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Service Code CPT 73564
Hospital Charge Code 711790
Min. Negotiated Rate $108.67
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $108.67
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $494.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $380.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $364.80
Rate for Payer: Anthem Medicare Advantage $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $108.67
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $108.67
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $108.67
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $404.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $108.67
Rate for Payer: Independent Care Health Plan Medicare $108.67
Rate for Payer: Managed Health Services Medicare Advantage $108.67
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $108.67
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $163.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $494.00
Rate for Payer: Quartz Medicare Advantage $108.67
Rate for Payer: The Alliance Commercial $195.52
Rate for Payer: United Healthcare Medicare Advantage $108.67
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: Wellcare Medicare $108.67
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537156
Hospital Revenue Code 320
Min. Negotiated Rate $347.60
Max. Negotiated Rate $750.50
Rate for Payer: Aetna Commercial $750.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $679.40
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cigna Commercial $750.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $395.00
Rate for Payer: Dean Health DHI/DHP/ASO $474.00
Rate for Payer: Health EOS Commercial $718.90
Rate for Payer: Multiplan Commercial $632.00
Rate for Payer: Preferred Network Access Commercial $750.50
Rate for Payer: Quartz Beloit One Network $347.60
Rate for Payer: Quartz Commercial $450.30
Rate for Payer: The Alliance Commercial $395.00
Rate for Payer: WEA Trust Commercial $434.50
Rate for Payer: WPS Commercial $585.15
Service Code CPT 73564
Hospital Charge Code 711790
Min. Negotiated Rate $45.01
Max. Negotiated Rate $722.00
Rate for Payer: Aetna Commercial $722.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $45.01
Rate for Payer: Anthem Medicare Advantage $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45.01
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $722.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $380.00
Rate for Payer: Dean Health DHI/DHP/ASO $45.01
Rate for Payer: Health EOS Commercial $691.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $155.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $155.46
Rate for Payer: Independent Care Health Plan Medicare $45.01
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: Preferred Network Access Commercial $722.00
Rate for Payer: Quartz Beloit One Network $334.40
Rate for Payer: Quartz Commercial $433.20
Rate for Payer: Quartz Medicare Advantage $45.01
Rate for Payer: The Alliance Commercial $171.04
Rate for Payer: United Healthcare Medicare Advantage $45.01
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $225.05
Service Code CPT 73564
Hospital Charge Code 711790
Min. Negotiated Rate $372.40
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $456.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $456.00
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537156
Hospital Revenue Code 320
Min. Negotiated Rate $221.20
Max. Negotiated Rate $3,160.00
Rate for Payer: Aetna Commercial $711.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $679.40
Rate for Payer: Aetna Managed Medicare $221.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $513.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $395.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $379.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $418.70
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cigna Commercial $726.80
Rate for Payer: Health EOS Commercial $703.10
Rate for Payer: HFN Commercial $726.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $592.50
Rate for Payer: Multiplan Commercial $632.00
Rate for Payer: NAPHCARE Commercial $474.00
Rate for Payer: Preferred Network Access Commercial $726.80
Rate for Payer: Quartz Beloit One Network $387.10
Rate for Payer: Quartz Commercial $513.50
Rate for Payer: Quartz Medicare Advantage $474.00
Rate for Payer: The Alliance Commercial $3,160.00
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $434.50
Rate for Payer: WPS Commercial $585.15
Service Code CPT 73564 RT,TC
Hospital Charge Code 1537159
Hospital Revenue Code 320
Min. Negotiated Rate $387.10
Max. Negotiated Rate $726.80
Rate for Payer: Aetna Commercial $711.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $418.70
Rate for Payer: Cash Price $237.00
Rate for Payer: Cigna Commercial $726.80
Rate for Payer: Health EOS Commercial $703.10
Rate for Payer: HFN Commercial $726.80
Rate for Payer: Multiplan Commercial $632.00
Rate for Payer: NAPHCARE Commercial $474.00
Rate for Payer: Preferred Network Access Commercial $726.80
Rate for Payer: Quartz Beloit One Network $387.10
Rate for Payer: Quartz Commercial $474.00
Rate for Payer: WEA Trust Commercial $434.50
Rate for Payer: WPS Commercial $585.15
Service Code CPT 73564 RT,TC
Hospital Charge Code 1537159
Hospital Revenue Code 320
Min. Negotiated Rate $221.20
Max. Negotiated Rate $3,160.00
Rate for Payer: Aetna Commercial $711.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $679.40
Rate for Payer: Aetna Managed Medicare $221.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $513.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $395.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $379.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $418.70
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cigna Commercial $726.80
Rate for Payer: Health EOS Commercial $703.10
Rate for Payer: HFN Commercial $726.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $592.50
Rate for Payer: Multiplan Commercial $632.00
Rate for Payer: NAPHCARE Commercial $474.00
Rate for Payer: Preferred Network Access Commercial $726.80
Rate for Payer: Quartz Beloit One Network $387.10
Rate for Payer: Quartz Commercial $513.50
Rate for Payer: Quartz Medicare Advantage $474.00
Rate for Payer: The Alliance Commercial $3,160.00
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $434.50
Rate for Payer: WPS Commercial $585.15
Service Code CPT 73564 RT,TC
Hospital Charge Code 1537159
Hospital Revenue Code 320
Min. Negotiated Rate $347.60
Max. Negotiated Rate $750.50
Rate for Payer: Aetna Commercial $750.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $679.40
Rate for Payer: Cash Price $237.00
Rate for Payer: Cash Price $237.00
Rate for Payer: Cigna Commercial $750.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $395.00
Rate for Payer: Dean Health DHI/DHP/ASO $474.00
Rate for Payer: Health EOS Commercial $718.90
Rate for Payer: Multiplan Commercial $632.00
Rate for Payer: Preferred Network Access Commercial $750.50
Rate for Payer: Quartz Beloit One Network $347.60
Rate for Payer: Quartz Commercial $450.30
Rate for Payer: The Alliance Commercial $395.00
Rate for Payer: WEA Trust Commercial $434.50
Rate for Payer: WPS Commercial $585.15
Service Code CPT 73564
Hospital Charge Code 711791
Min. Negotiated Rate $45.01
Max. Negotiated Rate $722.00
Rate for Payer: Aetna Commercial $722.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $45.01
Rate for Payer: Anthem Medicare Advantage $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45.01
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $722.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $380.00
Rate for Payer: Dean Health DHI/DHP/ASO $45.01
Rate for Payer: Health EOS Commercial $691.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $155.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $155.46
Rate for Payer: Independent Care Health Plan Medicare $45.01
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: Preferred Network Access Commercial $722.00
Rate for Payer: Quartz Beloit One Network $334.40
Rate for Payer: Quartz Commercial $433.20
Rate for Payer: Quartz Medicare Advantage $45.01
Rate for Payer: The Alliance Commercial $171.04
Rate for Payer: United Healthcare Medicare Advantage $45.01
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $225.05
Service Code CPT 73564
Hospital Charge Code 711791
Min. Negotiated Rate $108.67
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $108.67
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $494.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $380.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $364.80
Rate for Payer: Anthem Medicare Advantage $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $108.67
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $108.67
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $108.67
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $404.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $108.67
Rate for Payer: Independent Care Health Plan Medicare $108.67
Rate for Payer: Managed Health Services Medicare Advantage $108.67
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $108.67
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $163.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $494.00
Rate for Payer: Quartz Medicare Advantage $108.67
Rate for Payer: The Alliance Commercial $195.52
Rate for Payer: United Healthcare Medicare Advantage $108.67
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: Wellcare Medicare $108.67
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564
Hospital Charge Code 711791
Min. Negotiated Rate $372.40
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $456.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $456.00
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564
Hospital Charge Code 630391
Min. Negotiated Rate $744.80
Max. Negotiated Rate $1,398.40
Rate for Payer: Aetna Commercial $1,368.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $805.60
Rate for Payer: Cash Price $456.00
Rate for Payer: Cigna Commercial $1,398.40
Rate for Payer: Health EOS Commercial $1,352.80
Rate for Payer: HFN Commercial $1,398.40
Rate for Payer: Multiplan Commercial $1,216.00
Rate for Payer: NAPHCARE Commercial $912.00
Rate for Payer: Preferred Network Access Commercial $1,398.40
Rate for Payer: Quartz Beloit One Network $744.80
Rate for Payer: Quartz Commercial $912.00
Rate for Payer: WEA Trust Commercial $836.00
Rate for Payer: WPS Commercial $1,125.86
Service Code CPT 73564
Hospital Charge Code 630391
Min. Negotiated Rate $45.01
Max. Negotiated Rate $1,444.00
Rate for Payer: Aetna Commercial $1,444.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,307.20
Rate for Payer: Aetna Managed Medicare $45.01
Rate for Payer: Anthem Medicare Advantage $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45.01
Rate for Payer: Cash Price $456.00
Rate for Payer: Cash Price $456.00
Rate for Payer: Cigna Commercial $1,444.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $760.00
Rate for Payer: Dean Health DHI/DHP/ASO $45.01
Rate for Payer: Health EOS Commercial $1,383.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $155.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $155.46
Rate for Payer: Independent Care Health Plan Medicare $45.01
Rate for Payer: Multiplan Commercial $1,216.00
Rate for Payer: Preferred Network Access Commercial $1,444.00
Rate for Payer: Quartz Beloit One Network $668.80
Rate for Payer: Quartz Commercial $866.40
Rate for Payer: Quartz Medicare Advantage $45.01
Rate for Payer: The Alliance Commercial $171.04
Rate for Payer: United Healthcare Medicare Advantage $45.01
Rate for Payer: WEA Trust Commercial $836.00
Rate for Payer: WPS Commercial $225.05
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537162
Hospital Revenue Code 320
Min. Negotiated Rate $361.24
Max. Negotiated Rate $779.95
Rate for Payer: Aetna Commercial $779.95
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $706.06
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $779.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $410.50
Rate for Payer: Dean Health DHI/DHP/ASO $492.60
Rate for Payer: Health EOS Commercial $747.11
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: Preferred Network Access Commercial $779.95
Rate for Payer: Quartz Beloit One Network $361.24
Rate for Payer: Quartz Commercial $467.97
Rate for Payer: The Alliance Commercial $410.50
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537162
Hospital Revenue Code 320
Min. Negotiated Rate $402.29
Max. Negotiated Rate $755.32
Rate for Payer: Aetna Commercial $738.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $435.13
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $755.32
Rate for Payer: Health EOS Commercial $730.69
Rate for Payer: HFN Commercial $755.32
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: NAPHCARE Commercial $492.60
Rate for Payer: Preferred Network Access Commercial $755.32
Rate for Payer: Quartz Beloit One Network $402.29
Rate for Payer: Quartz Commercial $492.60
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564
Hospital Charge Code 630391
Min. Negotiated Rate $108.67
Max. Negotiated Rate $1,398.40
Rate for Payer: Aetna Commercial $1,368.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,307.20
Rate for Payer: Aetna Managed Medicare $108.67
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $988.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $760.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $729.60
Rate for Payer: Anthem Medicare Advantage $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $805.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $108.67
Rate for Payer: Cash Price $456.00
Rate for Payer: Cash Price $456.00
Rate for Payer: Cigna Commercial $1,398.40
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $108.67
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $108.67
Rate for Payer: Health EOS Commercial $1,352.80
Rate for Payer: HFN Commercial $1,398.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $404.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $108.67
Rate for Payer: Independent Care Health Plan Medicare $108.67
Rate for Payer: Managed Health Services Medicare Advantage $108.67
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $108.67
Rate for Payer: Multiplan Commercial $1,216.00
Rate for Payer: NAPHCARE Commercial $163.00
Rate for Payer: Preferred Network Access Commercial $1,398.40
Rate for Payer: Quartz Beloit One Network $744.80
Rate for Payer: Quartz Commercial $988.00
Rate for Payer: Quartz Medicare Advantage $108.67
Rate for Payer: The Alliance Commercial $195.52
Rate for Payer: United Healthcare Medicare Advantage $108.67
Rate for Payer: WEA Trust Commercial $836.00
Rate for Payer: Wellcare Medicare $108.67
Rate for Payer: WPS Commercial $1,125.86
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537162
Hospital Revenue Code 320
Min. Negotiated Rate $229.88
Max. Negotiated Rate $3,284.00
Rate for Payer: Aetna Commercial $738.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $706.06
Rate for Payer: Aetna Managed Medicare $229.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $533.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $410.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $394.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $435.13
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $755.32
Rate for Payer: Health EOS Commercial $730.69
Rate for Payer: HFN Commercial $755.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $615.75
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: NAPHCARE Commercial $492.60
Rate for Payer: Preferred Network Access Commercial $755.32
Rate for Payer: Quartz Beloit One Network $402.29
Rate for Payer: Quartz Commercial $533.65
Rate for Payer: Quartz Medicare Advantage $492.60
Rate for Payer: The Alliance Commercial $3,284.00
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537164
Hospital Revenue Code 320
Min. Negotiated Rate $229.88
Max. Negotiated Rate $3,284.00
Rate for Payer: Aetna Commercial $738.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $706.06
Rate for Payer: Aetna Managed Medicare $229.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $533.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $410.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $394.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $435.13
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $755.32
Rate for Payer: Health EOS Commercial $730.69
Rate for Payer: HFN Commercial $755.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $615.75
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: NAPHCARE Commercial $492.60
Rate for Payer: Preferred Network Access Commercial $755.32
Rate for Payer: Quartz Beloit One Network $402.29
Rate for Payer: Quartz Commercial $533.65
Rate for Payer: Quartz Medicare Advantage $492.60
Rate for Payer: The Alliance Commercial $3,284.00
Rate for Payer: United Healthcare PPO $301.00
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564
Hospital Charge Code 630373
Min. Negotiated Rate $45.01
Max. Negotiated Rate $722.00
Rate for Payer: Aetna Commercial $722.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $45.01
Rate for Payer: Anthem Medicare Advantage $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45.01
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $722.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $380.00
Rate for Payer: Dean Health DHI/DHP/ASO $45.01
Rate for Payer: Health EOS Commercial $691.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $155.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $155.46
Rate for Payer: Independent Care Health Plan Medicare $45.01
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: Preferred Network Access Commercial $722.00
Rate for Payer: Quartz Beloit One Network $334.40
Rate for Payer: Quartz Commercial $433.20
Rate for Payer: Quartz Medicare Advantage $45.01
Rate for Payer: The Alliance Commercial $171.04
Rate for Payer: United Healthcare Medicare Advantage $45.01
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $225.05
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537164
Hospital Revenue Code 320
Min. Negotiated Rate $402.29
Max. Negotiated Rate $755.32
Rate for Payer: Aetna Commercial $738.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $435.13
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $755.32
Rate for Payer: Health EOS Commercial $730.69
Rate for Payer: HFN Commercial $755.32
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: NAPHCARE Commercial $492.60
Rate for Payer: Preferred Network Access Commercial $755.32
Rate for Payer: Quartz Beloit One Network $402.29
Rate for Payer: Quartz Commercial $492.60
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564 LT,TC
Hospital Charge Code 1537164
Hospital Revenue Code 320
Min. Negotiated Rate $361.24
Max. Negotiated Rate $779.95
Rate for Payer: Aetna Commercial $779.95
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $706.06
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $779.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $410.50
Rate for Payer: Dean Health DHI/DHP/ASO $492.60
Rate for Payer: Health EOS Commercial $747.11
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: Preferred Network Access Commercial $779.95
Rate for Payer: Quartz Beloit One Network $361.24
Rate for Payer: Quartz Commercial $467.97
Rate for Payer: The Alliance Commercial $410.50
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11
Service Code CPT 73564
Hospital Charge Code 630373
Min. Negotiated Rate $108.67
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $108.67
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $494.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $380.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $364.80
Rate for Payer: Anthem Medicare Advantage $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $108.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $108.67
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $108.67
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $108.67
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $404.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $108.67
Rate for Payer: Independent Care Health Plan Medicare $108.67
Rate for Payer: Managed Health Services Medicare Advantage $108.67
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $108.67
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $163.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $494.00
Rate for Payer: Quartz Medicare Advantage $108.67
Rate for Payer: The Alliance Commercial $195.52
Rate for Payer: United Healthcare Medicare Advantage $108.67
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: Wellcare Medicare $108.67
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564
Hospital Charge Code 630373
Min. Negotiated Rate $372.40
Max. Negotiated Rate $699.20
Rate for Payer: Aetna Commercial $684.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $402.80
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $699.20
Rate for Payer: Health EOS Commercial $676.40
Rate for Payer: HFN Commercial $699.20
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: NAPHCARE Commercial $456.00
Rate for Payer: Preferred Network Access Commercial $699.20
Rate for Payer: Quartz Beloit One Network $372.40
Rate for Payer: Quartz Commercial $456.00
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $562.93
Service Code CPT 73564
Hospital Charge Code 630369
Min. Negotiated Rate $45.01
Max. Negotiated Rate $722.00
Rate for Payer: Aetna Commercial $722.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $653.60
Rate for Payer: Aetna Managed Medicare $45.01
Rate for Payer: Anthem Medicare Advantage $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45.01
Rate for Payer: Cash Price $228.00
Rate for Payer: Cash Price $228.00
Rate for Payer: Cigna Commercial $722.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $380.00
Rate for Payer: Dean Health DHI/DHP/ASO $45.01
Rate for Payer: Health EOS Commercial $691.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $155.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $155.46
Rate for Payer: Independent Care Health Plan Medicare $45.01
Rate for Payer: Multiplan Commercial $608.00
Rate for Payer: Preferred Network Access Commercial $722.00
Rate for Payer: Quartz Beloit One Network $334.40
Rate for Payer: Quartz Commercial $433.20
Rate for Payer: Quartz Medicare Advantage $45.01
Rate for Payer: The Alliance Commercial $171.04
Rate for Payer: United Healthcare Medicare Advantage $45.01
Rate for Payer: WEA Trust Commercial $418.00
Rate for Payer: WPS Commercial $225.05
Service Code CPT 73564 TC,RT
Hospital Charge Code 2980058
Hospital Revenue Code 320
Min. Negotiated Rate $361.24
Max. Negotiated Rate $779.95
Rate for Payer: Aetna Commercial $779.95
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $706.06
Rate for Payer: Cash Price $246.30
Rate for Payer: Cash Price $246.30
Rate for Payer: Cigna Commercial $779.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $410.50
Rate for Payer: Dean Health DHI/DHP/ASO $492.60
Rate for Payer: Health EOS Commercial $747.11
Rate for Payer: Multiplan Commercial $656.80
Rate for Payer: Preferred Network Access Commercial $779.95
Rate for Payer: Quartz Beloit One Network $361.24
Rate for Payer: Quartz Commercial $467.97
Rate for Payer: The Alliance Commercial $410.50
Rate for Payer: WEA Trust Commercial $451.55
Rate for Payer: WPS Commercial $608.11