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Service Code HCPCS J0171
Hospital Charge Code 2974933
Hospital Revenue Code 636
Min. Negotiated Rate $5.39
Max. Negotiated Rate $10.12
Rate for Payer: Aetna Commercial $9.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $9.46
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $5.83
Rate for Payer: Cash Price $3.30
Rate for Payer: Cigna Commercial $10.12
Rate for Payer: Health EOS Commercial $9.79
Rate for Payer: HFN Commercial $10.12
Rate for Payer: Multiplan Commercial $8.80
Rate for Payer: NAPHCARE Commercial $6.60
Rate for Payer: Preferred Network Access Commercial $10.12
Rate for Payer: Quartz Beloit One Network $5.39
Rate for Payer: Quartz Commercial $6.60
Rate for Payer: WEA Trust Commercial $6.05
Rate for Payer: WPS Commercial $8.15
Service Code HCPCS J0171
Hospital Charge Code 2974933
Hospital Revenue Code 636
Min. Negotiated Rate $1.07
Max. Negotiated Rate $44.00
Rate for Payer: Aetna Commercial $9.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $9.46
Rate for Payer: Aetna Managed Medicare $3.08
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $7.15
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $5.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5.28
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $5.83
Rate for Payer: Cash Price $3.30
Rate for Payer: Cash Price $3.30
Rate for Payer: Cigna Commercial $10.12
Rate for Payer: Dean Health DHI/DHP/ASO $1.07
Rate for Payer: Health EOS Commercial $9.79
Rate for Payer: HFN Commercial $10.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8.25
Rate for Payer: Multiplan Commercial $8.80
Rate for Payer: NAPHCARE Commercial $6.60
Rate for Payer: Preferred Network Access Commercial $10.12
Rate for Payer: Quartz Beloit One Network $5.39
Rate for Payer: Quartz Commercial $7.15
Rate for Payer: Quartz Medicare Advantage $6.60
Rate for Payer: The Alliance Commercial $44.00
Rate for Payer: WEA Trust Commercial $6.05
Rate for Payer: WPS Commercial $2.03
Service Code CPT 93609
Hospital Charge Code 3052505
Hospital Revenue Code 481
Min. Negotiated Rate $424.34
Max. Negotiated Rate $796.72
Rate for Payer: Aetna Commercial $779.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $744.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $458.98
Rate for Payer: Cash Price $259.80
Rate for Payer: Cigna Commercial $796.72
Rate for Payer: Health EOS Commercial $770.74
Rate for Payer: HFN Commercial $796.72
Rate for Payer: Multiplan Commercial $692.80
Rate for Payer: NAPHCARE Commercial $519.60
Rate for Payer: Preferred Network Access Commercial $796.72
Rate for Payer: Quartz Beloit One Network $424.34
Rate for Payer: Quartz Commercial $519.60
Rate for Payer: WEA Trust Commercial $476.30
Rate for Payer: WPS Commercial $641.45
Service Code CPT 93609
Hospital Charge Code 3052505
Hospital Revenue Code 481
Min. Negotiated Rate $242.48
Max. Negotiated Rate $29,139.00
Rate for Payer: Aetna Commercial $779.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $744.76
Rate for Payer: Aetna Managed Medicare $242.48
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 $458.98
Rate for Payer: Cash Price $259.80
Rate for Payer: Cash Price $259.80
Rate for Payer: Cigna Commercial $796.72
Rate for Payer: Dean Health DHI/DHP/ASO $484.61
Rate for Payer: Health EOS Commercial $770.74
Rate for Payer: HFN Commercial $796.72
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $649.50
Rate for Payer: Multiplan Commercial $692.80
Rate for Payer: NAPHCARE Commercial $519.60
Rate for Payer: Preferred Network Access Commercial $796.72
Rate for Payer: Quartz Beloit One Network $424.34
Rate for Payer: Quartz Commercial $562.90
Rate for Payer: Quartz Medicare Advantage $519.60
Rate for Payer: The Alliance Commercial $3,464.00
Rate for Payer: WEA Trust Commercial $476.30
Rate for Payer: WPS Commercial $641.45
Service Code CPT 93610
Hospital Charge Code 4125699
Hospital Revenue Code 481
Min. Negotiated Rate $616.42
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $1,132.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,081.88
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 $666.74
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 $377.40
Rate for Payer: Cash Price $377.40
Rate for Payer: Cash Price $377.40
Rate for Payer: Cigna Commercial $1,157.36
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $703.98
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $1,119.62
Rate for Payer: HFN Commercial $1,157.36
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 $1,006.40
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $1,157.36
Rate for Payer: Quartz Beloit One Network $616.42
Rate for Payer: Quartz Commercial $817.70
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 $691.90
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $931.80
Service Code CPT 93610
Hospital Charge Code 4125699
Hospital Revenue Code 481
Min. Negotiated Rate $616.42
Max. Negotiated Rate $1,157.36
Rate for Payer: Aetna Commercial $1,132.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,081.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $666.74
Rate for Payer: Cash Price $377.40
Rate for Payer: Cigna Commercial $1,157.36
Rate for Payer: Health EOS Commercial $1,119.62
Rate for Payer: HFN Commercial $1,157.36
Rate for Payer: Multiplan Commercial $1,006.40
Rate for Payer: NAPHCARE Commercial $754.80
Rate for Payer: Preferred Network Access Commercial $1,157.36
Rate for Payer: Quartz Beloit One Network $616.42
Rate for Payer: Quartz Commercial $754.80
Rate for Payer: WEA Trust Commercial $691.90
Rate for Payer: WPS Commercial $931.80
Service Code CPT 93602
Hospital Charge Code 4125701
Hospital Revenue Code 481
Min. Negotiated Rate $431.69
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $792.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $757.66
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 $466.93
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 $264.30
Rate for Payer: Cash Price $264.30
Rate for Payer: Cash Price $264.30
Rate for Payer: Cigna Commercial $810.52
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $493.01
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $784.09
Rate for Payer: HFN Commercial $810.52
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 $704.80
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $810.52
Rate for Payer: Quartz Beloit One Network $431.69
Rate for Payer: Quartz Commercial $572.65
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 $484.55
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $652.56
Service Code CPT 93602
Hospital Charge Code 4125701
Hospital Revenue Code 481
Min. Negotiated Rate $431.69
Max. Negotiated Rate $810.52
Rate for Payer: Aetna Commercial $792.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $757.66
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $466.93
Rate for Payer: Cash Price $264.30
Rate for Payer: Cigna Commercial $810.52
Rate for Payer: Health EOS Commercial $784.09
Rate for Payer: HFN Commercial $810.52
Rate for Payer: Multiplan Commercial $704.80
Rate for Payer: NAPHCARE Commercial $528.60
Rate for Payer: Preferred Network Access Commercial $810.52
Rate for Payer: Quartz Beloit One Network $431.69
Rate for Payer: Quartz Commercial $528.60
Rate for Payer: WEA Trust Commercial $484.55
Rate for Payer: WPS Commercial $652.56
Service Code CPT 93612
Hospital Charge Code 4125698
Hospital Revenue Code 481
Min. Negotiated Rate $547.33
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $1,005.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $960.62
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 $592.01
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 $335.10
Rate for Payer: Cash Price $335.10
Rate for Payer: Cash Price $335.10
Rate for Payer: Cigna Commercial $1,027.64
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $625.07
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $994.13
Rate for Payer: HFN Commercial $1,027.64
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 $893.60
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $1,027.64
Rate for Payer: Quartz Beloit One Network $547.33
Rate for Payer: Quartz Commercial $726.05
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 $614.35
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $827.36
Service Code CPT 93612
Hospital Charge Code 4125698
Hospital Revenue Code 481
Min. Negotiated Rate $547.33
Max. Negotiated Rate $1,027.64
Rate for Payer: Aetna Commercial $1,005.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $960.62
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $592.01
Rate for Payer: Cash Price $335.10
Rate for Payer: Cigna Commercial $1,027.64
Rate for Payer: Health EOS Commercial $994.13
Rate for Payer: HFN Commercial $1,027.64
Rate for Payer: Multiplan Commercial $893.60
Rate for Payer: NAPHCARE Commercial $670.20
Rate for Payer: Preferred Network Access Commercial $1,027.64
Rate for Payer: Quartz Beloit One Network $547.33
Rate for Payer: Quartz Commercial $670.20
Rate for Payer: WEA Trust Commercial $614.35
Rate for Payer: WPS Commercial $827.36
Service Code CPT 59300
Hospital Charge Code 3015153
Hospital Revenue Code 510
Min. Negotiated Rate $167.08
Max. Negotiated Rate $705.85
Rate for Payer: Aetna Commercial $705.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $638.98
Rate for Payer: Cash Price $222.90
Rate for Payer: Cash Price $222.90
Rate for Payer: Cigna Commercial $705.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $167.08
Rate for Payer: Dean Health DHI/DHP/ASO $445.80
Rate for Payer: Health EOS Commercial $676.13
Rate for Payer: HFN Commercial $705.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $464.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $464.80
Rate for Payer: Multiplan Commercial $594.40
Rate for Payer: Preferred Network Access Commercial $705.85
Rate for Payer: Quartz Beloit One Network $326.92
Rate for Payer: Quartz Commercial $423.51
Rate for Payer: The Alliance Commercial $371.50
Rate for Payer: United Healthcare Medicaid $167.08
Rate for Payer: WEA Trust Commercial $408.65
Rate for Payer: WPS Commercial $550.34
Hospital Charge Code 2960016
Hospital Revenue Code 360
Min. Negotiated Rate $492.94
Max. Negotiated Rate $925.52
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $603.60
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Hospital Charge Code 2960016
Hospital Revenue Code 360
Min. Negotiated Rate $281.68
Max. Negotiated Rate $4,024.00
Rate for Payer: Aetna Commercial $905.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $865.16
Rate for Payer: Aetna Managed Medicare $281.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $653.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $503.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $482.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $533.18
Rate for Payer: Cash Price $301.80
Rate for Payer: Cigna Commercial $925.52
Rate for Payer: Dean Health DHI/DHP/ASO $562.96
Rate for Payer: Health EOS Commercial $895.34
Rate for Payer: HFN Commercial $925.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $754.50
Rate for Payer: Multiplan Commercial $804.80
Rate for Payer: NAPHCARE Commercial $603.60
Rate for Payer: Preferred Network Access Commercial $925.52
Rate for Payer: Quartz Beloit One Network $492.94
Rate for Payer: Quartz Commercial $653.90
Rate for Payer: Quartz Medicare Advantage $603.60
Rate for Payer: The Alliance Commercial $4,024.00
Rate for Payer: WEA Trust Commercial $553.30
Rate for Payer: WPS Commercial $745.14
Service Code MSDRG 150
Min. Negotiated Rate $12,686.21
Max. Negotiated Rate $35,268.00
Rate for Payer: Aetna Managed Medicare $12,686.21
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $27,483.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $21,066.11
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $20,014.18
Rate for Payer: Anthem Medicare Advantage $12,686.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $12,686.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $12,686.21
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $12,686.21
Rate for Payer: Dean Health DHI/DHP/ASO $22,217.57
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $12,686.21
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $25,632.75
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $12,686.21
Rate for Payer: Independent Care Health Plan Medicare $12,686.21
Rate for Payer: Managed Health Services Medicare Advantage $12,686.21
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $12,686.21
Rate for Payer: NAPHCARE Commercial $19,029.32
Rate for Payer: Quartz Medicare Advantage $12,686.21
Rate for Payer: The Alliance Commercial $35,268.00
Rate for Payer: United Healthcare Medicare Advantage $12,686.21
Rate for Payer: United Healthcare PPO $19,955.42
Rate for Payer: Wellcare Medicare $12,686.21
Service Code MSDRG 151
Min. Negotiated Rate $7,485.69
Max. Negotiated Rate $20,810.00
Rate for Payer: Aetna Managed Medicare $7,485.69
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $16,154.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $12,382.37
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $11,764.06
Rate for Payer: Anthem Medicare Advantage $7,485.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,485.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,485.69
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,485.69
Rate for Payer: Dean Health DHI/DHP/ASO $13,059.18
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,485.69
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $15,028.65
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,485.69
Rate for Payer: Independent Care Health Plan Medicare $7,485.69
Rate for Payer: Managed Health Services Medicare Advantage $7,485.69
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,485.69
Rate for Payer: NAPHCARE Commercial $11,228.54
Rate for Payer: Quartz Medicare Advantage $7,485.69
Rate for Payer: The Alliance Commercial $20,810.00
Rate for Payer: United Healthcare Medicare Advantage $7,485.69
Rate for Payer: United Healthcare PPO $11,700.00
Rate for Payer: Wellcare Medicare $7,485.69
Service Code CPT 93622
Hospital Charge Code 3052509
Hospital Revenue Code 481
Min. Negotiated Rate $563.99
Max. Negotiated Rate $1,058.92
Rate for Payer: Aetna Commercial $1,035.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $989.86
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $610.03
Rate for Payer: Cash Price $345.30
Rate for Payer: Cigna Commercial $1,058.92
Rate for Payer: Health EOS Commercial $1,024.39
Rate for Payer: HFN Commercial $1,058.92
Rate for Payer: Multiplan Commercial $920.80
Rate for Payer: NAPHCARE Commercial $690.60
Rate for Payer: Preferred Network Access Commercial $1,058.92
Rate for Payer: Quartz Beloit One Network $563.99
Rate for Payer: Quartz Commercial $690.60
Rate for Payer: WEA Trust Commercial $633.05
Rate for Payer: WPS Commercial $852.55
Service Code CPT 93622
Hospital Charge Code 3052509
Hospital Revenue Code 481
Min. Negotiated Rate $322.28
Max. Negotiated Rate $29,139.00
Rate for Payer: Aetna Commercial $1,035.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $989.86
Rate for Payer: Aetna Managed Medicare $322.28
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 $610.03
Rate for Payer: Cash Price $345.30
Rate for Payer: Cash Price $345.30
Rate for Payer: Cigna Commercial $1,058.92
Rate for Payer: Dean Health DHI/DHP/ASO $644.10
Rate for Payer: Health EOS Commercial $1,024.39
Rate for Payer: HFN Commercial $1,058.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $863.25
Rate for Payer: Multiplan Commercial $920.80
Rate for Payer: NAPHCARE Commercial $690.60
Rate for Payer: Preferred Network Access Commercial $1,058.92
Rate for Payer: Quartz Beloit One Network $563.99
Rate for Payer: Quartz Commercial $748.15
Rate for Payer: Quartz Medicare Advantage $690.60
Rate for Payer: The Alliance Commercial $4,604.00
Rate for Payer: WEA Trust Commercial $633.05
Rate for Payer: WPS Commercial $852.55
Service Code HCPCS Q4081
Hospital Charge Code 3603551
Hospital Revenue Code 635
Min. Negotiated Rate $1.09
Max. Negotiated Rate $112.00
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Aetna Managed Medicare $7.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $18.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $14.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $13.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Dean Health DHI/DHP/ASO $1.09
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21.00
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $18.20
Rate for Payer: Quartz Medicare Advantage $16.80
Rate for Payer: The Alliance Commercial $112.00
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $2.07
Service Code HCPCS Q4081
Hospital Charge Code 3603551
Hospital Revenue Code 635
Min. Negotiated Rate $13.72
Max. Negotiated Rate $25.76
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $16.80
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $20.74
Service Code HCPCS Q4081
Hospital Charge Code 3603569
Hospital Revenue Code 635
Min. Negotiated Rate $1.09
Max. Negotiated Rate $48.00
Rate for Payer: Aetna Commercial $10.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10.32
Rate for Payer: Aetna Managed Medicare $3.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $7.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $6.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $5.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6.36
Rate for Payer: Cash Price $3.60
Rate for Payer: Cash Price $3.60
Rate for Payer: Cigna Commercial $11.04
Rate for Payer: Dean Health DHI/DHP/ASO $1.09
Rate for Payer: Health EOS Commercial $10.68
Rate for Payer: HFN Commercial $11.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $9.00
Rate for Payer: Multiplan Commercial $9.60
Rate for Payer: NAPHCARE Commercial $7.20
Rate for Payer: Preferred Network Access Commercial $11.04
Rate for Payer: Quartz Beloit One Network $5.88
Rate for Payer: Quartz Commercial $7.80
Rate for Payer: Quartz Medicare Advantage $7.20
Rate for Payer: The Alliance Commercial $48.00
Rate for Payer: WEA Trust Commercial $6.60
Rate for Payer: WPS Commercial $2.07
Service Code HCPCS Q4081
Hospital Charge Code 3603569
Hospital Revenue Code 635
Min. Negotiated Rate $5.88
Max. Negotiated Rate $11.04
Rate for Payer: Aetna Commercial $10.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $10.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $6.36
Rate for Payer: Cash Price $3.60
Rate for Payer: Cigna Commercial $11.04
Rate for Payer: Health EOS Commercial $10.68
Rate for Payer: HFN Commercial $11.04
Rate for Payer: Multiplan Commercial $9.60
Rate for Payer: NAPHCARE Commercial $7.20
Rate for Payer: Preferred Network Access Commercial $11.04
Rate for Payer: Quartz Beloit One Network $5.88
Rate for Payer: Quartz Commercial $7.20
Rate for Payer: WEA Trust Commercial $6.60
Rate for Payer: WPS Commercial $8.89
Service Code HCPCS Q4055
Hospital Charge Code 3005570
Hospital Revenue Code 635
Min. Negotiated Rate $13.72
Max. Negotiated Rate $25.76
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $16.80
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $20.74
Service Code HCPCS Q4055
Hospital Charge Code 3005570
Hospital Revenue Code 635
Min. Negotiated Rate $7.84
Max. Negotiated Rate $112.00
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Aetna Managed Medicare $7.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $18.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $14.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $13.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Dean Health DHI/DHP/ASO $15.67
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21.00
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $18.20
Rate for Payer: Quartz Medicare Advantage $16.80
Rate for Payer: The Alliance Commercial $112.00
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $20.74
Service Code HCPCS Q4055
Hospital Charge Code 3026469
Hospital Revenue Code 635
Min. Negotiated Rate $7.84
Max. Negotiated Rate $112.00
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Aetna Managed Medicare $7.84
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $18.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $14.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $13.44
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Dean Health DHI/DHP/ASO $15.67
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $21.00
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $18.20
Rate for Payer: Quartz Medicare Advantage $16.80
Rate for Payer: The Alliance Commercial $112.00
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $20.74
Service Code HCPCS Q4055
Hospital Charge Code 3026469
Hospital Revenue Code 635
Min. Negotiated Rate $13.72
Max. Negotiated Rate $25.76
Rate for Payer: Aetna Commercial $25.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $24.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $14.84
Rate for Payer: Cash Price $8.40
Rate for Payer: Cigna Commercial $25.76
Rate for Payer: Health EOS Commercial $24.92
Rate for Payer: HFN Commercial $25.76
Rate for Payer: Multiplan Commercial $22.40
Rate for Payer: NAPHCARE Commercial $16.80
Rate for Payer: Preferred Network Access Commercial $25.76
Rate for Payer: Quartz Beloit One Network $13.72
Rate for Payer: Quartz Commercial $16.80
Rate for Payer: WEA Trust Commercial $15.40
Rate for Payer: WPS Commercial $20.74