for Payer: Health EOS Commercial $101.46
Rate for Payer: HFN Commercial $104.88
Rate for Payer: Multiplan Commercial $91.20
Rate for Payer: NAPHCARE Commercial $68.40
Rate for Payer: Preferred Network Access Commercial $104.88
Rate for Payer: Quartz Beloit One Network $55.86
Rate for Payer: Quartz Commercial $68.40
Rate for Payer: WEA Trust Commercial $62.70
Rate for Payer: WPS Commercial $84.44
Hospital Charge Code 4595219
Hospital Revenue Code 272
Min. Negotiated Rate $31.92
Max. Negotiated Rate $456.00
Rate for Payer: Aetna Commercial $102.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $98.04
Rate for Payer: Aetna Managed Medicare $31.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $74.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $57.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $54.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $60.42
Rate for Payer: Cash Price $34.20
Rate for Payer: Cigna Commercial $104.88
Rate for Payer: Dean Health DHI/DHP/ASO $63.79
Rate for Payer: Health EOS Commercial $101.46
Rate for Payer: HFN Commercial $104.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $85.50
Rate for Payer: Multiplan Commercial $91.20
Rate for Payer: NAPHCARE Commercial $68.40
Rate for Payer: Preferred Network Access Commercial $104.88
Rate for Payer: Quartz Beloit One Network $55.86
Rate for Payer: Quartz Commercial $74.10
Rate for Payer: Quartz Medicare Advantage $68.40
Rate for Payer: The Alliance Commercial $456.00
Rate for Payer: WEA Trust Commercial $62.70
Rate for Payer: WPS Commercial $84.44
Hospital Charge Code 2963099
Hospital Revenue Code 272
Min. Negotiated Rate $836.43
Max. Negotiated Rate $1,570.44
Rate for Payer: Aetna Commercial $1,536.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,468.02
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $904.71
Rate for Payer: Cash Price $512.10
Rate for Payer: Cigna Commercial $1,570.44
Rate for Payer: Health EOS Commercial $1,519.23
Rate for Payer: HFN Commercial $1,570.44
Rate for Payer: Multiplan Commercial $1,365.60
Rate for Payer: NAPHCARE Commercial $1,024.20
Rate for Payer: Preferred Network Access Commercial $1,570.44
Rate for Payer: Quartz Beloit One Network $836.43
Rate for Payer: Quartz Commercial $1,024.20
Rate for Payer: WEA Trust Commercial $938.85
Rate for Payer: WPS Commercial $1,264.37
Hospital Charge Code 2963099
Hospital Revenue Code 272
Min. Negotiated Rate $477.96
Max. Negotiated Rate $6,828.00
Rate for Payer: Aetna Commercial $1,536.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,468.02
Rate for Payer: Aetna Managed Medicare $477.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,109.55
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $853.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $819.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $904.71
Rate for Payer: Cash Price $512.10
Rate for Payer: Cigna Commercial $1,570.44
Rate for Payer: Dean Health DHI/DHP/ASO $955.24
Rate for Payer: Health EOS Commercial $1,519.23
Rate for Payer: HFN Commercial $1,570.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,280.25
Rate for Payer: Multiplan Commercial $1,365.60
Rate for Payer: NAPHCARE Commercial $1,024.20
Rate for Payer: Preferred Network Access Commercial $1,570.44
Rate for Payer: Quartz Beloit One Network $836.43
Rate for Payer: Quartz Commercial $1,109.55
Rate for Payer: Quartz Medicare Advantage $1,024.20
Rate for Payer: The Alliance Commercial $6,828.00
Rate for Payer: WEA Trust Commercial $938.85
Rate for Payer: WPS Commercial $1,264.37
Hospital Charge Code 2963116
Hospital Revenue Code 272
Min. Negotiated Rate $932.96
Max. Negotiated Rate $1,751.68
Rate for Payer: Aetna Commercial $1,713.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,637.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,009.12
Rate for Payer: Cash Price $571.20
Rate for Payer: Cigna Commercial $1,751.68
Rate for Payer: Health EOS Commercial $1,694.56
Rate for Payer: HFN Commercial $1,751.68
Rate for Payer: Multiplan Commercial $1,523.20
Rate for Payer: NAPHCARE Commercial $1,142.40
Rate for Payer: Preferred Network Access Commercial $1,751.68
Rate for Payer: Quartz Beloit One Network $932.96
Rate for Payer: Quartz Commercial $1,142.40
Rate for Payer: WEA Trust Commercial $1,047.20
Rate for Payer: WPS Commercial $1,410.29
Hospital Charge Code 2963116
Hospital Revenue Code 272
Min. Negotiated Rate $533.12
Max. Negotiated Rate $7,616.00
Rate for Payer: Aetna Commercial $1,713.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,637.44
Rate for Payer: Aetna Managed Medicare $533.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,237.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $952.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $913.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,009.12
Rate for Payer: Cash Price $571.20
Rate for Payer: Cigna Commercial $1,751.68
Rate for Payer: Dean Health DHI/DHP/ASO $1,065.48
Rate for Payer: Health EOS Commercial $1,694.56
Rate for Payer: HFN Commercial $1,751.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,428.00
Rate for Payer: Multiplan Commercial $1,523.20
Rate for Payer: NAPHCARE Commercial $1,142.40
Rate for Payer: Preferred Network Access Commercial $1,751.68
Rate for Payer: Quartz Beloit One Network $932.96
Rate for Payer: Quartz Commercial $1,237.60
Rate for Payer: Quartz Medicare Advantage $1,142.40
Rate for Payer: The Alliance Commercial $7,616.00
Rate for Payer: WEA Trust Commercial $1,047.20
Rate for Payer: WPS Commercial $1,410.29
Service Code HCPCS A4355
Hospital Charge Code 2962814
Hospital Revenue Code 272
Min. Negotiated Rate $32.20
Max. Negotiated Rate $460.00
Rate for Payer: Aetna Commercial $103.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $98.90
Rate for Payer: Aetna Managed Medicare $32.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $74.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $57.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $55.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $60.95
Rate for Payer: Cash Price $34.50
Rate for Payer: Cigna Commercial $105.80
Rate for Payer: Dean Health DHI/DHP/ASO $64.35
Rate for Payer: Health EOS Commercial $102.35
Rate for Payer: HFN Commercial $105.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $86.25
Rate for Payer: Multiplan Commercial $92.00
Rate for Payer: NAPHCARE Commercial $69.00
Rate for Payer: Preferred Network Access Commercial $105.80
Rate for Payer: Quartz Beloit One Network $56.35
Rate for Payer: Quartz Commercial $74.75
Rate for Payer: Quartz Medicare Advantage $69.00
Rate for Payer: The Alliance Commercial $460.00
Rate for Payer: WEA Trust Commercial $63.25
Rate for Payer: WPS Commercial $85.18