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Service Code CPT 93923 TC
Hospital Charge Code 3114976
Hospital Revenue Code 921
Min. Negotiated Rate $102.59
Max. Negotiated Rate $767.60
Rate for Payer: Aetna Commercial $767.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $694.88
Rate for Payer: Aetna Managed Medicare $102.59
Rate for Payer: Anthem Medicare Advantage $102.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $102.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $102.59
Rate for Payer: Cash Price $242.40
Rate for Payer: Cash Price $242.40
Rate for Payer: Cigna Commercial $767.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $404.00
Rate for Payer: Dean Health DHI/DHP/ASO $102.59
Rate for Payer: Health EOS Commercial $735.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $374.36
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $374.36
Rate for Payer: Independent Care Health Plan Medicare $102.59
Rate for Payer: Multiplan Commercial $646.40
Rate for Payer: Preferred Network Access Commercial $767.60
Rate for Payer: Quartz Beloit One Network $355.52
Rate for Payer: Quartz Commercial $460.56
Rate for Payer: Quartz Medicare Advantage $102.59
Rate for Payer: The Alliance Commercial $256.48
Rate for Payer: United Healthcare Medicare Advantage $102.59
Rate for Payer: WEA Trust Commercial $444.40
Rate for Payer: WPS Commercial $410.36
Service Code CPT 93930 TC
Hospital Charge Code 3114977
Hospital Revenue Code 921
Min. Negotiated Rate $456.40
Max. Negotiated Rate $6,520.00
Rate for Payer: Aetna Commercial $1,467.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,401.80
Rate for Payer: Aetna Managed Medicare $456.40
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,059.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $815.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $782.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $863.90
Rate for Payer: Cash Price $489.00
Rate for Payer: Cigna Commercial $1,499.60
Rate for Payer: Dean Health DHI/DHP/ASO $912.15
Rate for Payer: Health EOS Commercial $1,450.70
Rate for Payer: HFN Commercial $1,499.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,222.50
Rate for Payer: Multiplan Commercial $1,304.00
Rate for Payer: NAPHCARE Commercial $978.00
Rate for Payer: Preferred Network Access Commercial $1,499.60
Rate for Payer: Quartz Beloit One Network $798.70
Rate for Payer: Quartz Commercial $1,059.50
Rate for Payer: Quartz Medicare Advantage $978.00
Rate for Payer: The Alliance Commercial $6,520.00
Rate for Payer: United Healthcare PPO $1,222.50
Rate for Payer: WEA Trust Commercial $896.50
Rate for Payer: WPS Commercial $1,207.34
Service Code CPT 93930 TC
Hospital Charge Code 3114977
Hospital Revenue Code 921
Min. Negotiated Rate $152.05
Max. Negotiated Rate $1,548.50
Rate for Payer: Aetna Commercial $1,548.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,401.80
Rate for Payer: Aetna Managed Medicare $152.05
Rate for Payer: Anthem Medicare Advantage $152.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $152.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $152.05
Rate for Payer: Cash Price $489.00
Rate for Payer: Cash Price $489.00
Rate for Payer: Cigna Commercial $1,548.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $815.00
Rate for Payer: Dean Health DHI/DHP/ASO $152.05
Rate for Payer: Health EOS Commercial $1,483.30
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $566.53
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $566.53
Rate for Payer: Independent Care Health Plan Medicare $152.05
Rate for Payer: Multiplan Commercial $1,304.00
Rate for Payer: Preferred Network Access Commercial $1,548.50
Rate for Payer: Quartz Beloit One Network $717.20
Rate for Payer: Quartz Commercial $929.10
Rate for Payer: Quartz Medicare Advantage $152.05
Rate for Payer: The Alliance Commercial $380.12
Rate for Payer: United Healthcare Medicare Advantage $152.05
Rate for Payer: WEA Trust Commercial $896.50
Rate for Payer: WPS Commercial $608.20
Service Code CPT 93930 TC
Hospital Charge Code 3114977
Hospital Revenue Code 921
Min. Negotiated Rate $798.70
Max. Negotiated Rate $1,499.60
Rate for Payer: Aetna Commercial $1,467.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $863.90
Rate for Payer: Cash Price $489.00
Rate for Payer: Cigna Commercial $1,499.60
Rate for Payer: Health EOS Commercial $1,450.70
Rate for Payer: HFN Commercial $1,499.60
Rate for Payer: Multiplan Commercial $1,304.00
Rate for Payer: NAPHCARE Commercial $978.00
Rate for Payer: Preferred Network Access Commercial $1,499.60
Rate for Payer: Quartz Beloit One Network $798.70
Rate for Payer: Quartz Commercial $978.00
Rate for Payer: WEA Trust Commercial $896.50
Rate for Payer: WPS Commercial $1,207.34
Service Code CPT 93931 TC,LT
Hospital Charge Code 3114978
Hospital Revenue Code 921
Min. Negotiated Rate $499.40
Max. Negotiated Rate $1,078.25
Rate for Payer: Aetna Commercial $1,078.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $976.10
Rate for Payer: Cash Price $340.50
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,078.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $567.50
Rate for Payer: Dean Health DHI/DHP/ASO $681.00
Rate for Payer: Health EOS Commercial $1,032.85
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: Preferred Network Access Commercial $1,078.25
Rate for Payer: Quartz Beloit One Network $499.40
Rate for Payer: Quartz Commercial $646.95
Rate for Payer: The Alliance Commercial $567.50
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93931 TC,LT
Hospital Charge Code 3114978
Hospital Revenue Code 921
Min. Negotiated Rate $556.15
Max. Negotiated Rate $1,044.20
Rate for Payer: Aetna Commercial $1,021.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $601.55
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,044.20
Rate for Payer: Health EOS Commercial $1,010.15
Rate for Payer: HFN Commercial $1,044.20
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: NAPHCARE Commercial $681.00
Rate for Payer: Preferred Network Access Commercial $1,044.20
Rate for Payer: Quartz Beloit One Network $556.15
Rate for Payer: Quartz Commercial $681.00
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93931 TC,LT
Hospital Charge Code 3114978
Hospital Revenue Code 921
Min. Negotiated Rate $317.80
Max. Negotiated Rate $4,540.00
Rate for Payer: Aetna Commercial $1,021.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $976.10
Rate for Payer: Aetna Managed Medicare $317.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $737.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $567.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $544.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $601.55
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,044.20
Rate for Payer: Dean Health DHI/DHP/ASO $635.15
Rate for Payer: Health EOS Commercial $1,010.15
Rate for Payer: HFN Commercial $1,044.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $851.25
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: NAPHCARE Commercial $681.00
Rate for Payer: Preferred Network Access Commercial $1,044.20
Rate for Payer: Quartz Beloit One Network $556.15
Rate for Payer: Quartz Commercial $737.75
Rate for Payer: Quartz Medicare Advantage $681.00
Rate for Payer: The Alliance Commercial $4,540.00
Rate for Payer: United Healthcare PPO $851.25
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93931 TC,RT
Hospital Charge Code 3114979
Hospital Revenue Code 921
Min. Negotiated Rate $317.80
Max. Negotiated Rate $4,540.00
Rate for Payer: Aetna Commercial $1,021.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $976.10
Rate for Payer: Aetna Managed Medicare $317.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $737.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $567.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $544.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $601.55
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,044.20
Rate for Payer: Dean Health DHI/DHP/ASO $635.15
Rate for Payer: Health EOS Commercial $1,010.15
Rate for Payer: HFN Commercial $1,044.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $851.25
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: NAPHCARE Commercial $681.00
Rate for Payer: Preferred Network Access Commercial $1,044.20
Rate for Payer: Quartz Beloit One Network $556.15
Rate for Payer: Quartz Commercial $737.75
Rate for Payer: Quartz Medicare Advantage $681.00
Rate for Payer: The Alliance Commercial $4,540.00
Rate for Payer: United Healthcare PPO $851.25
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93931 TC,RT
Hospital Charge Code 3114979
Hospital Revenue Code 921
Min. Negotiated Rate $499.40
Max. Negotiated Rate $1,078.25
Rate for Payer: Aetna Commercial $1,078.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $976.10
Rate for Payer: Cash Price $340.50
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,078.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $567.50
Rate for Payer: Dean Health DHI/DHP/ASO $681.00
Rate for Payer: Health EOS Commercial $1,032.85
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: Preferred Network Access Commercial $1,078.25
Rate for Payer: Quartz Beloit One Network $499.40
Rate for Payer: Quartz Commercial $646.95
Rate for Payer: The Alliance Commercial $567.50
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93931 TC,RT
Hospital Charge Code 3114979
Hospital Revenue Code 921
Min. Negotiated Rate $556.15
Max. Negotiated Rate $1,044.20
Rate for Payer: Aetna Commercial $1,021.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $601.55
Rate for Payer: Cash Price $340.50
Rate for Payer: Cigna Commercial $1,044.20
Rate for Payer: Health EOS Commercial $1,010.15
Rate for Payer: HFN Commercial $1,044.20
Rate for Payer: Multiplan Commercial $908.00
Rate for Payer: NAPHCARE Commercial $681.00
Rate for Payer: Preferred Network Access Commercial $1,044.20
Rate for Payer: Quartz Beloit One Network $556.15
Rate for Payer: Quartz Commercial $681.00
Rate for Payer: WEA Trust Commercial $624.25
Rate for Payer: WPS Commercial $840.69
Service Code CPT 93923 TC
Hospital Charge Code 3114982
Hospital Revenue Code 921
Min. Negotiated Rate $102.59
Max. Negotiated Rate $1,552.30
Rate for Payer: Aetna Commercial $1,552.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,405.24
Rate for Payer: Aetna Managed Medicare $102.59
Rate for Payer: Anthem Medicare Advantage $102.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $102.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $102.59
Rate for Payer: Cash Price $490.20
Rate for Payer: Cash Price $490.20
Rate for Payer: Cigna Commercial $1,552.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $817.00
Rate for Payer: Dean Health DHI/DHP/ASO $102.59
Rate for Payer: Health EOS Commercial $1,486.94
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $374.36
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $374.36
Rate for Payer: Independent Care Health Plan Medicare $102.59
Rate for Payer: Multiplan Commercial $1,307.20
Rate for Payer: Preferred Network Access Commercial $1,552.30
Rate for Payer: Quartz Beloit One Network $718.96
Rate for Payer: Quartz Commercial $931.38
Rate for Payer: Quartz Medicare Advantage $102.59
Rate for Payer: The Alliance Commercial $256.48
Rate for Payer: United Healthcare Medicare Advantage $102.59
Rate for Payer: WEA Trust Commercial $898.70
Rate for Payer: WPS Commercial $410.36
Service Code CPT 93923 TC
Hospital Charge Code 3114982
Hospital Revenue Code 921
Min. Negotiated Rate $800.66
Max. Negotiated Rate $1,503.28
Rate for Payer: Aetna Commercial $1,470.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $866.02
Rate for Payer: Cash Price $490.20
Rate for Payer: Cigna Commercial $1,503.28
Rate for Payer: Health EOS Commercial $1,454.26
Rate for Payer: HFN Commercial $1,503.28
Rate for Payer: Multiplan Commercial $1,307.20
Rate for Payer: NAPHCARE Commercial $980.40
Rate for Payer: Preferred Network Access Commercial $1,503.28
Rate for Payer: Quartz Beloit One Network $800.66
Rate for Payer: Quartz Commercial $980.40
Rate for Payer: WEA Trust Commercial $898.70
Rate for Payer: WPS Commercial $1,210.30
Service Code CPT 93923 TC
Hospital Charge Code 3114982
Hospital Revenue Code 921
Min. Negotiated Rate $457.52
Max. Negotiated Rate $6,536.00
Rate for Payer: Aetna Commercial $1,470.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,405.24
Rate for Payer: Aetna Managed Medicare $457.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,062.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $817.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $784.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $866.02
Rate for Payer: Cash Price $490.20
Rate for Payer: Cigna Commercial $1,503.28
Rate for Payer: Dean Health DHI/DHP/ASO $914.39
Rate for Payer: Health EOS Commercial $1,454.26
Rate for Payer: HFN Commercial $1,503.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,225.50
Rate for Payer: Multiplan Commercial $1,307.20
Rate for Payer: NAPHCARE Commercial $980.40
Rate for Payer: Preferred Network Access Commercial $1,503.28
Rate for Payer: Quartz Beloit One Network $800.66
Rate for Payer: Quartz Commercial $1,062.10
Rate for Payer: Quartz Medicare Advantage $980.40
Rate for Payer: The Alliance Commercial $6,536.00
Rate for Payer: United Healthcare PPO $1,225.50
Rate for Payer: WEA Trust Commercial $898.70
Rate for Payer: WPS Commercial $1,210.30
Service Code CPT 93970 TC
Hospital Charge Code 3114980
Hospital Revenue Code 921
Min. Negotiated Rate $553.00
Max. Negotiated Rate $7,900.00
Rate for Payer: Aetna Commercial $1,777.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,698.50
Rate for Payer: Aetna Managed Medicare $553.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,283.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $987.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $948.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,046.75
Rate for Payer: Cash Price $592.50
Rate for Payer: Cigna Commercial $1,817.00
Rate for Payer: Dean Health DHI/DHP/ASO $1,105.21
Rate for Payer: Health EOS Commercial $1,757.75
Rate for Payer: HFN Commercial $1,817.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,481.25
Rate for Payer: Multiplan Commercial $1,580.00
Rate for Payer: NAPHCARE Commercial $1,185.00
Rate for Payer: Preferred Network Access Commercial $1,817.00
Rate for Payer: Quartz Beloit One Network $967.75
Rate for Payer: Quartz Commercial $1,283.75
Rate for Payer: Quartz Medicare Advantage $1,185.00
Rate for Payer: The Alliance Commercial $7,900.00
Rate for Payer: United Healthcare PPO $1,481.25
Rate for Payer: WEA Trust Commercial $1,086.25
Rate for Payer: WPS Commercial $1,462.88
Service Code CPT 93970 TC
Hospital Charge Code 3114980
Hospital Revenue Code 921
Min. Negotiated Rate $967.75
Max. Negotiated Rate $1,817.00
Rate for Payer: Aetna Commercial $1,777.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,046.75
Rate for Payer: Cash Price $592.50
Rate for Payer: Cigna Commercial $1,817.00
Rate for Payer: Health EOS Commercial $1,757.75
Rate for Payer: HFN Commercial $1,817.00
Rate for Payer: Multiplan Commercial $1,580.00
Rate for Payer: NAPHCARE Commercial $1,185.00
Rate for Payer: Preferred Network Access Commercial $1,817.00
Rate for Payer: Quartz Beloit One Network $967.75
Rate for Payer: Quartz Commercial $1,185.00
Rate for Payer: WEA Trust Commercial $1,086.25
Rate for Payer: WPS Commercial $1,462.88
Service Code CPT 93970 TC
Hospital Charge Code 3114980
Hospital Revenue Code 921
Min. Negotiated Rate $149.48
Max. Negotiated Rate $1,876.25
Rate for Payer: Aetna Commercial $1,876.25
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,698.50
Rate for Payer: Aetna Managed Medicare $149.48
Rate for Payer: Anthem Medicare Advantage $149.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $149.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $149.48
Rate for Payer: Cash Price $592.50
Rate for Payer: Cash Price $592.50
Rate for Payer: Cigna Commercial $1,876.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $987.50
Rate for Payer: Dean Health DHI/DHP/ASO $149.48
Rate for Payer: Health EOS Commercial $1,797.25
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $551.88
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $551.88
Rate for Payer: Independent Care Health Plan Medicare $149.48
Rate for Payer: Multiplan Commercial $1,580.00
Rate for Payer: Preferred Network Access Commercial $1,876.25
Rate for Payer: Quartz Beloit One Network $869.00
Rate for Payer: Quartz Commercial $1,125.75
Rate for Payer: Quartz Medicare Advantage $149.48
Rate for Payer: The Alliance Commercial $373.70
Rate for Payer: United Healthcare Medicare Advantage $149.48
Rate for Payer: WEA Trust Commercial $1,086.25
Rate for Payer: WPS Commercial $597.92
Service Code CPT 93971 TC,LT
Hospital Charge Code 3114981
Hospital Revenue Code 921
Min. Negotiated Rate $604.66
Max. Negotiated Rate $1,135.28
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $740.40
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,LT
Hospital Charge Code 3114981
Hospital Revenue Code 921
Min. Negotiated Rate $542.96
Max. Negotiated Rate $1,172.30
Rate for Payer: Aetna Commercial $1,172.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Cash Price $370.20
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,172.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $617.00
Rate for Payer: Dean Health DHI/DHP/ASO $740.40
Rate for Payer: Health EOS Commercial $1,122.94
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: Preferred Network Access Commercial $1,172.30
Rate for Payer: Quartz Beloit One Network $542.96
Rate for Payer: Quartz Commercial $703.38
Rate for Payer: The Alliance Commercial $617.00
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,LT
Hospital Charge Code 3114981
Hospital Revenue Code 921
Min. Negotiated Rate $345.52
Max. Negotiated Rate $4,936.00
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Aetna Managed Medicare $345.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $802.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $617.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $592.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Dean Health DHI/DHP/ASO $690.55
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $925.50
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $802.10
Rate for Payer: Quartz Medicare Advantage $740.40
Rate for Payer: The Alliance Commercial $4,936.00
Rate for Payer: United Healthcare PPO $925.50
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3116548
Hospital Revenue Code 921
Min. Negotiated Rate $604.66
Max. Negotiated Rate $1,135.28
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $740.40
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3116548
Hospital Revenue Code 921
Min. Negotiated Rate $542.96
Max. Negotiated Rate $1,172.30
Rate for Payer: Aetna Commercial $1,172.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Cash Price $370.20
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,172.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $617.00
Rate for Payer: Dean Health DHI/DHP/ASO $740.40
Rate for Payer: Health EOS Commercial $1,122.94
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: Preferred Network Access Commercial $1,172.30
Rate for Payer: Quartz Beloit One Network $542.96
Rate for Payer: Quartz Commercial $703.38
Rate for Payer: The Alliance Commercial $617.00
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3114945
Hospital Revenue Code 921
Min. Negotiated Rate $542.96
Max. Negotiated Rate $1,172.30
Rate for Payer: Aetna Commercial $1,172.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Cash Price $370.20
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,172.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $617.00
Rate for Payer: Dean Health DHI/DHP/ASO $740.40
Rate for Payer: Health EOS Commercial $1,122.94
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: Preferred Network Access Commercial $1,172.30
Rate for Payer: Quartz Beloit One Network $542.96
Rate for Payer: Quartz Commercial $703.38
Rate for Payer: The Alliance Commercial $617.00
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3114945
Hospital Revenue Code 921
Min. Negotiated Rate $345.52
Max. Negotiated Rate $4,936.00
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Aetna Managed Medicare $345.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $802.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $617.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $592.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Dean Health DHI/DHP/ASO $690.55
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $925.50
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $802.10
Rate for Payer: Quartz Medicare Advantage $740.40
Rate for Payer: The Alliance Commercial $4,936.00
Rate for Payer: United Healthcare PPO $925.50
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3114945
Hospital Revenue Code 921
Min. Negotiated Rate $604.66
Max. Negotiated Rate $1,135.28
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $740.40
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02
Service Code CPT 93971 TC,RT
Hospital Charge Code 3116548
Hospital Revenue Code 921
Min. Negotiated Rate $345.52
Max. Negotiated Rate $4,936.00
Rate for Payer: Aetna Commercial $1,110.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,061.24
Rate for Payer: Aetna Managed Medicare $345.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $802.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $617.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $592.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $654.02
Rate for Payer: Cash Price $370.20
Rate for Payer: Cigna Commercial $1,135.28
Rate for Payer: Dean Health DHI/DHP/ASO $690.55
Rate for Payer: Health EOS Commercial $1,098.26
Rate for Payer: HFN Commercial $1,135.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $925.50
Rate for Payer: Multiplan Commercial $987.20
Rate for Payer: NAPHCARE Commercial $740.40
Rate for Payer: Preferred Network Access Commercial $1,135.28
Rate for Payer: Quartz Beloit One Network $604.66
Rate for Payer: Quartz Commercial $802.10
Rate for Payer: Quartz Medicare Advantage $740.40
Rate for Payer: The Alliance Commercial $4,936.00
Rate for Payer: United Healthcare PPO $925.50
Rate for Payer: WEA Trust Commercial $678.70
Rate for Payer: WPS Commercial $914.02