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Charge Type Price  
Hospital Charge Code 2959824
Hospital Revenue Code 360
Min. Negotiated Rate $2,406.88
Max. Negotiated Rate $4,519.04
Rate for Payer: Aetna Commercial $4,420.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,603.36
Rate for Payer: Cash Price $1,473.60
Rate for Payer: Cigna Commercial $4,519.04
Rate for Payer: Health EOS Commercial $4,371.68
Rate for Payer: HFN Commercial $4,519.04
Rate for Payer: Multiplan Commercial $3,929.60
Rate for Payer: NAPHCARE Commercial $2,947.20
Rate for Payer: Preferred Network Access Commercial $4,519.04
Rate for Payer: Quartz Beloit One Network $2,406.88
Rate for Payer: Quartz Commercial $2,947.20
Rate for Payer: WEA Trust Commercial $2,701.60
Rate for Payer: WPS Commercial $3,638.32
Service Code CPT 73115
Hospital Charge Code 3072709
Hospital Revenue Code 320
Min. Negotiated Rate $131.18
Max. Negotiated Rate $1,157.10
Rate for Payer: Aetna Commercial $1,157.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,047.48
Rate for Payer: Aetna Managed Medicare $131.18
Rate for Payer: Anthem Medicare Advantage $131.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $131.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $131.18
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,157.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $609.00
Rate for Payer: Dean Health DHI/DHP/ASO $131.18
Rate for Payer: Health EOS Commercial $1,108.38
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $465.15
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $465.15
Rate for Payer: Independent Care Health Plan Medicare $131.18
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: Preferred Network Access Commercial $1,157.10
Rate for Payer: Quartz Beloit One Network $535.92
Rate for Payer: Quartz Commercial $694.26
Rate for Payer: Quartz Medicare Advantage $131.18
Rate for Payer: The Alliance Commercial $498.48
Rate for Payer: United Healthcare Medicare Advantage $131.18
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: WPS Commercial $655.90
Service Code CPT 73115
Hospital Charge Code 3072709
Hospital Revenue Code 320
Min. Negotiated Rate $596.82
Max. Negotiated Rate $1,120.56
Rate for Payer: Aetna Commercial $1,096.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $645.54
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,120.56
Rate for Payer: Health EOS Commercial $1,084.02
Rate for Payer: HFN Commercial $1,120.56
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: NAPHCARE Commercial $730.80
Rate for Payer: Preferred Network Access Commercial $1,120.56
Rate for Payer: Quartz Beloit One Network $596.82
Rate for Payer: Quartz Commercial $730.80
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: WPS Commercial $902.17
Service Code CPT 73115
Hospital Charge Code 3072709
Hospital Revenue Code 320
Min. Negotiated Rate $301.00
Max. Negotiated Rate $1,425.45
Rate for Payer: Aetna Commercial $1,096.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,047.48
Rate for Payer: Aetna Managed Medicare $380.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,425.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,140.36
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,083.34
Rate for Payer: Anthem Medicare Advantage $380.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $645.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $380.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $380.12
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,120.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $380.12
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $380.12
Rate for Payer: Health EOS Commercial $1,084.02
Rate for Payer: HFN Commercial $1,120.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,414.05
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $380.12
Rate for Payer: Independent Care Health Plan Medicare $380.12
Rate for Payer: Managed Health Services Medicare Advantage $380.12
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $380.12
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: NAPHCARE Commercial $570.18
Rate for Payer: Preferred Network Access Commercial $1,120.56
Rate for Payer: Quartz Beloit One Network $596.82
Rate for Payer: Quartz Commercial $791.70
Rate for Payer: Quartz Medicare Advantage $380.12
Rate for Payer: The Alliance Commercial $1,132.88
Rate for Payer: United Healthcare Medicare Advantage $380.12
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: Wellcare Medicare $380.12
Rate for Payer: WPS Commercial $902.17
Service Code CPT 73115
Hospital Charge Code 3072710
Hospital Revenue Code 320
Min. Negotiated Rate $301.00
Max. Negotiated Rate $1,425.45
Rate for Payer: Aetna Commercial $1,096.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,047.48
Rate for Payer: Aetna Managed Medicare $380.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,425.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,140.36
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,083.34
Rate for Payer: Anthem Medicare Advantage $380.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $645.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $380.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $380.12
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,120.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $380.12
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $380.12
Rate for Payer: Health EOS Commercial $1,084.02
Rate for Payer: HFN Commercial $1,120.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,414.05
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $380.12
Rate for Payer: Independent Care Health Plan Medicare $380.12
Rate for Payer: Managed Health Services Medicare Advantage $380.12
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $380.12
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: NAPHCARE Commercial $570.18
Rate for Payer: Preferred Network Access Commercial $1,120.56
Rate for Payer: Quartz Beloit One Network $596.82
Rate for Payer: Quartz Commercial $791.70
Rate for Payer: Quartz Medicare Advantage $380.12
Rate for Payer: The Alliance Commercial $1,132.88
Rate for Payer: United Healthcare Medicare Advantage $380.12
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: Wellcare Medicare $380.12
Rate for Payer: WPS Commercial $902.17
Service Code CPT 73115
Hospital Charge Code 3072710
Hospital Revenue Code 320
Min. Negotiated Rate $131.18
Max. Negotiated Rate $1,157.10
Rate for Payer: Aetna Commercial $1,157.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,047.48
Rate for Payer: Aetna Managed Medicare $131.18
Rate for Payer: Anthem Medicare Advantage $131.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $131.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $131.18
Rate for Payer: Cash Price $365.40
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,157.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $609.00
Rate for Payer: Dean Health DHI/DHP/ASO $131.18
Rate for Payer: Health EOS Commercial $1,108.38
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $465.15
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $465.15
Rate for Payer: Independent Care Health Plan Medicare $131.18
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: Preferred Network Access Commercial $1,157.10
Rate for Payer: Quartz Beloit One Network $535.92
Rate for Payer: Quartz Commercial $694.26
Rate for Payer: Quartz Medicare Advantage $131.18
Rate for Payer: The Alliance Commercial $498.48
Rate for Payer: United Healthcare Medicare Advantage $131.18
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: WPS Commercial $655.90
Service Code CPT 73115
Hospital Charge Code 3072710
Hospital Revenue Code 320
Min. Negotiated Rate $596.82
Max. Negotiated Rate $1,120.56
Rate for Payer: Aetna Commercial $1,096.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $645.54
Rate for Payer: Cash Price $365.40
Rate for Payer: Cigna Commercial $1,120.56
Rate for Payer: Health EOS Commercial $1,084.02
Rate for Payer: HFN Commercial $1,120.56
Rate for Payer: Multiplan Commercial $974.40
Rate for Payer: NAPHCARE Commercial $730.80
Rate for Payer: Preferred Network Access Commercial $1,120.56
Rate for Payer: Quartz Beloit One Network $596.82
Rate for Payer: Quartz Commercial $730.80
Rate for Payer: WEA Trust Commercial $669.90
Rate for Payer: WPS Commercial $902.17
Hospital Charge Code 2960446
Hospital Revenue Code 360
Min. Negotiated Rate $2,243.36
Max. Negotiated Rate $32,048.00
Rate for Payer: Aetna Commercial $7,210.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,890.32
Rate for Payer: Aetna Managed Medicare $2,243.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,207.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,006.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,845.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,246.36
Rate for Payer: Cash Price $2,403.60
Rate for Payer: Cigna Commercial $7,371.04
Rate for Payer: Dean Health DHI/DHP/ASO $4,483.52
Rate for Payer: Health EOS Commercial $7,130.68
Rate for Payer: HFN Commercial $7,371.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,009.00
Rate for Payer: Multiplan Commercial $6,409.60
Rate for Payer: NAPHCARE Commercial $4,807.20
Rate for Payer: Preferred Network Access Commercial $7,371.04
Rate for Payer: Quartz Beloit One Network $3,925.88
Rate for Payer: Quartz Commercial $5,207.80
Rate for Payer: Quartz Medicare Advantage $4,807.20
Rate for Payer: The Alliance Commercial $32,048.00
Rate for Payer: WEA Trust Commercial $4,406.60
Rate for Payer: WPS Commercial $5,934.49
Hospital Charge Code 2960446
Hospital Revenue Code 360
Min. Negotiated Rate $3,925.88
Max. Negotiated Rate $7,371.04
Rate for Payer: Aetna Commercial $7,210.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,246.36
Rate for Payer: Cash Price $2,403.60
Rate for Payer: Cigna Commercial $7,371.04
Rate for Payer: Health EOS Commercial $7,130.68
Rate for Payer: HFN Commercial $7,371.04
Rate for Payer: Multiplan Commercial $6,409.60
Rate for Payer: NAPHCARE Commercial $4,807.20
Rate for Payer: Preferred Network Access Commercial $7,371.04
Rate for Payer: Quartz Beloit One Network $3,925.88
Rate for Payer: Quartz Commercial $4,807.20
Rate for Payer: WEA Trust Commercial $4,406.60
Rate for Payer: WPS Commercial $5,934.49
Hospital Charge Code 2959831
Hospital Revenue Code 360
Min. Negotiated Rate $3,895.50
Max. Negotiated Rate $7,314.00
Rate for Payer: Aetna Commercial $7,155.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,213.50
Rate for Payer: Cash Price $2,385.00
Rate for Payer: Cigna Commercial $7,314.00
Rate for Payer: Health EOS Commercial $7,075.50
Rate for Payer: HFN Commercial $7,314.00
Rate for Payer: Multiplan Commercial $6,360.00
Rate for Payer: NAPHCARE Commercial $4,770.00
Rate for Payer: Preferred Network Access Commercial $7,314.00
Rate for Payer: Quartz Beloit One Network $3,895.50
Rate for Payer: Quartz Commercial $4,770.00
Rate for Payer: WEA Trust Commercial $4,372.50
Rate for Payer: WPS Commercial $5,888.56
Hospital Charge Code 2959831
Hospital Revenue Code 360
Min. Negotiated Rate $2,226.00
Max. Negotiated Rate $31,800.00
Rate for Payer: Aetna Commercial $7,155.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,837.00
Rate for Payer: Aetna Managed Medicare $2,226.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,167.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,975.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,816.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,213.50
Rate for Payer: Cash Price $2,385.00
Rate for Payer: Cigna Commercial $7,314.00
Rate for Payer: Dean Health DHI/DHP/ASO $4,448.82
Rate for Payer: Health EOS Commercial $7,075.50
Rate for Payer: HFN Commercial $7,314.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,962.50
Rate for Payer: Multiplan Commercial $6,360.00
Rate for Payer: NAPHCARE Commercial $4,770.00
Rate for Payer: Preferred Network Access Commercial $7,314.00
Rate for Payer: Quartz Beloit One Network $3,895.50
Rate for Payer: Quartz Commercial $5,167.50
Rate for Payer: Quartz Medicare Advantage $4,770.00
Rate for Payer: The Alliance Commercial $31,800.00
Rate for Payer: WEA Trust Commercial $4,372.50
Rate for Payer: WPS Commercial $5,888.56
Hospital Charge Code 2959868
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: 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 2959868
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 2970944
Hospital Revenue Code 271
Min. Negotiated Rate $162.68
Max. Negotiated Rate $305.44
Rate for Payer: Aetna Commercial $298.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $175.96
Rate for Payer: Cash Price $99.60
Rate for Payer: Cigna Commercial $305.44
Rate for Payer: Health EOS Commercial $295.48
Rate for Payer: HFN Commercial $305.44
Rate for Payer: Multiplan Commercial $265.60
Rate for Payer: NAPHCARE Commercial $199.20
Rate for Payer: Preferred Network Access Commercial $305.44
Rate for Payer: Quartz Beloit One Network $162.68
Rate for Payer: Quartz Commercial $199.20
Rate for Payer: WEA Trust Commercial $182.60
Rate for Payer: WPS Commercial $245.91
Hospital Charge Code 2970944
Hospital Revenue Code 271
Min. Negotiated Rate $92.96
Max. Negotiated Rate $1,328.00
Rate for Payer: Aetna Commercial $298.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $285.52
Rate for Payer: Aetna Managed Medicare $92.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $215.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $166.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $159.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $175.96
Rate for Payer: Cash Price $99.60
Rate for Payer: Cigna Commercial $305.44
Rate for Payer: Dean Health DHI/DHP/ASO $185.79
Rate for Payer: Health EOS Commercial $295.48
Rate for Payer: HFN Commercial $305.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $249.00
Rate for Payer: Multiplan Commercial $265.60
Rate for Payer: NAPHCARE Commercial $199.20
Rate for Payer: Preferred Network Access Commercial $305.44
Rate for Payer: Quartz Beloit One Network $162.68
Rate for Payer: Quartz Commercial $215.80
Rate for Payer: Quartz Medicare Advantage $199.20
Rate for Payer: The Alliance Commercial $1,328.00
Rate for Payer: WEA Trust Commercial $182.60
Rate for Payer: WPS Commercial $245.91
Hospital Charge Code 2969685
Hospital Revenue Code 271
Min. Negotiated Rate $176.40
Max. Negotiated Rate $331.20
Rate for Payer: Aetna Commercial $324.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $190.80
Rate for Payer: Cash Price $108.00
Rate for Payer: Cigna Commercial $331.20
Rate for Payer: Health EOS Commercial $320.40
Rate for Payer: HFN Commercial $331.20
Rate for Payer: Multiplan Commercial $288.00
Rate for Payer: NAPHCARE Commercial $216.00
Rate for Payer: Preferred Network Access Commercial $331.20
Rate for Payer: Quartz Beloit One Network $176.40
Rate for Payer: Quartz Commercial $216.00
Rate for Payer: WEA Trust Commercial $198.00
Rate for Payer: WPS Commercial $266.65
Hospital Charge Code 2969685
Hospital Revenue Code 271
Min. Negotiated Rate $100.80
Max. Negotiated Rate $1,440.00
Rate for Payer: Aetna Commercial $324.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $309.60
Rate for Payer: Aetna Managed Medicare $100.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $234.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $180.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $172.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $190.80
Rate for Payer: Cash Price $108.00
Rate for Payer: Cigna Commercial $331.20
Rate for Payer: Dean Health DHI/DHP/ASO $201.46
Rate for Payer: Health EOS Commercial $320.40
Rate for Payer: HFN Commercial $331.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $270.00
Rate for Payer: Multiplan Commercial $288.00
Rate for Payer: NAPHCARE Commercial $216.00
Rate for Payer: Preferred Network Access Commercial $331.20
Rate for Payer: Quartz Beloit One Network $176.40
Rate for Payer: Quartz Commercial $234.00
Rate for Payer: Quartz Medicare Advantage $216.00
Rate for Payer: The Alliance Commercial $1,440.00
Rate for Payer: WEA Trust Commercial $198.00
Rate for Payer: WPS Commercial $266.65
Hospital Charge Code 2960041
Hospital Revenue Code 360
Min. Negotiated Rate $2,671.97
Max. Negotiated Rate $5,016.76
Rate for Payer: Aetna Commercial $4,907.70
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,890.09
Rate for Payer: Cash Price $1,635.90
Rate for Payer: Cigna Commercial $5,016.76
Rate for Payer: Health EOS Commercial $4,853.17
Rate for Payer: HFN Commercial $5,016.76
Rate for Payer: Multiplan Commercial $4,362.40
Rate for Payer: NAPHCARE Commercial $3,271.80
Rate for Payer: Preferred Network Access Commercial $5,016.76
Rate for Payer: Quartz Beloit One Network $2,671.97
Rate for Payer: Quartz Commercial $3,271.80
Rate for Payer: WEA Trust Commercial $2,999.15
Rate for Payer: WPS Commercial $4,039.04
Hospital Charge Code 2960041
Hospital Revenue Code 360
Min. Negotiated Rate $1,526.84
Max. Negotiated Rate $21,812.00
Rate for Payer: Aetna Commercial $4,907.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,689.58
Rate for Payer: Aetna Managed Medicare $1,526.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,544.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,726.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,617.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,890.09
Rate for Payer: Cash Price $1,635.90
Rate for Payer: Cigna Commercial $5,016.76
Rate for Payer: Dean Health DHI/DHP/ASO $3,051.50
Rate for Payer: Health EOS Commercial $4,853.17
Rate for Payer: HFN Commercial $5,016.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,089.75
Rate for Payer: Multiplan Commercial $4,362.40
Rate for Payer: NAPHCARE Commercial $3,271.80
Rate for Payer: Preferred Network Access Commercial $5,016.76
Rate for Payer: Quartz Beloit One Network $2,671.97
Rate for Payer: Quartz Commercial $3,544.45
Rate for Payer: Quartz Medicare Advantage $3,271.80
Rate for Payer: The Alliance Commercial $21,812.00
Rate for Payer: WEA Trust Commercial $2,999.15
Rate for Payer: WPS Commercial $4,039.04
Service Code HCPCS C1713
Hospital Charge Code 4519002
Hospital Revenue Code 278
Min. Negotiated Rate $2,268.28
Max. Negotiated Rate $7,452.92
Rate for Payer: Aetna Commercial $7,290.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,966.86
Rate for Payer: Aetna Managed Medicare $2,268.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,265.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,050.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,888.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,293.53
Rate for Payer: Cash Price $2,430.30
Rate for Payer: Cigna Commercial $7,452.92
Rate for Payer: Dean Health DHI/DHP/ASO $4,533.32
Rate for Payer: Health EOS Commercial $7,209.89
Rate for Payer: HFN Commercial $7,452.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,075.75
Rate for Payer: Multiplan Commercial $6,480.80
Rate for Payer: NAPHCARE Commercial $4,860.60
Rate for Payer: Preferred Network Access Commercial $7,452.92
Rate for Payer: Quartz Beloit One Network $3,969.49
Rate for Payer: Quartz Commercial $5,265.65
Rate for Payer: Quartz Medicare Advantage $4,860.60
Rate for Payer: WEA Trust Commercial $4,455.55
Rate for Payer: WPS Commercial $6,000.41
Service Code HCPCS C1713
Hospital Charge Code 4519002
Hospital Revenue Code 278
Min. Negotiated Rate $3,969.49
Max. Negotiated Rate $7,452.92
Rate for Payer: Aetna Commercial $7,290.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,293.53
Rate for Payer: Cash Price $2,430.30
Rate for Payer: Cigna Commercial $7,452.92
Rate for Payer: Health EOS Commercial $7,209.89
Rate for Payer: HFN Commercial $7,452.92
Rate for Payer: Multiplan Commercial $6,480.80
Rate for Payer: NAPHCARE Commercial $4,860.60
Rate for Payer: Preferred Network Access Commercial $7,452.92
Rate for Payer: Quartz Beloit One Network $3,969.49
Rate for Payer: Quartz Commercial $4,860.60
Rate for Payer: WEA Trust Commercial $4,455.55
Rate for Payer: WPS Commercial $6,000.41
Hospital Charge Code 2974323
Hospital Revenue Code 271
Min. Negotiated Rate $70.84
Max. Negotiated Rate $1,012.00
Rate for Payer: Aetna Commercial $227.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $217.58
Rate for Payer: Aetna Managed Medicare $70.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $164.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $126.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $121.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $134.09
Rate for Payer: Cash Price $75.90
Rate for Payer: Cigna Commercial $232.76
Rate for Payer: Dean Health DHI/DHP/ASO $141.58
Rate for Payer: Health EOS Commercial $225.17
Rate for Payer: HFN Commercial $232.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $189.75
Rate for Payer: Multiplan Commercial $202.40
Rate for Payer: NAPHCARE Commercial $151.80
Rate for Payer: Preferred Network Access Commercial $232.76
Rate for Payer: Quartz Beloit One Network $123.97
Rate for Payer: Quartz Commercial $164.45
Rate for Payer: Quartz Medicare Advantage $151.80
Rate for Payer: The Alliance Commercial $1,012.00
Rate for Payer: WEA Trust Commercial $139.15
Rate for Payer: WPS Commercial $187.40
Hospital Charge Code 2974323
Hospital Revenue Code 271
Min. Negotiated Rate $123.97
Max. Negotiated Rate $232.76
Rate for Payer: Aetna Commercial $227.70
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $134.09
Rate for Payer: Cash Price $75.90
Rate for Payer: Cigna Commercial $232.76
Rate for Payer: Health EOS Commercial $225.17
Rate for Payer: HFN Commercial $232.76
Rate for Payer: Multiplan Commercial $202.40
Rate for Payer: NAPHCARE Commercial $151.80
Rate for Payer: Preferred Network Access Commercial $232.76
Rate for Payer: Quartz Beloit One Network $123.97
Rate for Payer: Quartz Commercial $151.80
Rate for Payer: WEA Trust Commercial $139.15
Rate for Payer: WPS Commercial $187.40
Hospital Charge Code 2965834
Hospital Revenue Code 271
Min. Negotiated Rate $54.32
Max. Negotiated Rate $776.00
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $166.84
Rate for Payer: Aetna Managed Medicare $54.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $126.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $97.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $93.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Dean Health DHI/DHP/ASO $108.56
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $145.50
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $116.40
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $126.10
Rate for Payer: Quartz Medicare Advantage $116.40
Rate for Payer: The Alliance Commercial $776.00
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70
Hospital Charge Code 2965834
Hospital Revenue Code 271
Min. Negotiated Rate $95.06
Max. Negotiated Rate $178.48
Rate for Payer: Aetna Commercial $174.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $102.82
Rate for Payer: Cash Price $58.20
Rate for Payer: Cigna Commercial $178.48
Rate for Payer: Health EOS Commercial $172.66
Rate for Payer: HFN Commercial $178.48
Rate for Payer: Multiplan Commercial $155.20
Rate for Payer: NAPHCARE Commercial $116.40
Rate for Payer: Preferred Network Access Commercial $178.48
Rate for Payer: Quartz Beloit One Network $95.06
Rate for Payer: Quartz Commercial $116.40
Rate for Payer: WEA Trust Commercial $106.70
Rate for Payer: WPS Commercial $143.70