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Charge Type Setting Price  
Service Code MSDRG 574
Min. Negotiated Rate $32,685.94
Max. Negotiated Rate $90,867.00
Rate for Payer: Aetna Managed Medicare $32,685.94
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $71,541.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $54,836.21
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $52,097.98
Rate for Payer: Anthem Medicare Advantage $32,685.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $32,685.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $32,685.94
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $32,685.94
Rate for Payer: Dean Health DHI/DHP/ASO $57,833.53
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $32,685.94
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $66,413.10
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $32,685.94
Rate for Payer: Independent Care Health Plan Medicare $32,685.94
Rate for Payer: Managed Health Services Medicare Advantage $32,685.94
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $32,685.94
Rate for Payer: NAPHCARE Commercial $49,028.91
Rate for Payer: Quartz Medicare Advantage $32,685.94
Rate for Payer: The Alliance Commercial $90,867.00
Rate for Payer: United Healthcare Medicare Advantage $32,685.94
Rate for Payer: United Healthcare PPO $51,703.45
Rate for Payer: Wellcare Medicare $32,685.94
Service Code MSDRG 573
Min. Negotiated Rate $59,580.78
Max. Negotiated Rate $165,635.00
Rate for Payer: Aetna Managed Medicare $59,580.78
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $130,495.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $100,023.82
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $95,029.16
Rate for Payer: Anthem Medicare Advantage $59,580.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $59,580.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $59,580.78
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $59,580.78
Rate for Payer: Dean Health DHI/DHP/ASO $105,491.08
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $59,580.78
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $121,253.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $59,580.78
Rate for Payer: Independent Care Health Plan Medicare $59,580.78
Rate for Payer: Managed Health Services Medicare Advantage $59,580.78
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $59,580.78
Rate for Payer: NAPHCARE Commercial $89,371.17
Rate for Payer: Quartz Medicare Advantage $59,580.78
Rate for Payer: The Alliance Commercial $165,635.00
Rate for Payer: United Healthcare Medicare Advantage $59,580.78
Rate for Payer: United Healthcare PPO $94,396.98
Rate for Payer: Wellcare Medicare $59,580.78
Service Code MSDRG 575
Min. Negotiated Rate $19,681.76
Max. Negotiated Rate $54,715.00
Rate for Payer: Aetna Managed Medicare $19,681.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $43,009.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $32,966.05
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $31,319.90
Rate for Payer: Anthem Medicare Advantage $19,681.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $19,681.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $19,681.76
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $19,681.76
Rate for Payer: Dean Health DHI/DHP/ASO $34,767.96
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $19,681.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $39,897.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $19,681.76
Rate for Payer: Independent Care Health Plan Medicare $19,681.76
Rate for Payer: Managed Health Services Medicare Advantage $19,681.76
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $19,681.76
Rate for Payer: NAPHCARE Commercial $29,522.64
Rate for Payer: Quartz Medicare Advantage $19,681.76
Rate for Payer: The Alliance Commercial $54,715.00
Rate for Payer: United Healthcare Medicare Advantage $19,681.76
Rate for Payer: United Healthcare PPO $31,060.33
Rate for Payer: Wellcare Medicare $19,681.76
Hospital Charge Code 2960377
Hospital Revenue Code 360
Min. Negotiated Rate $391.16
Max. Negotiated Rate $5,588.00
Rate for Payer: Aetna Commercial $1,257.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,201.42
Rate for Payer: Aetna Managed Medicare $391.16
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $908.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $698.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $670.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $740.41
Rate for Payer: Cash Price $419.10
Rate for Payer: Cigna Commercial $1,285.24
Rate for Payer: Dean Health DHI/DHP/ASO $781.76
Rate for Payer: Health EOS Commercial $1,243.33
Rate for Payer: HFN Commercial $1,285.24
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,047.75
Rate for Payer: Multiplan Commercial $1,117.60
Rate for Payer: NAPHCARE Commercial $838.20
Rate for Payer: Preferred Network Access Commercial $1,285.24
Rate for Payer: Quartz Beloit One Network $684.53
Rate for Payer: Quartz Commercial $908.05
Rate for Payer: Quartz Medicare Advantage $838.20
Rate for Payer: The Alliance Commercial $5,588.00
Rate for Payer: WEA Trust Commercial $768.35
Rate for Payer: WPS Commercial $1,034.76
Hospital Charge Code 2960377
Hospital Revenue Code 360
Min. Negotiated Rate $684.53
Max. Negotiated Rate $1,285.24
Rate for Payer: Aetna Commercial $1,257.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,201.42
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $740.41
Rate for Payer: Cash Price $419.10
Rate for Payer: Cigna Commercial $1,285.24
Rate for Payer: Health EOS Commercial $1,243.33
Rate for Payer: HFN Commercial $1,285.24
Rate for Payer: Multiplan Commercial $1,117.60
Rate for Payer: NAPHCARE Commercial $838.20
Rate for Payer: Preferred Network Access Commercial $1,285.24
Rate for Payer: Quartz Beloit One Network $684.53
Rate for Payer: Quartz Commercial $838.20
Rate for Payer: WEA Trust Commercial $768.35
Rate for Payer: WPS Commercial $1,034.76
Service Code MSDRG 623
Min. Negotiated Rate $17,916.38
Max. Negotiated Rate $49,808.00
Rate for Payer: Aetna Managed Medicare $17,916.38
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $39,022.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $29,910.66
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $28,417.08
Rate for Payer: Anthem Medicare Advantage $17,916.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $17,916.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $17,916.38
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $17,916.38
Rate for Payer: Dean Health DHI/DHP/ASO $31,545.56
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $17,916.38
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $36,297.30
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $17,916.38
Rate for Payer: Independent Care Health Plan Medicare $17,916.38
Rate for Payer: Managed Health Services Medicare Advantage $17,916.38
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $17,916.38
Rate for Payer: NAPHCARE Commercial $26,874.57
Rate for Payer: Quartz Medicare Advantage $17,916.38
Rate for Payer: The Alliance Commercial $49,808.00
Rate for Payer: United Healthcare Medicare Advantage $17,916.38
Rate for Payer: United Healthcare PPO $28,257.91
Rate for Payer: Wellcare Medicare $17,916.38
Service Code MSDRG 622
Min. Negotiated Rate $36,700.61
Max. Negotiated Rate $102,028.00
Rate for Payer: Aetna Managed Medicare $36,700.61
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $80,353.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $61,590.23
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $58,514.74
Rate for Payer: Anthem Medicare Advantage $36,700.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $36,700.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $36,700.61
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $36,700.61
Rate for Payer: Dean Health DHI/DHP/ASO $64,956.72
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $36,700.61
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $74,599.20
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $36,700.61
Rate for Payer: Independent Care Health Plan Medicare $36,700.61
Rate for Payer: Managed Health Services Medicare Advantage $36,700.61
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $36,700.61
Rate for Payer: NAPHCARE Commercial $55,050.92
Rate for Payer: Quartz Medicare Advantage $36,700.61
Rate for Payer: The Alliance Commercial $102,028.00
Rate for Payer: United Healthcare Medicare Advantage $36,700.61
Rate for Payer: United Healthcare PPO $58,076.43
Rate for Payer: Wellcare Medicare $36,700.61
Service Code MSDRG 624
Min. Negotiated Rate $10,773.56
Max. Negotiated Rate $29,950.00
Rate for Payer: Aetna Managed Medicare $10,773.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $23,287.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $17,849.91
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $16,958.58
Rate for Payer: Anthem Medicare Advantage $10,773.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $10,773.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $10,773.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $10,773.56
Rate for Payer: Dean Health DHI/DHP/ASO $18,825.58
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $10,773.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21,732.75
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $10,773.56
Rate for Payer: Independent Care Health Plan Medicare $10,773.56
Rate for Payer: Managed Health Services Medicare Advantage $10,773.56
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $10,773.56
Rate for Payer: NAPHCARE Commercial $16,160.34
Rate for Payer: Quartz Medicare Advantage $10,773.56
Rate for Payer: The Alliance Commercial $29,950.00
Rate for Payer: United Healthcare Medicare Advantage $10,773.56
Rate for Payer: United Healthcare PPO $16,919.22
Rate for Payer: Wellcare Medicare $10,773.56
Service Code MSDRG 904
Min. Negotiated Rate $31,255.26
Max. Negotiated Rate $86,890.00
Rate for Payer: Aetna Managed Medicare $31,255.26
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $68,394.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $52,424.06
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $49,806.28
Rate for Payer: Anthem Medicare Advantage $31,255.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $31,255.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $31,255.26
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $31,255.26
Rate for Payer: Dean Health DHI/DHP/ASO $55,289.53
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $31,255.26
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $63,495.90
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $31,255.26
Rate for Payer: Independent Care Health Plan Medicare $31,255.26
Rate for Payer: Managed Health Services Medicare Advantage $31,255.26
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $31,255.26
Rate for Payer: NAPHCARE Commercial $46,882.89
Rate for Payer: Quartz Medicare Advantage $31,255.26
Rate for Payer: The Alliance Commercial $86,890.00
Rate for Payer: United Healthcare Medicare Advantage $31,255.26
Rate for Payer: United Healthcare PPO $49,432.37
Rate for Payer: Wellcare Medicare $31,255.26
Service Code MSDRG 905
Min. Negotiated Rate $15,260.65
Max. Negotiated Rate $42,425.00
Rate for Payer: Aetna Managed Medicare $15,260.65
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $33,148.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $25,407.98
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24,139.24
Rate for Payer: Anthem Medicare Advantage $15,260.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $15,260.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $15,260.65
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $15,260.65
Rate for Payer: Dean Health DHI/DHP/ASO $26,796.77
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $15,260.65
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $30,882.15
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $15,260.65
Rate for Payer: Independent Care Health Plan Medicare $15,260.65
Rate for Payer: Managed Health Services Medicare Advantage $15,260.65
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $15,260.65
Rate for Payer: NAPHCARE Commercial $22,890.98
Rate for Payer: Quartz Medicare Advantage $15,260.65
Rate for Payer: The Alliance Commercial $42,425.00
Rate for Payer: United Healthcare Medicare Advantage $15,260.65
Rate for Payer: United Healthcare PPO $24,042.15
Rate for Payer: Wellcare Medicare $15,260.65
Hospital Charge Code 2960538
Hospital Revenue Code 360
Min. Negotiated Rate $736.47
Max. Negotiated Rate $1,382.76
Rate for Payer: Aetna Commercial $1,352.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,292.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $796.59
Rate for Payer: Cash Price $450.90
Rate for Payer: Cigna Commercial $1,382.76
Rate for Payer: Health EOS Commercial $1,337.67
Rate for Payer: HFN Commercial $1,382.76
Rate for Payer: Multiplan Commercial $1,202.40
Rate for Payer: NAPHCARE Commercial $901.80
Rate for Payer: Preferred Network Access Commercial $1,382.76
Rate for Payer: Quartz Beloit One Network $736.47
Rate for Payer: Quartz Commercial $901.80
Rate for Payer: WEA Trust Commercial $826.65
Rate for Payer: WPS Commercial $1,113.27
Hospital Charge Code 2960538
Hospital Revenue Code 360
Min. Negotiated Rate $420.84
Max. Negotiated Rate $6,012.00
Rate for Payer: Aetna Commercial $1,352.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,292.58
Rate for Payer: Aetna Managed Medicare $420.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $976.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $751.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $721.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $796.59
Rate for Payer: Cash Price $450.90
Rate for Payer: Cigna Commercial $1,382.76
Rate for Payer: Dean Health DHI/DHP/ASO $841.08
Rate for Payer: Health EOS Commercial $1,337.67
Rate for Payer: HFN Commercial $1,382.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,127.25
Rate for Payer: Multiplan Commercial $1,202.40
Rate for Payer: NAPHCARE Commercial $901.80
Rate for Payer: Preferred Network Access Commercial $1,382.76
Rate for Payer: Quartz Beloit One Network $736.47
Rate for Payer: Quartz Commercial $976.95
Rate for Payer: Quartz Medicare Advantage $901.80
Rate for Payer: The Alliance Commercial $6,012.00
Rate for Payer: WEA Trust Commercial $826.65
Rate for Payer: WPS Commercial $1,113.27
Hospital Charge Code 3065498
Hospital Revenue Code 272
Min. Negotiated Rate $24.99
Max. Negotiated Rate $46.92
Rate for Payer: Aetna Commercial $45.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $43.86
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $27.03
Rate for Payer: Cash Price $15.30
Rate for Payer: Cigna Commercial $46.92
Rate for Payer: Health EOS Commercial $45.39
Rate for Payer: HFN Commercial $46.92
Rate for Payer: Multiplan Commercial $40.80
Rate for Payer: NAPHCARE Commercial $30.60
Rate for Payer: Preferred Network Access Commercial $46.92
Rate for Payer: Quartz Beloit One Network $24.99
Rate for Payer: Quartz Commercial $30.60
Rate for Payer: WEA Trust Commercial $28.05
Rate for Payer: WPS Commercial $37.78
Hospital Charge Code 3065498
Hospital Revenue Code 272
Min. Negotiated Rate $14.28
Max. Negotiated Rate $204.00
Rate for Payer: Aetna Commercial $45.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $43.86
Rate for Payer: Aetna Managed Medicare $14.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $33.15
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $25.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $27.03
Rate for Payer: Cash Price $15.30
Rate for Payer: Cigna Commercial $46.92
Rate for Payer: Dean Health DHI/DHP/ASO $28.54
Rate for Payer: Health EOS Commercial $45.39
Rate for Payer: HFN Commercial $46.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $38.25
Rate for Payer: Multiplan Commercial $40.80
Rate for Payer: NAPHCARE Commercial $30.60
Rate for Payer: Preferred Network Access Commercial $46.92
Rate for Payer: Quartz Beloit One Network $24.99
Rate for Payer: Quartz Commercial $33.15
Rate for Payer: Quartz Medicare Advantage $30.60
Rate for Payer: The Alliance Commercial $204.00
Rate for Payer: WEA Trust Commercial $28.05
Rate for Payer: WPS Commercial $37.78
Hospital Charge Code 3231470
Hospital Revenue Code 272
Min. Negotiated Rate $5.32
Max. Negotiated Rate $76.00
Rate for Payer: Aetna Commercial $17.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $16.34
Rate for Payer: Aetna Managed Medicare $5.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $12.35
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $9.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $9.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $10.07
Rate for Payer: Cash Price $5.70
Rate for Payer: Cigna Commercial $17.48
Rate for Payer: Dean Health DHI/DHP/ASO $10.63
Rate for Payer: Health EOS Commercial $16.91
Rate for Payer: HFN Commercial $17.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $14.25
Rate for Payer: Multiplan Commercial $15.20
Rate for Payer: NAPHCARE Commercial $11.40
Rate for Payer: Preferred Network Access Commercial $17.48
Rate for Payer: Quartz Beloit One Network $9.31
Rate for Payer: Quartz Commercial $12.35
Rate for Payer: Quartz Medicare Advantage $11.40
Rate for Payer: The Alliance Commercial $76.00
Rate for Payer: WEA Trust Commercial $10.45
Rate for Payer: WPS Commercial $14.07
Hospital Charge Code 3231470
Hospital Revenue Code 272
Min. Negotiated Rate $9.31
Max. Negotiated Rate $17.48
Rate for Payer: Aetna Commercial $17.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $16.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $10.07
Rate for Payer: Cash Price $5.70
Rate for Payer: Cigna Commercial $17.48
Rate for Payer: Health EOS Commercial $16.91
Rate for Payer: HFN Commercial $17.48
Rate for Payer: Multiplan Commercial $15.20
Rate for Payer: NAPHCARE Commercial $11.40
Rate for Payer: Preferred Network Access Commercial $17.48
Rate for Payer: Quartz Beloit One Network $9.31
Rate for Payer: Quartz Commercial $11.40
Rate for Payer: WEA Trust Commercial $10.45
Rate for Payer: WPS Commercial $14.07
Hospital Charge Code 3101744
Hospital Revenue Code 271
Min. Negotiated Rate $38.22
Max. Negotiated Rate $71.76
Rate for Payer: Aetna Commercial $70.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $67.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $41.34
Rate for Payer: Cash Price $23.40
Rate for Payer: Cigna Commercial $71.76
Rate for Payer: Health EOS Commercial $69.42
Rate for Payer: HFN Commercial $71.76
Rate for Payer: Multiplan Commercial $62.40
Rate for Payer: NAPHCARE Commercial $46.80
Rate for Payer: Preferred Network Access Commercial $71.76
Rate for Payer: Quartz Beloit One Network $38.22
Rate for Payer: Quartz Commercial $46.80
Rate for Payer: WEA Trust Commercial $42.90
Rate for Payer: WPS Commercial $57.77
Hospital Charge Code 3101744
Hospital Revenue Code 271
Min. Negotiated Rate $21.84
Max. Negotiated Rate $312.00
Rate for Payer: Aetna Commercial $70.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $67.08
Rate for Payer: Aetna Managed Medicare $21.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $50.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $39.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $37.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $41.34
Rate for Payer: Cash Price $23.40
Rate for Payer: Cigna Commercial $71.76
Rate for Payer: Dean Health DHI/DHP/ASO $43.65
Rate for Payer: Health EOS Commercial $69.42
Rate for Payer: HFN Commercial $71.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $58.50
Rate for Payer: Multiplan Commercial $62.40
Rate for Payer: NAPHCARE Commercial $46.80
Rate for Payer: Preferred Network Access Commercial $71.76
Rate for Payer: Quartz Beloit One Network $38.22
Rate for Payer: Quartz Commercial $50.70
Rate for Payer: Quartz Medicare Advantage $46.80
Rate for Payer: The Alliance Commercial $312.00
Rate for Payer: WEA Trust Commercial $42.90
Rate for Payer: WPS Commercial $57.77
Service Code CPT 15101
Hospital Charge Code 3013634
Hospital Revenue Code 510
Min. Negotiated Rate $214.58
Max. Negotiated Rate $755.25
Rate for Payer: Aetna Commercial $755.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $683.70
Rate for Payer: Cash Price $238.50
Rate for Payer: Cash Price $238.50
Rate for Payer: Cigna Commercial $755.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $214.58
Rate for Payer: Dean Health DHI/DHP/ASO $477.00
Rate for Payer: Health EOS Commercial $723.45
Rate for Payer: HFN Commercial $755.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $368.14
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $368.14
Rate for Payer: Multiplan Commercial $636.00
Rate for Payer: Preferred Network Access Commercial $755.25
Rate for Payer: Quartz Beloit One Network $349.80
Rate for Payer: Quartz Commercial $453.15
Rate for Payer: The Alliance Commercial $397.50
Rate for Payer: United Healthcare Medicaid $214.58
Rate for Payer: WEA Trust Commercial $437.25
Rate for Payer: WPS Commercial $588.86
Service Code CPT 15100
Hospital Charge Code 3013633
Hospital Revenue Code 510
Min. Negotiated Rate $512.11
Max. Negotiated Rate $2,350.77
Rate for Payer: Aetna Commercial $2,322.75
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,102.70
Rate for Payer: Cash Price $733.50
Rate for Payer: Cash Price $733.50
Rate for Payer: Cigna Commercial $2,322.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $512.11
Rate for Payer: Dean Health DHI/DHP/ASO $1,467.00
Rate for Payer: Health EOS Commercial $2,224.95
Rate for Payer: HFN Commercial $2,322.75
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,350.77
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,350.77
Rate for Payer: Multiplan Commercial $1,956.00
Rate for Payer: Preferred Network Access Commercial $2,322.75
Rate for Payer: Quartz Beloit One Network $1,075.80
Rate for Payer: Quartz Commercial $1,393.65
Rate for Payer: The Alliance Commercial $1,222.50
Rate for Payer: United Healthcare Medicaid $512.11
Rate for Payer: WEA Trust Commercial $1,344.75
Rate for Payer: WPS Commercial $1,811.01
Service Code HCPCS Q4101
Hospital Charge Code 3542168
Hospital Revenue Code 636
Min. Negotiated Rate $40.51
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 $112.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $86.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $83.04
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 $40.51
Rate for Payer: Health EOS Commercial $153.97
Rate for Payer: HFN Commercial $159.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $129.75
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: WEA Trust Commercial $95.15
Rate for Payer: WPS Commercial $76.55
Service Code HCPCS Q4101
Hospital Charge Code 3542168
Hospital Revenue Code 636
Min. Negotiated Rate $30.62
Max. Negotiated Rate $164.35
Rate for Payer: Aetna Commercial $164.35
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $148.78
Rate for Payer: Cash Price $51.90
Rate for Payer: Cash Price $51.90
Rate for Payer: Cigna Commercial $164.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $31.17
Rate for Payer: Dean Health DHI/DHP/ASO $30.62
Rate for Payer: Health EOS Commercial $157.43
Rate for Payer: HFN Commercial $164.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $107.56
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $107.56
Rate for Payer: Multiplan Commercial $138.40
Rate for Payer: Preferred Network Access Commercial $164.35
Rate for Payer: Quartz Beloit One Network $76.12
Rate for Payer: Quartz Commercial $98.61
Rate for Payer: The Alliance Commercial $86.50
Rate for Payer: United Healthcare Medicaid $31.17
Rate for Payer: WEA Trust Commercial $95.15
Rate for Payer: WPS Commercial $76.55
Service Code HCPCS Q4101
Hospital Charge Code 3542168
Hospital Revenue Code 636
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 14000
Hospital Charge Code 3013619
Hospital Revenue Code 510
Min. Negotiated Rate $195.73
Max. Negotiated Rate $2,058.65
Rate for Payer: Aetna Commercial $2,058.65
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,863.62
Rate for Payer: Cash Price $650.10
Rate for Payer: Cash Price $650.10
Rate for Payer: Cigna Commercial $2,058.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $195.73
Rate for Payer: Dean Health DHI/DHP/ASO $1,300.20
Rate for Payer: Health EOS Commercial $1,971.97
Rate for Payer: HFN Commercial $2,058.65
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,652.92
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,652.92
Rate for Payer: Multiplan Commercial $1,733.60
Rate for Payer: Preferred Network Access Commercial $2,058.65
Rate for Payer: Quartz Beloit One Network $953.48
Rate for Payer: Quartz Commercial $1,235.19
Rate for Payer: The Alliance Commercial $1,083.50
Rate for Payer: United Healthcare Medicaid $195.73
Rate for Payer: WEA Trust Commercial $1,191.85
Rate for Payer: WPS Commercial $1,605.10
Service Code CPT 14001
Hospital Charge Code 3013620
Hospital Revenue Code 510
Min. Negotiated Rate $322.56
Max. Negotiated Rate $2,142.92
Rate for Payer: Aetna Commercial $1,867.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,690.76
Rate for Payer: Cash Price $589.80
Rate for Payer: Cash Price $589.80
Rate for Payer: Cigna Commercial $1,867.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $322.56
Rate for Payer: Dean Health DHI/DHP/ASO $1,179.60
Rate for Payer: Health EOS Commercial $1,789.06
Rate for Payer: HFN Commercial $1,867.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,142.92
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,142.92
Rate for Payer: Multiplan Commercial $1,572.80
Rate for Payer: Preferred Network Access Commercial $1,867.70
Rate for Payer: Quartz Beloit One Network $865.04
Rate for Payer: Quartz Commercial $1,120.62
Rate for Payer: The Alliance Commercial $983.00
Rate for Payer: United Healthcare Medicaid $322.56
Rate for Payer: WEA Trust Commercial $1,081.30
Rate for Payer: WPS Commercial $1,456.22