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Service Code CPT 28090
Hospital Revenue Code 360
Min. Negotiated Rate $1,588.57
Max. Negotiated Rate $6,546.14
Rate for Payer: Aetna Managed Medicare $1,588.57
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $1,588.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $1,588.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $1,588.57
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $1,588.57
Rate for Payer: Dean Health DHI/DHP/ASO $6,546.14
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $1,588.57
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,909.48
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,588.57
Rate for Payer: Independent Care Health Plan Medicare $1,588.57
Rate for Payer: Managed Health Services Medicare Advantage $1,588.57
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $1,588.57
Rate for Payer: NAPHCARE Commercial $2,382.86
Rate for Payer: Quartz Medicare Advantage $1,588.57
Rate for Payer: The Alliance Commercial $6,354.28
Rate for Payer: United Healthcare Medicare Advantage $1,588.57
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $1,588.57
Service Code CPT 28092
Hospital Revenue Code 360
Min. Negotiated Rate $1,588.57
Max. Negotiated Rate $6,546.14
Rate for Payer: Aetna Managed Medicare $1,588.57
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $1,588.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $1,588.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $1,588.57
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $1,588.57
Rate for Payer: Dean Health DHI/DHP/ASO $6,546.14
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $1,588.57
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,909.48
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,588.57
Rate for Payer: Independent Care Health Plan Medicare $1,588.57
Rate for Payer: Managed Health Services Medicare Advantage $1,588.57
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $1,588.57
Rate for Payer: NAPHCARE Commercial $2,382.86
Rate for Payer: Quartz Medicare Advantage $1,588.57
Rate for Payer: The Alliance Commercial $6,354.28
Rate for Payer: United Healthcare Medicare Advantage $1,588.57
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $1,588.57
Service Code CPT 40525
Hospital Revenue Code 360
Min. Negotiated Rate $2,726.00
Max. Negotiated Rate $12,729.16
Rate for Payer: Aetna Managed Medicare $3,182.29
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,496.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,871.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,726.00
Rate for Payer: Anthem Medicare Advantage $3,182.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $3,182.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $3,182.29
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $3,182.29
Rate for Payer: Dean Health DHI/DHP/ASO $4,757.59
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $3,182.29
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $11,838.12
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $3,182.29
Rate for Payer: Independent Care Health Plan Medicare $3,182.29
Rate for Payer: Managed Health Services Medicare Advantage $3,182.29
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $3,182.29
Rate for Payer: NAPHCARE Commercial $4,773.44
Rate for Payer: Quartz Medicare Advantage $3,182.29
Rate for Payer: The Alliance Commercial $12,729.16
Rate for Payer: United Healthcare Medicare Advantage $3,182.29
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $3,182.29
Service Code CPT 11640
Hospital Charge Code 1152815
Hospital Revenue Code 510
Min. Negotiated Rate $196.76
Max. Negotiated Rate $787.55
Rate for Payer: Aetna Commercial $787.55
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $712.94
Rate for Payer: Cash Price $248.70
Rate for Payer: Cash Price $248.70
Rate for Payer: Cigna Commercial $787.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $196.76
Rate for Payer: Dean Health DHI/DHP/ASO $497.40
Rate for Payer: Health EOS Commercial $754.39
Rate for Payer: HFN Commercial $787.55
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $421.06
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $421.06
Rate for Payer: Multiplan Commercial $663.20
Rate for Payer: Preferred Network Access Commercial $787.55
Rate for Payer: Quartz Beloit One Network $364.76
Rate for Payer: Quartz Commercial $472.53
Rate for Payer: The Alliance Commercial $414.50
Rate for Payer: United Healthcare Medicaid $196.76
Rate for Payer: WEA Trust Commercial $455.95
Rate for Payer: WPS Commercial $614.04
Service Code CPT 11641
Hospital Charge Code 3013566
Hospital Revenue Code 510
Min. Negotiated Rate $253.34
Max. Negotiated Rate $1,094.40
Rate for Payer: Aetna Commercial $1,094.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $990.72
Rate for Payer: Cash Price $345.60
Rate for Payer: Cash Price $345.60
Rate for Payer: Cigna Commercial $1,094.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $253.34
Rate for Payer: Dean Health DHI/DHP/ASO $691.20
Rate for Payer: Health EOS Commercial $1,048.32
Rate for Payer: HFN Commercial $1,094.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $516.93
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $516.93
Rate for Payer: Multiplan Commercial $921.60
Rate for Payer: Preferred Network Access Commercial $1,094.40
Rate for Payer: Quartz Beloit One Network $506.88
Rate for Payer: Quartz Commercial $656.64
Rate for Payer: The Alliance Commercial $576.00
Rate for Payer: United Healthcare Medicaid $253.34
Rate for Payer: WEA Trust Commercial $633.60
Rate for Payer: WPS Commercial $853.29
Service Code CPT 11642
Hospital Charge Code 3013567
Hospital Revenue Code 510
Min. Negotiated Rate $224.04
Max. Negotiated Rate $1,183.70
Rate for Payer: Aetna Commercial $1,183.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,071.56
Rate for Payer: Cash Price $373.80
Rate for Payer: Cash Price $373.80
Rate for Payer: Cigna Commercial $1,183.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $224.04
Rate for Payer: Dean Health DHI/DHP/ASO $747.60
Rate for Payer: Health EOS Commercial $1,133.86
Rate for Payer: HFN Commercial $1,183.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $605.54
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $605.54
Rate for Payer: Multiplan Commercial $996.80
Rate for Payer: Preferred Network Access Commercial $1,183.70
Rate for Payer: Quartz Beloit One Network $548.24
Rate for Payer: Quartz Commercial $710.22
Rate for Payer: The Alliance Commercial $623.00
Rate for Payer: United Healthcare Medicaid $224.04
Rate for Payer: WEA Trust Commercial $685.30
Rate for Payer: WPS Commercial $922.91
Service Code CPT 11643
Hospital Charge Code 3013568
Hospital Revenue Code 510
Min. Negotiated Rate $382.71
Max. Negotiated Rate $2,100.45
Rate for Payer: Aetna Commercial $2,100.45
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,901.46
Rate for Payer: Cash Price $663.30
Rate for Payer: Cash Price $663.30
Rate for Payer: Cigna Commercial $2,100.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $382.71
Rate for Payer: Dean Health DHI/DHP/ASO $1,326.60
Rate for Payer: Health EOS Commercial $2,012.01
Rate for Payer: HFN Commercial $2,100.45
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $756.37
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $756.37
Rate for Payer: Multiplan Commercial $1,768.80
Rate for Payer: Preferred Network Access Commercial $2,100.45
Rate for Payer: Quartz Beloit One Network $972.84
Rate for Payer: Quartz Commercial $1,260.27
Rate for Payer: The Alliance Commercial $1,105.50
Rate for Payer: United Healthcare Medicaid $382.71
Rate for Payer: WEA Trust Commercial $1,216.05
Rate for Payer: WPS Commercial $1,637.69
Service Code CPT 11644
Hospital Charge Code 3013569
Hospital Revenue Code 510
Min. Negotiated Rate $584.69
Max. Negotiated Rate $2,811.05
Rate for Payer: Aetna Commercial $2,811.05
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,544.74
Rate for Payer: Cash Price $887.70
Rate for Payer: Cash Price $887.70
Rate for Payer: Cigna Commercial $2,811.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $584.69
Rate for Payer: Dean Health DHI/DHP/ASO $1,775.40
Rate for Payer: Health EOS Commercial $2,692.69
Rate for Payer: HFN Commercial $2,811.05
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $936.23
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $936.23
Rate for Payer: Multiplan Commercial $2,367.20
Rate for Payer: Preferred Network Access Commercial $2,811.05
Rate for Payer: Quartz Beloit One Network $1,301.96
Rate for Payer: Quartz Commercial $1,686.63
Rate for Payer: The Alliance Commercial $1,479.50
Rate for Payer: United Healthcare Medicaid $584.69
Rate for Payer: WEA Trust Commercial $1,627.45
Rate for Payer: WPS Commercial $2,191.73
Service Code CPT 11646
Hospital Charge Code 3013570
Hospital Revenue Code 510
Min. Negotiated Rate $671.07
Max. Negotiated Rate $3,308.85
Rate for Payer: Aetna Commercial $3,308.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,995.38
Rate for Payer: Cash Price $1,044.90
Rate for Payer: Cash Price $1,044.90
Rate for Payer: Cigna Commercial $3,308.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $671.07
Rate for Payer: Dean Health DHI/DHP/ASO $2,089.80
Rate for Payer: Health EOS Commercial $3,169.53
Rate for Payer: HFN Commercial $3,308.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,293.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,293.46
Rate for Payer: Multiplan Commercial $2,786.40
Rate for Payer: Preferred Network Access Commercial $3,308.85
Rate for Payer: Quartz Beloit One Network $1,532.52
Rate for Payer: Quartz Commercial $1,985.31
Rate for Payer: The Alliance Commercial $1,741.50
Rate for Payer: United Healthcare Medicaid $671.07
Rate for Payer: WEA Trust Commercial $1,915.65
Rate for Payer: WPS Commercial $2,579.86
Service Code CPT 11620
Hospital Charge Code 3013560
Hospital Revenue Code 510
Min. Negotiated Rate $119.23
Max. Negotiated Rate $727.70
Rate for Payer: Aetna Commercial $727.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $658.76
Rate for Payer: Cash Price $229.80
Rate for Payer: Cash Price $229.80
Rate for Payer: Cigna Commercial $727.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $119.23
Rate for Payer: Dean Health DHI/DHP/ASO $459.60
Rate for Payer: Health EOS Commercial $697.06
Rate for Payer: HFN Commercial $727.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $410.40
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $410.40
Rate for Payer: Multiplan Commercial $612.80
Rate for Payer: Preferred Network Access Commercial $727.70
Rate for Payer: Quartz Beloit One Network $337.04
Rate for Payer: Quartz Commercial $436.62
Rate for Payer: The Alliance Commercial $383.00
Rate for Payer: United Healthcare Medicaid $119.23
Rate for Payer: WEA Trust Commercial $421.30
Rate for Payer: WPS Commercial $567.38
Service Code CPT 11621
Hospital Charge Code 3013561
Hospital Revenue Code 510
Min. Negotiated Rate $201.40
Max. Negotiated Rate $805.60
Rate for Payer: Aetna Commercial $805.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $729.28
Rate for Payer: Cash Price $254.40
Rate for Payer: Cash Price $254.40
Rate for Payer: Cigna Commercial $805.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $201.40
Rate for Payer: Dean Health DHI/DHP/ASO $508.80
Rate for Payer: Health EOS Commercial $771.68
Rate for Payer: HFN Commercial $805.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $496.21
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $496.21
Rate for Payer: Multiplan Commercial $678.40
Rate for Payer: Preferred Network Access Commercial $805.60
Rate for Payer: Quartz Beloit One Network $373.12
Rate for Payer: Quartz Commercial $483.36
Rate for Payer: The Alliance Commercial $424.00
Rate for Payer: United Healthcare Medicaid $201.40
Rate for Payer: WEA Trust Commercial $466.40
Rate for Payer: WPS Commercial $628.11
Service Code CPT 11622
Hospital Charge Code 3013562
Hospital Revenue Code 510
Min. Negotiated Rate $247.94
Max. Negotiated Rate $1,169.45
Rate for Payer: Aetna Commercial $1,169.45
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,058.66
Rate for Payer: Cash Price $369.30
Rate for Payer: Cash Price $369.30
Rate for Payer: Cigna Commercial $1,169.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $247.94
Rate for Payer: Dean Health DHI/DHP/ASO $738.60
Rate for Payer: Health EOS Commercial $1,120.21
Rate for Payer: HFN Commercial $1,169.45
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $563.92
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $563.92
Rate for Payer: Multiplan Commercial $984.80
Rate for Payer: Preferred Network Access Commercial $1,169.45
Rate for Payer: Quartz Beloit One Network $541.64
Rate for Payer: Quartz Commercial $701.67
Rate for Payer: The Alliance Commercial $615.50
Rate for Payer: United Healthcare Medicaid $247.94
Rate for Payer: WEA Trust Commercial $677.05
Rate for Payer: WPS Commercial $911.80
Service Code CPT 11623
Hospital Charge Code 3013563
Hospital Revenue Code 510
Min. Negotiated Rate $283.02
Max. Negotiated Rate $1,776.50
Rate for Payer: Aetna Commercial $1,776.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,608.20
Rate for Payer: Cash Price $561.00
Rate for Payer: Cash Price $561.00
Rate for Payer: Cigna Commercial $1,776.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $283.02
Rate for Payer: Dean Health DHI/DHP/ASO $1,122.00
Rate for Payer: Health EOS Commercial $1,701.70
Rate for Payer: HFN Commercial $1,776.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $697.42
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $697.42
Rate for Payer: Multiplan Commercial $1,496.00
Rate for Payer: Preferred Network Access Commercial $1,776.50
Rate for Payer: Quartz Beloit One Network $822.80
Rate for Payer: Quartz Commercial $1,065.90
Rate for Payer: The Alliance Commercial $935.00
Rate for Payer: United Healthcare Medicaid $283.02
Rate for Payer: WEA Trust Commercial $1,028.50
Rate for Payer: WPS Commercial $1,385.11
Service Code CPT 11624
Hospital Charge Code 3013564
Hospital Revenue Code 510
Min. Negotiated Rate $382.71
Max. Negotiated Rate $1,635.90
Rate for Payer: Aetna Commercial $1,635.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,480.92
Rate for Payer: Cash Price $516.60
Rate for Payer: Cash Price $516.60
Rate for Payer: Cigna Commercial $1,635.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $382.71
Rate for Payer: Dean Health DHI/DHP/ASO $1,033.20
Rate for Payer: Health EOS Commercial $1,567.02
Rate for Payer: HFN Commercial $1,635.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $788.25
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $788.25
Rate for Payer: Multiplan Commercial $1,377.60
Rate for Payer: Preferred Network Access Commercial $1,635.90
Rate for Payer: Quartz Beloit One Network $757.68
Rate for Payer: Quartz Commercial $981.54
Rate for Payer: The Alliance Commercial $861.00
Rate for Payer: United Healthcare Medicaid $382.71
Rate for Payer: WEA Trust Commercial $947.10
Rate for Payer: WPS Commercial $1,275.49
Service Code CPT 11626
Hospital Charge Code 3013565
Hospital Revenue Code 510
Min. Negotiated Rate $448.16
Max. Negotiated Rate $2,483.30
Rate for Payer: Aetna Commercial $2,483.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,248.04
Rate for Payer: Cash Price $784.20
Rate for Payer: Cash Price $784.20
Rate for Payer: Cigna Commercial $2,483.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $448.16
Rate for Payer: Dean Health DHI/DHP/ASO $1,568.40
Rate for Payer: Health EOS Commercial $2,378.74
Rate for Payer: HFN Commercial $2,483.30
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $962.63
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $962.63
Rate for Payer: Multiplan Commercial $2,091.20
Rate for Payer: Preferred Network Access Commercial $2,483.30
Rate for Payer: Quartz Beloit One Network $1,150.16
Rate for Payer: Quartz Commercial $1,489.98
Rate for Payer: The Alliance Commercial $1,307.00
Rate for Payer: United Healthcare Medicaid $448.16
Rate for Payer: WEA Trust Commercial $1,437.70
Rate for Payer: WPS Commercial $1,936.19
Service Code CPT 11600
Hospital Charge Code 1152814
Hospital Revenue Code 510
Min. Negotiated Rate $90.38
Max. Negotiated Rate $492.10
Rate for Payer: Aetna Commercial $492.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $445.48
Rate for Payer: Cash Price $155.40
Rate for Payer: Cash Price $155.40
Rate for Payer: Cigna Commercial $492.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $90.38
Rate for Payer: Dean Health DHI/DHP/ASO $310.80
Rate for Payer: Health EOS Commercial $471.38
Rate for Payer: HFN Commercial $492.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $408.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $408.00
Rate for Payer: Multiplan Commercial $414.40
Rate for Payer: Preferred Network Access Commercial $492.10
Rate for Payer: Quartz Beloit One Network $227.92
Rate for Payer: Quartz Commercial $295.26
Rate for Payer: The Alliance Commercial $259.00
Rate for Payer: United Healthcare Medicaid $90.38
Rate for Payer: WEA Trust Commercial $284.90
Rate for Payer: WPS Commercial $383.68
Service Code CPT 11601
Hospital Charge Code 3013555
Hospital Revenue Code 510
Min. Negotiated Rate $120.52
Max. Negotiated Rate $581.40
Rate for Payer: Aetna Commercial $581.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $526.32
Rate for Payer: Cash Price $183.60
Rate for Payer: Cash Price $183.60
Rate for Payer: Cigna Commercial $581.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $120.52
Rate for Payer: Dean Health DHI/DHP/ASO $367.20
Rate for Payer: Health EOS Commercial $556.92
Rate for Payer: HFN Commercial $581.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $494.98
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $494.98
Rate for Payer: Multiplan Commercial $489.60
Rate for Payer: Preferred Network Access Commercial $581.40
Rate for Payer: Quartz Beloit One Network $269.28
Rate for Payer: Quartz Commercial $348.84
Rate for Payer: The Alliance Commercial $306.00
Rate for Payer: United Healthcare Medicaid $120.52
Rate for Payer: WEA Trust Commercial $336.60
Rate for Payer: WPS Commercial $453.31
Service Code CPT 11602
Hospital Charge Code 3013556
Hospital Revenue Code 510
Min. Negotiated Rate $184.72
Max. Negotiated Rate $720.10
Rate for Payer: Aetna Commercial $720.10
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $651.88
Rate for Payer: Cash Price $227.40
Rate for Payer: Cash Price $227.40
Rate for Payer: Cigna Commercial $720.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $184.72
Rate for Payer: Dean Health DHI/DHP/ASO $454.80
Rate for Payer: Health EOS Commercial $689.78
Rate for Payer: HFN Commercial $720.10
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $539.35
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $539.35
Rate for Payer: Multiplan Commercial $606.40
Rate for Payer: Preferred Network Access Commercial $720.10
Rate for Payer: Quartz Beloit One Network $333.52
Rate for Payer: Quartz Commercial $432.06
Rate for Payer: The Alliance Commercial $379.00
Rate for Payer: United Healthcare Medicaid $184.72
Rate for Payer: WEA Trust Commercial $416.90
Rate for Payer: WPS Commercial $561.45
Service Code CPT 11603
Hospital Charge Code 3013557
Hospital Revenue Code 510
Min. Negotiated Rate $245.99
Max. Negotiated Rate $1,057.35
Rate for Payer: Aetna Commercial $1,057.35
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $957.18
Rate for Payer: Cash Price $333.90
Rate for Payer: Cash Price $333.90
Rate for Payer: Cigna Commercial $1,057.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $245.99
Rate for Payer: Dean Health DHI/DHP/ASO $667.80
Rate for Payer: Health EOS Commercial $1,012.83
Rate for Payer: HFN Commercial $1,057.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $643.27
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $643.27
Rate for Payer: Multiplan Commercial $890.40
Rate for Payer: Preferred Network Access Commercial $1,057.35
Rate for Payer: Quartz Beloit One Network $489.72
Rate for Payer: Quartz Commercial $634.41
Rate for Payer: The Alliance Commercial $556.50
Rate for Payer: United Healthcare Medicaid $245.99
Rate for Payer: WEA Trust Commercial $612.15
Rate for Payer: WPS Commercial $824.40
Service Code CPT 11604
Hospital Charge Code 3013558
Hospital Revenue Code 510
Min. Negotiated Rate $362.15
Max. Negotiated Rate $1,145.70
Rate for Payer: Aetna Commercial $1,145.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,037.16
Rate for Payer: Cash Price $361.80
Rate for Payer: Cash Price $361.80
Rate for Payer: Cigna Commercial $1,145.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $362.15
Rate for Payer: Dean Health DHI/DHP/ASO $723.60
Rate for Payer: Health EOS Commercial $1,097.46
Rate for Payer: HFN Commercial $1,145.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $707.45
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $707.45
Rate for Payer: Multiplan Commercial $964.80
Rate for Payer: Preferred Network Access Commercial $1,145.70
Rate for Payer: Quartz Beloit One Network $530.64
Rate for Payer: Quartz Commercial $687.42
Rate for Payer: The Alliance Commercial $603.00
Rate for Payer: United Healthcare Medicaid $362.15
Rate for Payer: WEA Trust Commercial $663.30
Rate for Payer: WPS Commercial $893.28
Service Code CPT 11606
Hospital Charge Code 3013559
Hospital Revenue Code 510
Min. Negotiated Rate $430.96
Max. Negotiated Rate $1,726.15
Rate for Payer: Aetna Commercial $1,726.15
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,562.62
Rate for Payer: Cash Price $545.10
Rate for Payer: Cash Price $545.10
Rate for Payer: Cigna Commercial $1,726.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $430.96
Rate for Payer: Dean Health DHI/DHP/ASO $1,090.20
Rate for Payer: Health EOS Commercial $1,653.47
Rate for Payer: HFN Commercial $1,726.15
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,044.74
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,044.74
Rate for Payer: Multiplan Commercial $1,453.60
Rate for Payer: Preferred Network Access Commercial $1,726.15
Rate for Payer: Quartz Beloit One Network $799.48
Rate for Payer: Quartz Commercial $1,035.69
Rate for Payer: The Alliance Commercial $908.50
Rate for Payer: United Healthcare Medicaid $430.96
Rate for Payer: WEA Trust Commercial $999.35
Rate for Payer: WPS Commercial $1,345.85
Service Code CPT 40810
Hospital Charge Code 3190222
Hospital Revenue Code 510
Min. Negotiated Rate $45.18
Max. Negotiated Rate $411.99
Rate for Payer: Aetna Commercial $230.85
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $208.98
Rate for Payer: Cash Price $72.90
Rate for Payer: Cash Price $72.90
Rate for Payer: Cigna Commercial $230.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $45.18
Rate for Payer: Dean Health DHI/DHP/ASO $145.80
Rate for Payer: Health EOS Commercial $221.13
Rate for Payer: HFN Commercial $230.85
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $411.99
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $411.99
Rate for Payer: Multiplan Commercial $194.40
Rate for Payer: Preferred Network Access Commercial $230.85
Rate for Payer: Quartz Beloit One Network $106.92
Rate for Payer: Quartz Commercial $138.51
Rate for Payer: The Alliance Commercial $121.50
Rate for Payer: United Healthcare Medicaid $45.18
Rate for Payer: WEA Trust Commercial $133.65
Rate for Payer: WPS Commercial $179.99
Service Code CPT 40816
Hospital Charge Code 3014608
Hospital Revenue Code 510
Min. Negotiated Rate $209.35
Max. Negotiated Rate $1,445.90
Rate for Payer: Aetna Commercial $1,445.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,308.92
Rate for Payer: Cash Price $456.60
Rate for Payer: Cash Price $456.60
Rate for Payer: Cigna Commercial $1,445.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $209.35
Rate for Payer: Dean Health DHI/DHP/ASO $913.20
Rate for Payer: Health EOS Commercial $1,385.02
Rate for Payer: HFN Commercial $1,445.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,021.90
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,021.90
Rate for Payer: Multiplan Commercial $1,217.60
Rate for Payer: Preferred Network Access Commercial $1,445.90
Rate for Payer: Quartz Beloit One Network $669.68
Rate for Payer: Quartz Commercial $867.54
Rate for Payer: The Alliance Commercial $761.00
Rate for Payer: United Healthcare Medicaid $209.35
Rate for Payer: WEA Trust Commercial $837.10
Rate for Payer: WPS Commercial $1,127.35
Service Code CPT 41116
Hospital Charge Code 3014616
Hospital Revenue Code 510
Min. Negotiated Rate $209.35
Max. Negotiated Rate $723.16
Rate for Payer: Aetna Commercial $586.15
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $530.62
Rate for Payer: Cash Price $185.10
Rate for Payer: Cash Price $185.10
Rate for Payer: Cigna Commercial $586.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $209.35
Rate for Payer: Dean Health DHI/DHP/ASO $370.20
Rate for Payer: Health EOS Commercial $561.47
Rate for Payer: HFN Commercial $586.15
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $723.16
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $723.16
Rate for Payer: Multiplan Commercial $493.60
Rate for Payer: Preferred Network Access Commercial $586.15
Rate for Payer: Quartz Beloit One Network $271.48
Rate for Payer: Quartz Commercial $351.69
Rate for Payer: The Alliance Commercial $308.50
Rate for Payer: United Healthcare Medicaid $209.35
Rate for Payer: WEA Trust Commercial $339.35
Rate for Payer: WPS Commercial $457.01
Service Code CPT 46230
Hospital Charge Code 1190849
Hospital Revenue Code 510
Min. Negotiated Rate $75.33
Max. Negotiated Rate $673.55
Rate for Payer: Aetna Commercial $673.55
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $609.74
Rate for Payer: Cash Price $212.70
Rate for Payer: Cash Price $212.70
Rate for Payer: Cigna Commercial $673.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $75.33
Rate for Payer: Dean Health DHI/DHP/ASO $425.40
Rate for Payer: Health EOS Commercial $645.19
Rate for Payer: HFN Commercial $673.55
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $573.13
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $573.13
Rate for Payer: Multiplan Commercial $567.20
Rate for Payer: Preferred Network Access Commercial $673.55
Rate for Payer: Quartz Beloit One Network $311.96
Rate for Payer: Quartz Commercial $404.13
Rate for Payer: The Alliance Commercial $354.50
Rate for Payer: United Healthcare Medicaid $75.33
Rate for Payer: WEA Trust Commercial $389.95
Rate for Payer: WPS Commercial $525.16