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Service Code CPT 81015
Hospital Charge Code 633722
Hospital Revenue Code 300
Min. Negotiated Rate $50.47
Max. Negotiated Rate $94.76
Rate for Payer: Aetna Commercial $92.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $88.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $54.59
Rate for Payer: Cash Price $30.90
Rate for Payer: Cigna Commercial $94.76
Rate for Payer: Health EOS Commercial $91.67
Rate for Payer: HFN Commercial $94.76
Rate for Payer: Multiplan Commercial $82.40
Rate for Payer: NAPHCARE Commercial $61.80
Rate for Payer: Preferred Network Access Commercial $94.76
Rate for Payer: Quartz Beloit One Network $50.47
Rate for Payer: Quartz Commercial $61.80
Rate for Payer: WEA Trust Commercial $56.65
Rate for Payer: WPS Commercial $76.29
Service Code CPT 81015
Hospital Charge Code 633722
Hospital Revenue Code 300
Min. Negotiated Rate $3.05
Max. Negotiated Rate $94.76
Rate for Payer: Aetna Commercial $92.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $88.58
Rate for Payer: Aetna Managed Medicare $3.05
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $11.44
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $5.34
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5.06
Rate for Payer: Anthem Medicaid $3.15
Rate for Payer: Anthem Medicare Advantage $3.05
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $54.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3.05
Rate for Payer: Cash Price $30.90
Rate for Payer: Cash Price $30.90
Rate for Payer: Cigna Commercial $94.76
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $3.15
Rate for Payer: Dean Health DHI/DHP/ASO $57.64
Rate for Payer: Dean Health Medicaid $3.15
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3.05
Rate for Payer: Health EOS Commercial $91.67
Rate for Payer: HFN Commercial $94.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $11.35
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3.05
Rate for Payer: Independent Care Health Plan Medicaid $3.15
Rate for Payer: Independent Care Health Plan Medicare $3.05
Rate for Payer: Managed Health Services Medicaid $3.28
Rate for Payer: Managed Health Services Medicare Advantage $3.05
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3.05
Rate for Payer: Multiplan Commercial $82.40
Rate for Payer: NAPHCARE Commercial $4.58
Rate for Payer: Preferred Network Access Commercial $94.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $3.15
Rate for Payer: Quartz Beloit One Network $50.47
Rate for Payer: Quartz Commercial $66.95
Rate for Payer: Quartz Medicare Advantage $3.05
Rate for Payer: The Alliance Commercial $12.20
Rate for Payer: United Healthcare Medicaid $3.15
Rate for Payer: United Healthcare Medicare Advantage $3.05
Rate for Payer: United Healthcare PPO $77.25
Rate for Payer: WEA Trust Commercial $56.65
Rate for Payer: Wellcare Medicare $3.05
Rate for Payer: WMAP Medicaid $3.15
Rate for Payer: WPS Commercial $76.29
Service Code HCPCS L3760
Hospital Charge Code 3713509
Hospital Revenue Code 274
Min. Negotiated Rate $70.28
Max. Negotiated Rate $1,004.00
Rate for Payer: Aetna Commercial $225.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $215.86
Rate for Payer: Aetna Managed Medicare $70.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $353.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $353.40
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $353.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $133.03
Rate for Payer: Cash Price $75.30
Rate for Payer: Cash Price $75.30
Rate for Payer: Cigna Commercial $230.92
Rate for Payer: Dean Health DHI/DHP/ASO $140.46
Rate for Payer: Health EOS Commercial $223.39
Rate for Payer: HFN Commercial $230.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $188.25
Rate for Payer: Multiplan Commercial $200.80
Rate for Payer: NAPHCARE Commercial $150.60
Rate for Payer: Preferred Network Access Commercial $230.92
Rate for Payer: Quartz Beloit One Network $122.99
Rate for Payer: Quartz Commercial $163.15
Rate for Payer: Quartz Medicare Advantage $150.60
Rate for Payer: The Alliance Commercial $1,004.00
Rate for Payer: WEA Trust Commercial $138.05
Rate for Payer: WPS Commercial $185.92
Service Code HCPCS L3760
Hospital Charge Code 3713509
Hospital Revenue Code 274
Min. Negotiated Rate $110.44
Max. Negotiated Rate $1,612.82
Rate for Payer: Aetna Commercial $238.45
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $215.86
Rate for Payer: Cash Price $75.30
Rate for Payer: Cash Price $75.30
Rate for Payer: Cigna Commercial $238.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $125.50
Rate for Payer: Dean Health DHI/DHP/ASO $150.60
Rate for Payer: Health EOS Commercial $228.41
Rate for Payer: HFN Commercial $238.45
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,612.82
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,612.82
Rate for Payer: Multiplan Commercial $200.80
Rate for Payer: Preferred Network Access Commercial $238.45
Rate for Payer: Quartz Beloit One Network $110.44
Rate for Payer: Quartz Commercial $143.07
Rate for Payer: The Alliance Commercial $125.50
Rate for Payer: WEA Trust Commercial $138.05
Rate for Payer: WPS Commercial $185.92
Service Code HCPCS L3760
Hospital Charge Code 3713509
Hospital Revenue Code 274
Min. Negotiated Rate $122.99
Max. Negotiated Rate $230.92
Rate for Payer: Aetna Commercial $225.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $215.86
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $133.03
Rate for Payer: Cash Price $75.30
Rate for Payer: Cigna Commercial $230.92
Rate for Payer: Health EOS Commercial $223.39
Rate for Payer: HFN Commercial $230.92
Rate for Payer: Multiplan Commercial $200.80
Rate for Payer: NAPHCARE Commercial $150.60
Rate for Payer: Preferred Network Access Commercial $230.92
Rate for Payer: Quartz Beloit One Network $122.99
Rate for Payer: Quartz Commercial $150.60
Rate for Payer: WEA Trust Commercial $138.05
Rate for Payer: WPS Commercial $185.92
Service Code HCPCS L3702
Hospital Charge Code 3375561
Hospital Revenue Code 274
Min. Negotiated Rate $5.04
Max. Negotiated Rate $129.56
Rate for Payer: Aetna Commercial $16.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15.48
Rate for Payer: Aetna Managed Medicare $5.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $129.56
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $129.56
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $129.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9.54
Rate for Payer: Cash Price $5.40
Rate for Payer: Cash Price $5.40
Rate for Payer: Cigna Commercial $16.56
Rate for Payer: Dean Health DHI/DHP/ASO $10.07
Rate for Payer: Health EOS Commercial $16.02
Rate for Payer: HFN Commercial $16.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $13.50
Rate for Payer: Multiplan Commercial $14.40
Rate for Payer: NAPHCARE Commercial $10.80
Rate for Payer: Preferred Network Access Commercial $16.56
Rate for Payer: Quartz Beloit One Network $8.82
Rate for Payer: Quartz Commercial $11.70
Rate for Payer: Quartz Medicare Advantage $10.80
Rate for Payer: The Alliance Commercial $72.00
Rate for Payer: WEA Trust Commercial $9.90
Rate for Payer: WPS Commercial $13.33
Service Code HCPCS L3702
Hospital Charge Code 3375561
Hospital Revenue Code 274
Min. Negotiated Rate $7.92
Max. Negotiated Rate $931.25
Rate for Payer: Aetna Commercial $17.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15.48
Rate for Payer: Cash Price $5.40
Rate for Payer: Cash Price $5.40
Rate for Payer: Cigna Commercial $17.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $9.00
Rate for Payer: Dean Health DHI/DHP/ASO $10.80
Rate for Payer: Health EOS Commercial $16.38
Rate for Payer: HFN Commercial $17.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $931.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $931.25
Rate for Payer: Multiplan Commercial $14.40
Rate for Payer: Preferred Network Access Commercial $17.10
Rate for Payer: Quartz Beloit One Network $7.92
Rate for Payer: Quartz Commercial $10.26
Rate for Payer: The Alliance Commercial $9.00
Rate for Payer: WEA Trust Commercial $9.90
Rate for Payer: WPS Commercial $13.33
Service Code HCPCS L3702
Hospital Charge Code 3375561
Hospital Revenue Code 274
Min. Negotiated Rate $8.82
Max. Negotiated Rate $16.56
Rate for Payer: Aetna Commercial $16.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9.54
Rate for Payer: Cash Price $5.40
Rate for Payer: Cigna Commercial $16.56
Rate for Payer: Health EOS Commercial $16.02
Rate for Payer: HFN Commercial $16.56
Rate for Payer: Multiplan Commercial $14.40
Rate for Payer: NAPHCARE Commercial $10.80
Rate for Payer: Preferred Network Access Commercial $16.56
Rate for Payer: Quartz Beloit One Network $8.82
Rate for Payer: Quartz Commercial $10.80
Rate for Payer: WEA Trust Commercial $9.90
Rate for Payer: WPS Commercial $13.33
Service Code CPT 93613
Hospital Charge Code 4125525
Hospital Revenue Code 481
Min. Negotiated Rate $845.88
Max. Negotiated Rate $29,139.00
Rate for Payer: Aetna Commercial $2,718.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,598.06
Rate for Payer: Aetna Managed Medicare $845.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,601.13
Rate for Payer: Cash Price $906.30
Rate for Payer: Cash Price $906.30
Rate for Payer: Cigna Commercial $2,779.32
Rate for Payer: Dean Health DHI/DHP/ASO $1,690.55
Rate for Payer: Health EOS Commercial $2,688.69
Rate for Payer: HFN Commercial $2,779.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,265.75
Rate for Payer: Multiplan Commercial $2,416.80
Rate for Payer: NAPHCARE Commercial $1,812.60
Rate for Payer: Preferred Network Access Commercial $2,779.32
Rate for Payer: Quartz Beloit One Network $1,480.29
Rate for Payer: Quartz Commercial $1,963.65
Rate for Payer: Quartz Medicare Advantage $1,812.60
Rate for Payer: The Alliance Commercial $12,084.00
Rate for Payer: WEA Trust Commercial $1,661.55
Rate for Payer: WPS Commercial $2,237.65
Service Code CPT 93613
Hospital Charge Code 4125525
Hospital Revenue Code 481
Min. Negotiated Rate $1,480.29
Max. Negotiated Rate $2,779.32
Rate for Payer: Aetna Commercial $2,718.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,598.06
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,601.13
Rate for Payer: Cash Price $906.30
Rate for Payer: Cigna Commercial $2,779.32
Rate for Payer: Health EOS Commercial $2,688.69
Rate for Payer: HFN Commercial $2,779.32
Rate for Payer: Multiplan Commercial $2,416.80
Rate for Payer: NAPHCARE Commercial $1,812.60
Rate for Payer: Preferred Network Access Commercial $2,779.32
Rate for Payer: Quartz Beloit One Network $1,480.29
Rate for Payer: Quartz Commercial $1,812.60
Rate for Payer: WEA Trust Commercial $1,661.55
Rate for Payer: WPS Commercial $2,237.65
Service Code CPT 93655
Hospital Charge Code 3052518
Hospital Revenue Code 481
Min. Negotiated Rate $1,114.96
Max. Negotiated Rate $29,139.00
Rate for Payer: Aetna Commercial $3,583.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,424.52
Rate for Payer: Aetna Managed Medicare $1,114.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,110.46
Rate for Payer: Cash Price $1,194.60
Rate for Payer: Cash Price $1,194.60
Rate for Payer: Cigna Commercial $3,663.44
Rate for Payer: Dean Health DHI/DHP/ASO $2,228.33
Rate for Payer: Health EOS Commercial $3,543.98
Rate for Payer: HFN Commercial $3,663.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,986.50
Rate for Payer: Multiplan Commercial $3,185.60
Rate for Payer: NAPHCARE Commercial $2,389.20
Rate for Payer: Preferred Network Access Commercial $3,663.44
Rate for Payer: Quartz Beloit One Network $1,951.18
Rate for Payer: Quartz Commercial $2,588.30
Rate for Payer: Quartz Medicare Advantage $2,389.20
Rate for Payer: The Alliance Commercial $15,928.00
Rate for Payer: WEA Trust Commercial $2,190.10
Rate for Payer: WPS Commercial $2,949.47
Service Code CPT 93655
Hospital Charge Code 3052518
Hospital Revenue Code 481
Min. Negotiated Rate $1,951.18
Max. Negotiated Rate $3,663.44
Rate for Payer: Aetna Commercial $3,583.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,424.52
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,110.46
Rate for Payer: Cash Price $1,194.60
Rate for Payer: Cigna Commercial $3,663.44
Rate for Payer: Health EOS Commercial $3,543.98
Rate for Payer: HFN Commercial $3,663.44
Rate for Payer: Multiplan Commercial $3,185.60
Rate for Payer: NAPHCARE Commercial $2,389.20
Rate for Payer: Preferred Network Access Commercial $3,663.44
Rate for Payer: Quartz Beloit One Network $1,951.18
Rate for Payer: Quartz Commercial $2,389.20
Rate for Payer: WEA Trust Commercial $2,190.10
Rate for Payer: WPS Commercial $2,949.47
Service Code CPT 93650
Hospital Charge Code 3052515
Hospital Revenue Code 481
Min. Negotiated Rate $5,919.20
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $10,872.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10,388.80
Rate for Payer: Aetna Managed Medicare $7,381.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Anthem Medicare Advantage $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,402.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,381.60
Rate for Payer: Cash Price $3,624.00
Rate for Payer: Cash Price $3,624.00
Rate for Payer: Cash Price $3,624.00
Rate for Payer: Cigna Commercial $11,113.60
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $6,759.97
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $10,751.20
Rate for Payer: HFN Commercial $11,113.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,459.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,381.60
Rate for Payer: Independent Care Health Plan Medicare $7,381.60
Rate for Payer: Managed Health Services Medicare Advantage $7,381.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,381.60
Rate for Payer: Multiplan Commercial $9,664.00
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $11,113.60
Rate for Payer: Quartz Beloit One Network $5,919.20
Rate for Payer: Quartz Commercial $7,852.00
Rate for Payer: Quartz Medicare Advantage $7,381.60
Rate for Payer: The Alliance Commercial $29,526.40
Rate for Payer: United Healthcare Medicare Advantage $7,381.60
Rate for Payer: United Healthcare PPO $6,154.00
Rate for Payer: WEA Trust Commercial $6,644.00
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $8,947.66
Service Code CPT 93650
Hospital Charge Code 3052515
Hospital Revenue Code 481
Min. Negotiated Rate $5,919.20
Max. Negotiated Rate $11,113.60
Rate for Payer: Aetna Commercial $10,872.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10,388.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6,402.40
Rate for Payer: Cash Price $3,624.00
Rate for Payer: Cigna Commercial $11,113.60
Rate for Payer: Health EOS Commercial $10,751.20
Rate for Payer: HFN Commercial $11,113.60
Rate for Payer: Multiplan Commercial $9,664.00
Rate for Payer: NAPHCARE Commercial $7,248.00
Rate for Payer: Preferred Network Access Commercial $11,113.60
Rate for Payer: Quartz Beloit One Network $5,919.20
Rate for Payer: Quartz Commercial $7,248.00
Rate for Payer: WEA Trust Commercial $6,644.00
Rate for Payer: WPS Commercial $8,947.66
Service Code HCPCS C1733
Hospital Charge Code 4534616
Hospital Revenue Code 272
Min. Negotiated Rate $3,088.47
Max. Negotiated Rate $5,798.76
Rate for Payer: Aetna Commercial $5,672.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,420.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,340.59
Rate for Payer: Cash Price $1,890.90
Rate for Payer: Cigna Commercial $5,798.76
Rate for Payer: Health EOS Commercial $5,609.67
Rate for Payer: HFN Commercial $5,798.76
Rate for Payer: Multiplan Commercial $5,042.40
Rate for Payer: NAPHCARE Commercial $3,781.80
Rate for Payer: Preferred Network Access Commercial $5,798.76
Rate for Payer: Quartz Beloit One Network $3,088.47
Rate for Payer: Quartz Commercial $3,781.80
Rate for Payer: WEA Trust Commercial $3,466.65
Rate for Payer: WPS Commercial $4,668.63
Service Code HCPCS C1733
Hospital Charge Code 4534616
Hospital Revenue Code 272
Min. Negotiated Rate $1,764.84
Max. Negotiated Rate $25,212.00
Rate for Payer: Aetna Commercial $5,672.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,420.58
Rate for Payer: Aetna Managed Medicare $1,764.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,096.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,151.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,025.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,340.59
Rate for Payer: Cash Price $1,890.90
Rate for Payer: Cigna Commercial $5,798.76
Rate for Payer: Dean Health DHI/DHP/ASO $3,527.16
Rate for Payer: Health EOS Commercial $5,609.67
Rate for Payer: HFN Commercial $5,798.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,727.25
Rate for Payer: Multiplan Commercial $5,042.40
Rate for Payer: NAPHCARE Commercial $3,781.80
Rate for Payer: Preferred Network Access Commercial $5,798.76
Rate for Payer: Quartz Beloit One Network $3,088.47
Rate for Payer: Quartz Commercial $4,096.95
Rate for Payer: Quartz Medicare Advantage $3,781.80
Rate for Payer: The Alliance Commercial $25,212.00
Rate for Payer: WEA Trust Commercial $3,466.65
Rate for Payer: WPS Commercial $4,668.63
Service Code HCPCS C1733
Hospital Charge Code 4534615
Hospital Revenue Code 272
Min. Negotiated Rate $1,847.44
Max. Negotiated Rate $26,392.00
Rate for Payer: Aetna Commercial $5,938.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,674.28
Rate for Payer: Aetna Managed Medicare $1,847.44
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,288.70
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,299.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,167.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,496.94
Rate for Payer: Cash Price $1,979.40
Rate for Payer: Cigna Commercial $6,070.16
Rate for Payer: Dean Health DHI/DHP/ASO $3,692.24
Rate for Payer: Health EOS Commercial $5,872.22
Rate for Payer: HFN Commercial $6,070.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,948.50
Rate for Payer: Multiplan Commercial $5,278.40
Rate for Payer: NAPHCARE Commercial $3,958.80
Rate for Payer: Preferred Network Access Commercial $6,070.16
Rate for Payer: Quartz Beloit One Network $3,233.02
Rate for Payer: Quartz Commercial $4,288.70
Rate for Payer: Quartz Medicare Advantage $3,958.80
Rate for Payer: The Alliance Commercial $26,392.00
Rate for Payer: WEA Trust Commercial $3,628.90
Rate for Payer: WPS Commercial $4,887.14
Service Code HCPCS C1733
Hospital Charge Code 4534615
Hospital Revenue Code 272
Min. Negotiated Rate $3,233.02
Max. Negotiated Rate $6,070.16
Rate for Payer: Aetna Commercial $5,938.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,674.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,496.94
Rate for Payer: Cash Price $1,979.40
Rate for Payer: Cigna Commercial $6,070.16
Rate for Payer: Health EOS Commercial $5,872.22
Rate for Payer: HFN Commercial $6,070.16
Rate for Payer: Multiplan Commercial $5,278.40
Rate for Payer: NAPHCARE Commercial $3,958.80
Rate for Payer: Preferred Network Access Commercial $6,070.16
Rate for Payer: Quartz Beloit One Network $3,233.02
Rate for Payer: Quartz Commercial $3,958.80
Rate for Payer: WEA Trust Commercial $3,628.90
Rate for Payer: WPS Commercial $4,887.14
Service Code CPT 93600
Hospital Charge Code 4125702
Hospital Revenue Code 481
Min. Negotiated Rate $927.08
Max. Negotiated Rate $1,740.64
Rate for Payer: Aetna Commercial $1,702.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,627.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,002.76
Rate for Payer: Cash Price $567.60
Rate for Payer: Cigna Commercial $1,740.64
Rate for Payer: Health EOS Commercial $1,683.88
Rate for Payer: HFN Commercial $1,740.64
Rate for Payer: Multiplan Commercial $1,513.60
Rate for Payer: NAPHCARE Commercial $1,135.20
Rate for Payer: Preferred Network Access Commercial $1,740.64
Rate for Payer: Quartz Beloit One Network $927.08
Rate for Payer: Quartz Commercial $1,135.20
Rate for Payer: WEA Trust Commercial $1,040.60
Rate for Payer: WPS Commercial $1,401.40
Service Code CPT 93600
Hospital Charge Code 4125702
Hospital Revenue Code 481
Min. Negotiated Rate $927.08
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $1,702.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,627.12
Rate for Payer: Aetna Managed Medicare $7,381.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Anthem Medicare Advantage $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,002.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,381.60
Rate for Payer: Cash Price $567.60
Rate for Payer: Cash Price $567.60
Rate for Payer: Cash Price $567.60
Rate for Payer: Cigna Commercial $1,740.64
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $1,058.76
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $1,683.88
Rate for Payer: HFN Commercial $1,740.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,459.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,381.60
Rate for Payer: Independent Care Health Plan Medicare $7,381.60
Rate for Payer: Managed Health Services Medicare Advantage $7,381.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,381.60
Rate for Payer: Multiplan Commercial $1,513.60
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $1,740.64
Rate for Payer: Quartz Beloit One Network $927.08
Rate for Payer: Quartz Commercial $1,229.80
Rate for Payer: Quartz Medicare Advantage $7,381.60
Rate for Payer: The Alliance Commercial $29,526.40
Rate for Payer: United Healthcare Medicare Advantage $7,381.60
Rate for Payer: WEA Trust Commercial $1,040.60
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $1,401.40
Hospital Charge Code 3075871
Hospital Revenue Code 271
Min. Negotiated Rate $996.66
Max. Negotiated Rate $1,871.28
Rate for Payer: Aetna Commercial $1,830.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,749.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,078.02
Rate for Payer: Cash Price $610.20
Rate for Payer: Cigna Commercial $1,871.28
Rate for Payer: Health EOS Commercial $1,810.26
Rate for Payer: HFN Commercial $1,871.28
Rate for Payer: Multiplan Commercial $1,627.20
Rate for Payer: NAPHCARE Commercial $1,220.40
Rate for Payer: Preferred Network Access Commercial $1,871.28
Rate for Payer: Quartz Beloit One Network $996.66
Rate for Payer: Quartz Commercial $1,220.40
Rate for Payer: WEA Trust Commercial $1,118.70
Rate for Payer: WPS Commercial $1,506.58
Hospital Charge Code 3075871
Hospital Revenue Code 271
Min. Negotiated Rate $569.52
Max. Negotiated Rate $8,136.00
Rate for Payer: Aetna Commercial $1,830.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,749.24
Rate for Payer: Aetna Managed Medicare $569.52
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,322.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,017.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $976.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,078.02
Rate for Payer: Cash Price $610.20
Rate for Payer: Cigna Commercial $1,871.28
Rate for Payer: Dean Health DHI/DHP/ASO $1,138.23
Rate for Payer: Health EOS Commercial $1,810.26
Rate for Payer: HFN Commercial $1,871.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,525.50
Rate for Payer: Multiplan Commercial $1,627.20
Rate for Payer: NAPHCARE Commercial $1,220.40
Rate for Payer: Preferred Network Access Commercial $1,871.28
Rate for Payer: Quartz Beloit One Network $996.66
Rate for Payer: Quartz Commercial $1,322.10
Rate for Payer: Quartz Medicare Advantage $1,220.40
Rate for Payer: The Alliance Commercial $8,136.00
Rate for Payer: WEA Trust Commercial $1,118.70
Rate for Payer: WPS Commercial $1,506.58
Service Code HCPCS C1732
Hospital Charge Code 4139319
Hospital Revenue Code 481
Min. Negotiated Rate $1,954.12
Max. Negotiated Rate $27,916.00
Rate for Payer: Aetna Commercial $6,281.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,001.94
Rate for Payer: Aetna Managed Medicare $1,954.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,536.35
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,489.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,349.92
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,698.87
Rate for Payer: Cash Price $2,093.70
Rate for Payer: Cigna Commercial $6,420.68
Rate for Payer: Dean Health DHI/DHP/ASO $3,905.45
Rate for Payer: Health EOS Commercial $6,211.31
Rate for Payer: HFN Commercial $6,420.68
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,234.25
Rate for Payer: Multiplan Commercial $5,583.20
Rate for Payer: NAPHCARE Commercial $4,187.40
Rate for Payer: Preferred Network Access Commercial $6,420.68
Rate for Payer: Quartz Beloit One Network $3,419.71
Rate for Payer: Quartz Commercial $4,536.35
Rate for Payer: Quartz Medicare Advantage $4,187.40
Rate for Payer: The Alliance Commercial $27,916.00
Rate for Payer: WEA Trust Commercial $3,838.45
Rate for Payer: WPS Commercial $5,169.35
Service Code HCPCS C1732
Hospital Charge Code 4139319
Hospital Revenue Code 481
Min. Negotiated Rate $3,419.71
Max. Negotiated Rate $6,420.68
Rate for Payer: Aetna Commercial $6,281.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,001.94
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,698.87
Rate for Payer: Cash Price $2,093.70
Rate for Payer: Cigna Commercial $6,420.68
Rate for Payer: Health EOS Commercial $6,211.31
Rate for Payer: HFN Commercial $6,420.68
Rate for Payer: Multiplan Commercial $5,583.20
Rate for Payer: NAPHCARE Commercial $4,187.40
Rate for Payer: Preferred Network Access Commercial $6,420.68
Rate for Payer: Quartz Beloit One Network $3,419.71
Rate for Payer: Quartz Commercial $4,187.40
Rate for Payer: WEA Trust Commercial $3,838.45
Rate for Payer: WPS Commercial $5,169.35
Service Code HCPCS C1730
Hospital Charge Code 4139317
Hospital Revenue Code 481
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