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Service Code HCPCS A6222
Hospital Charge Code 2963792
Hospital Revenue Code 272
Min. Negotiated Rate $7.56
Max. Negotiated Rate $108.00
Rate for Payer: Aetna Commercial $24.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $23.22
Rate for Payer: Aetna Managed Medicare $7.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $17.55
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $13.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $12.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.31
Rate for Payer: Cash Price $8.10
Rate for Payer: Cigna Commercial $24.84
Rate for Payer: Dean Health DHI/DHP/ASO $15.11
Rate for Payer: Health EOS Commercial $24.03
Rate for Payer: HFN Commercial $24.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $20.25
Rate for Payer: Multiplan Commercial $21.60
Rate for Payer: NAPHCARE Commercial $16.20
Rate for Payer: Preferred Network Access Commercial $24.84
Rate for Payer: Quartz Beloit One Network $13.23
Rate for Payer: Quartz Commercial $17.55
Rate for Payer: Quartz Medicare Advantage $16.20
Rate for Payer: The Alliance Commercial $108.00
Rate for Payer: WEA Trust Commercial $14.85
Rate for Payer: WPS Commercial $20.00
Service Code HCPCS A6222
Hospital Charge Code 2974367
Hospital Revenue Code 272
Min. Negotiated Rate $11.76
Max. Negotiated Rate $22.08
Rate for Payer: Aetna Commercial $21.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $20.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.72
Rate for Payer: Cash Price $7.20
Rate for Payer: Cigna Commercial $22.08
Rate for Payer: Health EOS Commercial $21.36
Rate for Payer: HFN Commercial $22.08
Rate for Payer: Multiplan Commercial $19.20
Rate for Payer: NAPHCARE Commercial $14.40
Rate for Payer: Preferred Network Access Commercial $22.08
Rate for Payer: Quartz Beloit One Network $11.76
Rate for Payer: Quartz Commercial $14.40
Rate for Payer: WEA Trust Commercial $13.20
Rate for Payer: WPS Commercial $17.78
Service Code HCPCS A6222
Hospital Charge Code 2974367
Hospital Revenue Code 272
Min. Negotiated Rate $6.72
Max. Negotiated Rate $96.00
Rate for Payer: Aetna Commercial $21.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $20.64
Rate for Payer: Aetna Managed Medicare $6.72
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $15.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $12.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $11.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $12.72
Rate for Payer: Cash Price $7.20
Rate for Payer: Cigna Commercial $22.08
Rate for Payer: Dean Health DHI/DHP/ASO $13.43
Rate for Payer: Health EOS Commercial $21.36
Rate for Payer: HFN Commercial $22.08
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $18.00
Rate for Payer: Multiplan Commercial $19.20
Rate for Payer: NAPHCARE Commercial $14.40
Rate for Payer: Preferred Network Access Commercial $22.08
Rate for Payer: Quartz Beloit One Network $11.76
Rate for Payer: Quartz Commercial $15.60
Rate for Payer: Quartz Medicare Advantage $14.40
Rate for Payer: The Alliance Commercial $96.00
Rate for Payer: WEA Trust Commercial $13.20
Rate for Payer: WPS Commercial $17.78
Service Code HCPCS A6223
Hospital Charge Code 2963703
Hospital Revenue Code 272
Min. Negotiated Rate $20.58
Max. Negotiated Rate $38.64
Rate for Payer: Aetna Commercial $37.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $36.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $22.26
Rate for Payer: Cash Price $12.60
Rate for Payer: Cigna Commercial $38.64
Rate for Payer: Health EOS Commercial $37.38
Rate for Payer: HFN Commercial $38.64
Rate for Payer: Multiplan Commercial $33.60
Rate for Payer: NAPHCARE Commercial $25.20
Rate for Payer: Preferred Network Access Commercial $38.64
Rate for Payer: Quartz Beloit One Network $20.58
Rate for Payer: Quartz Commercial $25.20
Rate for Payer: WEA Trust Commercial $23.10
Rate for Payer: WPS Commercial $31.11
Service Code HCPCS A6223
Hospital Charge Code 2963703
Hospital Revenue Code 272
Min. Negotiated Rate $11.76
Max. Negotiated Rate $168.00
Rate for Payer: Aetna Commercial $37.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $36.12
Rate for Payer: Aetna Managed Medicare $11.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $27.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $21.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $20.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $22.26
Rate for Payer: Cash Price $12.60
Rate for Payer: Cigna Commercial $38.64
Rate for Payer: Dean Health DHI/DHP/ASO $23.50
Rate for Payer: Health EOS Commercial $37.38
Rate for Payer: HFN Commercial $38.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $31.50
Rate for Payer: Multiplan Commercial $33.60
Rate for Payer: NAPHCARE Commercial $25.20
Rate for Payer: Preferred Network Access Commercial $38.64
Rate for Payer: Quartz Beloit One Network $20.58
Rate for Payer: Quartz Commercial $27.30
Rate for Payer: Quartz Medicare Advantage $25.20
Rate for Payer: The Alliance Commercial $168.00
Rate for Payer: WEA Trust Commercial $23.10
Rate for Payer: WPS Commercial $31.11
Hospital Charge Code 2966169
Hospital Revenue Code 272
Min. Negotiated Rate $357.00
Max. Negotiated Rate $5,100.00
Rate for Payer: Aetna Commercial $1,147.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,096.50
Rate for Payer: Aetna Managed Medicare $357.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $828.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $637.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $612.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $675.75
Rate for Payer: Cash Price $382.50
Rate for Payer: Cigna Commercial $1,173.00
Rate for Payer: Dean Health DHI/DHP/ASO $713.49
Rate for Payer: Health EOS Commercial $1,134.75
Rate for Payer: HFN Commercial $1,173.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $956.25
Rate for Payer: Multiplan Commercial $1,020.00
Rate for Payer: NAPHCARE Commercial $765.00
Rate for Payer: Preferred Network Access Commercial $1,173.00
Rate for Payer: Quartz Beloit One Network $624.75
Rate for Payer: Quartz Commercial $828.75
Rate for Payer: Quartz Medicare Advantage $765.00
Rate for Payer: The Alliance Commercial $5,100.00
Rate for Payer: WEA Trust Commercial $701.25
Rate for Payer: WPS Commercial $944.39
Hospital Charge Code 2966169
Hospital Revenue Code 272
Min. Negotiated Rate $624.75
Max. Negotiated Rate $1,173.00
Rate for Payer: Aetna Commercial $1,147.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,096.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $675.75
Rate for Payer: Cash Price $382.50
Rate for Payer: Cigna Commercial $1,173.00
Rate for Payer: Health EOS Commercial $1,134.75
Rate for Payer: HFN Commercial $1,173.00
Rate for Payer: Multiplan Commercial $1,020.00
Rate for Payer: NAPHCARE Commercial $765.00
Rate for Payer: Preferred Network Access Commercial $1,173.00
Rate for Payer: Quartz Beloit One Network $624.75
Rate for Payer: Quartz Commercial $765.00
Rate for Payer: WEA Trust Commercial $701.25
Rate for Payer: WPS Commercial $944.39
Hospital Charge Code 2964912
Hospital Revenue Code 272
Min. Negotiated Rate $409.92
Max. Negotiated Rate $5,856.00
Rate for Payer: Aetna Commercial $1,317.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,259.04
Rate for Payer: Aetna Managed Medicare $409.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $951.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $732.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $702.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $775.92
Rate for Payer: Cash Price $439.20
Rate for Payer: Cigna Commercial $1,346.88
Rate for Payer: Dean Health DHI/DHP/ASO $819.25
Rate for Payer: Health EOS Commercial $1,302.96
Rate for Payer: HFN Commercial $1,346.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,098.00
Rate for Payer: Multiplan Commercial $1,171.20
Rate for Payer: NAPHCARE Commercial $878.40
Rate for Payer: Preferred Network Access Commercial $1,346.88
Rate for Payer: Quartz Beloit One Network $717.36
Rate for Payer: Quartz Commercial $951.60
Rate for Payer: Quartz Medicare Advantage $878.40
Rate for Payer: The Alliance Commercial $5,856.00
Rate for Payer: WEA Trust Commercial $805.20
Rate for Payer: WPS Commercial $1,084.38
Hospital Charge Code 2964912
Hospital Revenue Code 272
Min. Negotiated Rate $717.36
Max. Negotiated Rate $1,346.88
Rate for Payer: Aetna Commercial $1,317.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,259.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $775.92
Rate for Payer: Cash Price $439.20
Rate for Payer: Cigna Commercial $1,346.88
Rate for Payer: Health EOS Commercial $1,302.96
Rate for Payer: HFN Commercial $1,346.88
Rate for Payer: Multiplan Commercial $1,171.20
Rate for Payer: NAPHCARE Commercial $878.40
Rate for Payer: Preferred Network Access Commercial $1,346.88
Rate for Payer: Quartz Beloit One Network $717.36
Rate for Payer: Quartz Commercial $878.40
Rate for Payer: WEA Trust Commercial $805.20
Rate for Payer: WPS Commercial $1,084.38
Hospital Charge Code 2969472
Hospital Revenue Code 272
Min. Negotiated Rate $1,442.07
Max. Negotiated Rate $2,707.56
Rate for Payer: Aetna Commercial $2,648.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,530.98
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,559.79
Rate for Payer: Cash Price $882.90
Rate for Payer: Cigna Commercial $2,707.56
Rate for Payer: Health EOS Commercial $2,619.27
Rate for Payer: HFN Commercial $2,707.56
Rate for Payer: Multiplan Commercial $2,354.40
Rate for Payer: NAPHCARE Commercial $1,765.80
Rate for Payer: Preferred Network Access Commercial $2,707.56
Rate for Payer: Quartz Beloit One Network $1,442.07
Rate for Payer: Quartz Commercial $1,765.80
Rate for Payer: WEA Trust Commercial $1,618.65
Rate for Payer: WPS Commercial $2,179.88
Hospital Charge Code 2969472
Hospital Revenue Code 272
Min. Negotiated Rate $824.04
Max. Negotiated Rate $11,772.00
Rate for Payer: Aetna Commercial $2,648.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,530.98
Rate for Payer: Aetna Managed Medicare $824.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,912.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,471.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,412.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,559.79
Rate for Payer: Cash Price $882.90
Rate for Payer: Cigna Commercial $2,707.56
Rate for Payer: Dean Health DHI/DHP/ASO $1,646.90
Rate for Payer: Health EOS Commercial $2,619.27
Rate for Payer: HFN Commercial $2,707.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,207.25
Rate for Payer: Multiplan Commercial $2,354.40
Rate for Payer: NAPHCARE Commercial $1,765.80
Rate for Payer: Preferred Network Access Commercial $2,707.56
Rate for Payer: Quartz Beloit One Network $1,442.07
Rate for Payer: Quartz Commercial $1,912.95
Rate for Payer: Quartz Medicare Advantage $1,765.80
Rate for Payer: The Alliance Commercial $11,772.00
Rate for Payer: WEA Trust Commercial $1,618.65
Rate for Payer: WPS Commercial $2,179.88
Hospital Charge Code 2964135
Hospital Revenue Code 272
Min. Negotiated Rate $502.25
Max. Negotiated Rate $943.00
Rate for Payer: Aetna Commercial $922.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $881.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $543.25
Rate for Payer: Cash Price $307.50
Rate for Payer: Cigna Commercial $943.00
Rate for Payer: Health EOS Commercial $912.25
Rate for Payer: HFN Commercial $943.00
Rate for Payer: Multiplan Commercial $820.00
Rate for Payer: NAPHCARE Commercial $615.00
Rate for Payer: Preferred Network Access Commercial $943.00
Rate for Payer: Quartz Beloit One Network $502.25
Rate for Payer: Quartz Commercial $615.00
Rate for Payer: WEA Trust Commercial $563.75
Rate for Payer: WPS Commercial $759.22
Hospital Charge Code 2964135
Hospital Revenue Code 272
Min. Negotiated Rate $287.00
Max. Negotiated Rate $4,100.00
Rate for Payer: Aetna Commercial $922.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $881.50
Rate for Payer: Aetna Managed Medicare $287.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $666.25
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $512.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $492.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $543.25
Rate for Payer: Cash Price $307.50
Rate for Payer: Cigna Commercial $943.00
Rate for Payer: Dean Health DHI/DHP/ASO $573.59
Rate for Payer: Health EOS Commercial $912.25
Rate for Payer: HFN Commercial $943.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $768.75
Rate for Payer: Multiplan Commercial $820.00
Rate for Payer: NAPHCARE Commercial $615.00
Rate for Payer: Preferred Network Access Commercial $943.00
Rate for Payer: Quartz Beloit One Network $502.25
Rate for Payer: Quartz Commercial $666.25
Rate for Payer: Quartz Medicare Advantage $615.00
Rate for Payer: The Alliance Commercial $4,100.00
Rate for Payer: WEA Trust Commercial $563.75
Rate for Payer: WPS Commercial $759.22
Hospital Charge Code 2964913
Hospital Revenue Code 272
Min. Negotiated Rate $851.62
Max. Negotiated Rate $1,598.96
Rate for Payer: Aetna Commercial $1,564.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,494.68
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $921.14
Rate for Payer: Cash Price $521.40
Rate for Payer: Cigna Commercial $1,598.96
Rate for Payer: Health EOS Commercial $1,546.82
Rate for Payer: HFN Commercial $1,598.96
Rate for Payer: Multiplan Commercial $1,390.40
Rate for Payer: NAPHCARE Commercial $1,042.80
Rate for Payer: Preferred Network Access Commercial $1,598.96
Rate for Payer: Quartz Beloit One Network $851.62
Rate for Payer: Quartz Commercial $1,042.80
Rate for Payer: WEA Trust Commercial $955.90
Rate for Payer: WPS Commercial $1,287.34
Hospital Charge Code 2964913
Hospital Revenue Code 272
Min. Negotiated Rate $486.64
Max. Negotiated Rate $6,952.00
Rate for Payer: Aetna Commercial $1,564.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,494.68
Rate for Payer: Aetna Managed Medicare $486.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,129.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $869.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $834.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $921.14
Rate for Payer: Cash Price $521.40
Rate for Payer: Cigna Commercial $1,598.96
Rate for Payer: Dean Health DHI/DHP/ASO $972.58
Rate for Payer: Health EOS Commercial $1,546.82
Rate for Payer: HFN Commercial $1,598.96
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,303.50
Rate for Payer: Multiplan Commercial $1,390.40
Rate for Payer: NAPHCARE Commercial $1,042.80
Rate for Payer: Preferred Network Access Commercial $1,598.96
Rate for Payer: Quartz Beloit One Network $851.62
Rate for Payer: Quartz Commercial $1,129.70
Rate for Payer: Quartz Medicare Advantage $1,042.80
Rate for Payer: The Alliance Commercial $6,952.00
Rate for Payer: WEA Trust Commercial $955.90
Rate for Payer: WPS Commercial $1,287.34
Hospital Charge Code 2966009
Hospital Revenue Code 272
Min. Negotiated Rate $1,294.09
Max. Negotiated Rate $2,429.72
Rate for Payer: Aetna Commercial $2,376.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,271.26
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,399.73
Rate for Payer: Cash Price $792.30
Rate for Payer: Cigna Commercial $2,429.72
Rate for Payer: Health EOS Commercial $2,350.49
Rate for Payer: HFN Commercial $2,429.72
Rate for Payer: Multiplan Commercial $2,112.80
Rate for Payer: NAPHCARE Commercial $1,584.60
Rate for Payer: Preferred Network Access Commercial $2,429.72
Rate for Payer: Quartz Beloit One Network $1,294.09
Rate for Payer: Quartz Commercial $1,584.60
Rate for Payer: WEA Trust Commercial $1,452.55
Rate for Payer: WPS Commercial $1,956.19
Hospital Charge Code 2966009
Hospital Revenue Code 272
Min. Negotiated Rate $739.48
Max. Negotiated Rate $10,564.00
Rate for Payer: Aetna Commercial $2,376.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,271.26
Rate for Payer: Aetna Managed Medicare $739.48
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,716.65
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,320.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,267.68
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,399.73
Rate for Payer: Cash Price $792.30
Rate for Payer: Cigna Commercial $2,429.72
Rate for Payer: Dean Health DHI/DHP/ASO $1,477.90
Rate for Payer: Health EOS Commercial $2,350.49
Rate for Payer: HFN Commercial $2,429.72
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,980.75
Rate for Payer: Multiplan Commercial $2,112.80
Rate for Payer: NAPHCARE Commercial $1,584.60
Rate for Payer: Preferred Network Access Commercial $2,429.72
Rate for Payer: Quartz Beloit One Network $1,294.09
Rate for Payer: Quartz Commercial $1,716.65
Rate for Payer: Quartz Medicare Advantage $1,584.60
Rate for Payer: The Alliance Commercial $10,564.00
Rate for Payer: WEA Trust Commercial $1,452.55
Rate for Payer: WPS Commercial $1,956.19
Hospital Charge Code 2964914
Hospital Revenue Code 272
Min. Negotiated Rate $784.98
Max. Negotiated Rate $1,473.84
Rate for Payer: Aetna Commercial $1,441.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,377.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $849.06
Rate for Payer: Cash Price $480.60
Rate for Payer: Cigna Commercial $1,473.84
Rate for Payer: Health EOS Commercial $1,425.78
Rate for Payer: HFN Commercial $1,473.84
Rate for Payer: Multiplan Commercial $1,281.60
Rate for Payer: NAPHCARE Commercial $961.20
Rate for Payer: Preferred Network Access Commercial $1,473.84
Rate for Payer: Quartz Beloit One Network $784.98
Rate for Payer: Quartz Commercial $961.20
Rate for Payer: WEA Trust Commercial $881.10
Rate for Payer: WPS Commercial $1,186.60
Hospital Charge Code 2964914
Hospital Revenue Code 272
Min. Negotiated Rate $448.56
Max. Negotiated Rate $6,408.00
Rate for Payer: Aetna Commercial $1,441.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,377.72
Rate for Payer: Aetna Managed Medicare $448.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,041.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $801.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $768.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $849.06
Rate for Payer: Cash Price $480.60
Rate for Payer: Cigna Commercial $1,473.84
Rate for Payer: Dean Health DHI/DHP/ASO $896.48
Rate for Payer: Health EOS Commercial $1,425.78
Rate for Payer: HFN Commercial $1,473.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,201.50
Rate for Payer: Multiplan Commercial $1,281.60
Rate for Payer: NAPHCARE Commercial $961.20
Rate for Payer: Preferred Network Access Commercial $1,473.84
Rate for Payer: Quartz Beloit One Network $784.98
Rate for Payer: Quartz Commercial $1,041.30
Rate for Payer: Quartz Medicare Advantage $961.20
Rate for Payer: The Alliance Commercial $6,408.00
Rate for Payer: WEA Trust Commercial $881.10
Rate for Payer: WPS Commercial $1,186.60
Hospital Charge Code 2964915
Hospital Revenue Code 272
Min. Negotiated Rate $789.39
Max. Negotiated Rate $1,482.12
Rate for Payer: Aetna Commercial $1,449.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,385.46
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $853.83
Rate for Payer: Cash Price $483.30
Rate for Payer: Cigna Commercial $1,482.12
Rate for Payer: Health EOS Commercial $1,433.79
Rate for Payer: HFN Commercial $1,482.12
Rate for Payer: Multiplan Commercial $1,288.80
Rate for Payer: NAPHCARE Commercial $966.60
Rate for Payer: Preferred Network Access Commercial $1,482.12
Rate for Payer: Quartz Beloit One Network $789.39
Rate for Payer: Quartz Commercial $966.60
Rate for Payer: WEA Trust Commercial $886.05
Rate for Payer: WPS Commercial $1,193.27
Hospital Charge Code 2964915
Hospital Revenue Code 272
Min. Negotiated Rate $451.08
Max. Negotiated Rate $6,444.00
Rate for Payer: Aetna Commercial $1,449.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,385.46
Rate for Payer: Aetna Managed Medicare $451.08
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,047.15
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $805.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $773.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $853.83
Rate for Payer: Cash Price $483.30
Rate for Payer: Cigna Commercial $1,482.12
Rate for Payer: Dean Health DHI/DHP/ASO $901.52
Rate for Payer: Health EOS Commercial $1,433.79
Rate for Payer: HFN Commercial $1,482.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,208.25
Rate for Payer: Multiplan Commercial $1,288.80
Rate for Payer: NAPHCARE Commercial $966.60
Rate for Payer: Preferred Network Access Commercial $1,482.12
Rate for Payer: Quartz Beloit One Network $789.39
Rate for Payer: Quartz Commercial $1,047.15
Rate for Payer: Quartz Medicare Advantage $966.60
Rate for Payer: The Alliance Commercial $6,444.00
Rate for Payer: WEA Trust Commercial $886.05
Rate for Payer: WPS Commercial $1,193.27
Hospital Charge Code 2967461
Hospital Revenue Code 272
Min. Negotiated Rate $791.35
Max. Negotiated Rate $1,485.80
Rate for Payer: Aetna Commercial $1,453.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,388.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $855.95
Rate for Payer: Cash Price $484.50
Rate for Payer: Cigna Commercial $1,485.80
Rate for Payer: Health EOS Commercial $1,437.35
Rate for Payer: HFN Commercial $1,485.80
Rate for Payer: Multiplan Commercial $1,292.00
Rate for Payer: NAPHCARE Commercial $969.00
Rate for Payer: Preferred Network Access Commercial $1,485.80
Rate for Payer: Quartz Beloit One Network $791.35
Rate for Payer: Quartz Commercial $969.00
Rate for Payer: WEA Trust Commercial $888.25
Rate for Payer: WPS Commercial $1,196.23
Hospital Charge Code 2967461
Hospital Revenue Code 272
Min. Negotiated Rate $452.20
Max. Negotiated Rate $6,460.00
Rate for Payer: Aetna Commercial $1,453.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,388.90
Rate for Payer: Aetna Managed Medicare $452.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,049.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $807.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $775.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $855.95
Rate for Payer: Cash Price $484.50
Rate for Payer: Cigna Commercial $1,485.80
Rate for Payer: Dean Health DHI/DHP/ASO $903.75
Rate for Payer: Health EOS Commercial $1,437.35
Rate for Payer: HFN Commercial $1,485.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,211.25
Rate for Payer: Multiplan Commercial $1,292.00
Rate for Payer: NAPHCARE Commercial $969.00
Rate for Payer: Preferred Network Access Commercial $1,485.80
Rate for Payer: Quartz Beloit One Network $791.35
Rate for Payer: Quartz Commercial $1,049.75
Rate for Payer: Quartz Medicare Advantage $969.00
Rate for Payer: The Alliance Commercial $6,460.00
Rate for Payer: WEA Trust Commercial $888.25
Rate for Payer: WPS Commercial $1,196.23
Hospital Charge Code 2965382
Hospital Revenue Code 272
Min. Negotiated Rate $747.25
Max. Negotiated Rate $1,403.00
Rate for Payer: Aetna Commercial $1,372.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,311.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $808.25
Rate for Payer: Cash Price $457.50
Rate for Payer: Cigna Commercial $1,403.00
Rate for Payer: Health EOS Commercial $1,357.25
Rate for Payer: HFN Commercial $1,403.00
Rate for Payer: Multiplan Commercial $1,220.00
Rate for Payer: NAPHCARE Commercial $915.00
Rate for Payer: Preferred Network Access Commercial $1,403.00
Rate for Payer: Quartz Beloit One Network $747.25
Rate for Payer: Quartz Commercial $915.00
Rate for Payer: WEA Trust Commercial $838.75
Rate for Payer: WPS Commercial $1,129.57
Hospital Charge Code 2965382
Hospital Revenue Code 272
Min. Negotiated Rate $427.00
Max. Negotiated Rate $6,100.00
Rate for Payer: Aetna Commercial $1,372.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,311.50
Rate for Payer: Aetna Managed Medicare $427.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $991.25
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $762.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $732.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $808.25
Rate for Payer: Cash Price $457.50
Rate for Payer: Cigna Commercial $1,403.00
Rate for Payer: Dean Health DHI/DHP/ASO $853.39
Rate for Payer: Health EOS Commercial $1,357.25
Rate for Payer: HFN Commercial $1,403.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,143.75
Rate for Payer: Multiplan Commercial $1,220.00
Rate for Payer: NAPHCARE Commercial $915.00
Rate for Payer: Preferred Network Access Commercial $1,403.00
Rate for Payer: Quartz Beloit One Network $747.25
Rate for Payer: Quartz Commercial $991.25
Rate for Payer: Quartz Medicare Advantage $915.00
Rate for Payer: The Alliance Commercial $6,100.00
Rate for Payer: WEA Trust Commercial $838.75
Rate for Payer: WPS Commercial $1,129.57