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Hospital Charge Code 2960037
Hospital Revenue Code 360
Min. Negotiated Rate $531.16
Max. Negotiated Rate $997.28
Rate for Payer: Aetna Commercial $975.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $932.24
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $574.52
Rate for Payer: Cash Price $325.20
Rate for Payer: Cigna Commercial $997.28
Rate for Payer: Health EOS Commercial $964.76
Rate for Payer: HFN Commercial $997.28
Rate for Payer: Multiplan Commercial $867.20
Rate for Payer: NAPHCARE Commercial $650.40
Rate for Payer: Preferred Network Access Commercial $997.28
Rate for Payer: Quartz Beloit One Network $531.16
Rate for Payer: Quartz Commercial $650.40
Rate for Payer: WEA Trust Commercial $596.20
Rate for Payer: WPS Commercial $802.92
Hospital Charge Code 2965393
Hospital Revenue Code 278
Min. Negotiated Rate $2,434.32
Max. Negotiated Rate $34,776.00
Rate for Payer: Aetna Commercial $7,824.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,476.84
Rate for Payer: Aetna Managed Medicare $2,434.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,651.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,347.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,173.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,607.82
Rate for Payer: Cash Price $2,608.20
Rate for Payer: Cigna Commercial $7,998.48
Rate for Payer: Dean Health DHI/DHP/ASO $4,865.16
Rate for Payer: Health EOS Commercial $7,737.66
Rate for Payer: HFN Commercial $7,998.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,520.50
Rate for Payer: Multiplan Commercial $6,955.20
Rate for Payer: NAPHCARE Commercial $5,216.40
Rate for Payer: Preferred Network Access Commercial $7,998.48
Rate for Payer: Quartz Beloit One Network $4,260.06
Rate for Payer: Quartz Commercial $5,651.10
Rate for Payer: Quartz Medicare Advantage $5,216.40
Rate for Payer: The Alliance Commercial $34,776.00
Rate for Payer: WEA Trust Commercial $4,781.70
Rate for Payer: WPS Commercial $6,439.65
Hospital Charge Code 2965393
Hospital Revenue Code 278
Min. Negotiated Rate $4,260.06
Max. Negotiated Rate $7,998.48
Rate for Payer: Aetna Commercial $7,824.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,476.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,607.82
Rate for Payer: Cash Price $2,608.20
Rate for Payer: Cigna Commercial $7,998.48
Rate for Payer: Health EOS Commercial $7,737.66
Rate for Payer: HFN Commercial $7,998.48
Rate for Payer: Multiplan Commercial $6,955.20
Rate for Payer: NAPHCARE Commercial $5,216.40
Rate for Payer: Preferred Network Access Commercial $7,998.48
Rate for Payer: Quartz Beloit One Network $4,260.06
Rate for Payer: Quartz Commercial $5,216.40
Rate for Payer: WEA Trust Commercial $4,781.70
Rate for Payer: WPS Commercial $6,439.65
Hospital Charge Code 5767653
Hospital Revenue Code 272
Min. Negotiated Rate $421.40
Max. Negotiated Rate $791.20
Rate for Payer: Aetna Commercial $774.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $739.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $455.80
Rate for Payer: Cash Price $258.00
Rate for Payer: Cigna Commercial $791.20
Rate for Payer: Health EOS Commercial $765.40
Rate for Payer: HFN Commercial $791.20
Rate for Payer: Multiplan Commercial $688.00
Rate for Payer: NAPHCARE Commercial $516.00
Rate for Payer: Preferred Network Access Commercial $791.20
Rate for Payer: Quartz Beloit One Network $421.40
Rate for Payer: Quartz Commercial $516.00
Rate for Payer: WEA Trust Commercial $473.00
Rate for Payer: WPS Commercial $637.00
Hospital Charge Code 5767653
Hospital Revenue Code 272
Min. Negotiated Rate $240.80
Max. Negotiated Rate $3,440.00
Rate for Payer: Aetna Commercial $774.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $739.60
Rate for Payer: Aetna Managed Medicare $240.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $559.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $430.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $412.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $455.80
Rate for Payer: Cash Price $258.00
Rate for Payer: Cigna Commercial $791.20
Rate for Payer: Dean Health DHI/DHP/ASO $481.26
Rate for Payer: Health EOS Commercial $765.40
Rate for Payer: HFN Commercial $791.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $645.00
Rate for Payer: Multiplan Commercial $688.00
Rate for Payer: NAPHCARE Commercial $516.00
Rate for Payer: Preferred Network Access Commercial $791.20
Rate for Payer: Quartz Beloit One Network $421.40
Rate for Payer: Quartz Commercial $559.00
Rate for Payer: Quartz Medicare Advantage $516.00
Rate for Payer: The Alliance Commercial $3,440.00
Rate for Payer: WEA Trust Commercial $473.00
Rate for Payer: WPS Commercial $637.00
Service Code HCPCS C9290
Hospital Charge Code 4594739
Hospital Revenue Code 636
Min. Negotiated Rate $250.88
Max. Negotiated Rate $3,584.00
Rate for Payer: Aetna Commercial $806.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $770.56
Rate for Payer: Aetna Managed Medicare $250.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $582.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $448.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $430.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $474.88
Rate for Payer: Cash Price $268.80
Rate for Payer: Cigna Commercial $824.32
Rate for Payer: Dean Health DHI/DHP/ASO $501.40
Rate for Payer: Health EOS Commercial $797.44
Rate for Payer: HFN Commercial $824.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $672.00
Rate for Payer: Multiplan Commercial $716.80
Rate for Payer: NAPHCARE Commercial $537.60
Rate for Payer: Preferred Network Access Commercial $824.32
Rate for Payer: Quartz Beloit One Network $439.04
Rate for Payer: Quartz Commercial $582.40
Rate for Payer: Quartz Medicare Advantage $537.60
Rate for Payer: The Alliance Commercial $3,584.00
Rate for Payer: WEA Trust Commercial $492.80
Rate for Payer: WPS Commercial $663.67
Service Code HCPCS C9290
Hospital Charge Code 4594739
Hospital Revenue Code 636
Min. Negotiated Rate $439.04
Max. Negotiated Rate $824.32
Rate for Payer: Aetna Commercial $806.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $770.56
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $474.88
Rate for Payer: Cash Price $268.80
Rate for Payer: Cigna Commercial $824.32
Rate for Payer: Health EOS Commercial $797.44
Rate for Payer: HFN Commercial $824.32
Rate for Payer: Multiplan Commercial $716.80
Rate for Payer: NAPHCARE Commercial $537.60
Rate for Payer: Preferred Network Access Commercial $824.32
Rate for Payer: Quartz Beloit One Network $439.04
Rate for Payer: Quartz Commercial $537.60
Rate for Payer: WEA Trust Commercial $492.80
Rate for Payer: WPS Commercial $663.67
Service Code CPT 31020
Hospital Charge Code 3014368
Hospital Revenue Code 510
Min. Negotiated Rate $226.00
Max. Negotiated Rate $1,320.54
Rate for Payer: Aetna Commercial $632.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $572.76
Rate for Payer: Cash Price $199.80
Rate for Payer: Cash Price $199.80
Rate for Payer: Cigna Commercial $632.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $226.00
Rate for Payer: Dean Health DHI/DHP/ASO $399.60
Rate for Payer: Health EOS Commercial $606.06
Rate for Payer: HFN Commercial $632.70
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,320.54
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,320.54
Rate for Payer: Multiplan Commercial $532.80
Rate for Payer: Preferred Network Access Commercial $632.70
Rate for Payer: Quartz Beloit One Network $293.04
Rate for Payer: Quartz Commercial $379.62
Rate for Payer: The Alliance Commercial $333.00
Rate for Payer: United Healthcare Medicaid $226.00
Rate for Payer: WEA Trust Commercial $366.30
Rate for Payer: WPS Commercial $493.31
Service Code CPT 31030
Hospital Charge Code 3014369
Hospital Revenue Code 510
Min. Negotiated Rate $753.31
Max. Negotiated Rate $2,669.50
Rate for Payer: Aetna Commercial $2,669.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,416.60
Rate for Payer: Cash Price $843.00
Rate for Payer: Cash Price $843.00
Rate for Payer: Cigna Commercial $2,669.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $753.31
Rate for Payer: Dean Health DHI/DHP/ASO $1,686.00
Rate for Payer: Health EOS Commercial $2,557.10
Rate for Payer: HFN Commercial $2,669.50
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,748.69
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,748.69
Rate for Payer: Multiplan Commercial $2,248.00
Rate for Payer: Preferred Network Access Commercial $2,669.50
Rate for Payer: Quartz Beloit One Network $1,236.40
Rate for Payer: Quartz Commercial $1,601.70
Rate for Payer: The Alliance Commercial $1,405.00
Rate for Payer: United Healthcare Medicaid $753.31
Rate for Payer: WEA Trust Commercial $1,545.50
Rate for Payer: WPS Commercial $2,081.37
Service Code CPT 28020
Hospital Charge Code 3014181
Hospital Revenue Code 510
Min. Negotiated Rate $452.00
Max. Negotiated Rate $2,160.30
Rate for Payer: Aetna Commercial $2,160.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,955.64
Rate for Payer: Cash Price $682.20
Rate for Payer: Cash Price $682.20
Rate for Payer: Cigna Commercial $2,160.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $452.00
Rate for Payer: Dean Health DHI/DHP/ASO $1,364.40
Rate for Payer: Health EOS Commercial $2,069.34
Rate for Payer: HFN Commercial $2,160.30
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,228.40
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,228.40
Rate for Payer: Multiplan Commercial $1,819.20
Rate for Payer: Preferred Network Access Commercial $2,160.30
Rate for Payer: Quartz Beloit One Network $1,000.56
Rate for Payer: Quartz Commercial $1,296.18
Rate for Payer: The Alliance Commercial $1,137.00
Rate for Payer: United Healthcare Medicaid $452.00
Rate for Payer: WEA Trust Commercial $1,250.70
Rate for Payer: WPS Commercial $1,684.35
Service Code CPT 28022
Hospital Charge Code 3014182
Hospital Revenue Code 510
Min. Negotiated Rate $271.17
Max. Negotiated Rate $1,097.58
Rate for Payer: Aetna Commercial $1,090.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $987.28
Rate for Payer: Cash Price $344.40
Rate for Payer: Cash Price $344.40
Rate for Payer: Cigna Commercial $1,090.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $271.17
Rate for Payer: Dean Health DHI/DHP/ASO $688.80
Rate for Payer: Health EOS Commercial $1,044.68
Rate for Payer: HFN Commercial $1,090.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,097.58
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,097.58
Rate for Payer: Multiplan Commercial $918.40
Rate for Payer: Preferred Network Access Commercial $1,090.60
Rate for Payer: Quartz Beloit One Network $505.12
Rate for Payer: Quartz Commercial $654.36
Rate for Payer: The Alliance Commercial $574.00
Rate for Payer: United Healthcare Medicaid $271.17
Rate for Payer: WEA Trust Commercial $631.40
Rate for Payer: WPS Commercial $850.32
Service Code CPT 28024
Hospital Charge Code 3014183
Hospital Revenue Code 510
Min. Negotiated Rate $195.86
Max. Negotiated Rate $1,061.15
Rate for Payer: Aetna Commercial $1,061.15
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $960.62
Rate for Payer: Cash Price $335.10
Rate for Payer: Cash Price $335.10
Rate for Payer: Cigna Commercial $1,061.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $195.86
Rate for Payer: Dean Health DHI/DHP/ASO $670.20
Rate for Payer: Health EOS Commercial $1,016.47
Rate for Payer: HFN Commercial $1,061.15
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,024.94
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,024.94
Rate for Payer: Multiplan Commercial $893.60
Rate for Payer: Preferred Network Access Commercial $1,061.15
Rate for Payer: Quartz Beloit One Network $491.48
Rate for Payer: Quartz Commercial $636.69
Rate for Payer: The Alliance Commercial $558.50
Rate for Payer: United Healthcare Medicaid $195.86
Rate for Payer: WEA Trust Commercial $614.35
Rate for Payer: WPS Commercial $827.36
Service Code CPT 68840
Hospital Charge Code 3015260
Hospital Revenue Code 510
Min. Negotiated Rate $63.84
Max. Negotiated Rate $514.90
Rate for Payer: Aetna Commercial $514.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $466.12
Rate for Payer: Cash Price $162.60
Rate for Payer: Cash Price $162.60
Rate for Payer: Cigna Commercial $514.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $63.84
Rate for Payer: Dean Health DHI/DHP/ASO $325.20
Rate for Payer: Health EOS Commercial $493.22
Rate for Payer: HFN Commercial $514.90
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $392.36
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $392.36
Rate for Payer: Multiplan Commercial $433.60
Rate for Payer: Preferred Network Access Commercial $514.90
Rate for Payer: Quartz Beloit One Network $238.48
Rate for Payer: Quartz Commercial $308.94
Rate for Payer: The Alliance Commercial $271.00
Rate for Payer: United Healthcare Medicaid $63.84
Rate for Payer: WEA Trust Commercial $298.10
Rate for Payer: WPS Commercial $401.46
Service Code CPT 20102
Hospital Charge Code 3013702
Hospital Revenue Code 510
Min. Negotiated Rate $244.63
Max. Negotiated Rate $1,725.20
Rate for Payer: Aetna Commercial $1,725.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,561.76
Rate for Payer: Cash Price $544.80
Rate for Payer: Cash Price $544.80
Rate for Payer: Cigna Commercial $1,725.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $244.63
Rate for Payer: Dean Health DHI/DHP/ASO $1,089.60
Rate for Payer: Health EOS Commercial $1,652.56
Rate for Payer: HFN Commercial $1,725.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $829.37
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $829.37
Rate for Payer: Multiplan Commercial $1,452.80
Rate for Payer: Preferred Network Access Commercial $1,725.20
Rate for Payer: Quartz Beloit One Network $799.04
Rate for Payer: Quartz Commercial $1,035.12
Rate for Payer: The Alliance Commercial $908.00
Rate for Payer: United Healthcare Medicaid $244.63
Rate for Payer: WEA Trust Commercial $998.80
Rate for Payer: WPS Commercial $1,345.11
Service Code CPT 20101
Hospital Charge Code 3013701
Hospital Revenue Code 510
Min. Negotiated Rate $199.76
Max. Negotiated Rate $2,455.75
Rate for Payer: Aetna Commercial $2,455.75
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,223.10
Rate for Payer: Cash Price $775.50
Rate for Payer: Cash Price $775.50
Rate for Payer: Cigna Commercial $2,455.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $199.76
Rate for Payer: Dean Health DHI/DHP/ASO $1,551.00
Rate for Payer: Health EOS Commercial $2,352.35
Rate for Payer: HFN Commercial $2,455.75
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $681.54
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $681.54
Rate for Payer: Multiplan Commercial $2,068.00
Rate for Payer: Preferred Network Access Commercial $2,455.75
Rate for Payer: Quartz Beloit One Network $1,137.40
Rate for Payer: Quartz Commercial $1,473.45
Rate for Payer: The Alliance Commercial $1,292.50
Rate for Payer: United Healthcare Medicaid $199.76
Rate for Payer: WEA Trust Commercial $1,421.75
Rate for Payer: WPS Commercial $1,914.71
Service Code CPT 20103
Hospital Charge Code 3013703
Hospital Revenue Code 510
Min. Negotiated Rate $329.12
Max. Negotiated Rate $2,272.40
Rate for Payer: Aetna Commercial $2,272.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,057.12
Rate for Payer: Cash Price $717.60
Rate for Payer: Cash Price $717.60
Rate for Payer: Cigna Commercial $2,272.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $329.12
Rate for Payer: Dean Health DHI/DHP/ASO $1,435.20
Rate for Payer: Health EOS Commercial $2,176.72
Rate for Payer: HFN Commercial $2,272.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,139.45
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,139.45
Rate for Payer: Multiplan Commercial $1,913.60
Rate for Payer: Preferred Network Access Commercial $2,272.40
Rate for Payer: Quartz Beloit One Network $1,052.48
Rate for Payer: Quartz Commercial $1,363.44
Rate for Payer: The Alliance Commercial $1,196.00
Rate for Payer: United Healthcare Medicaid $329.12
Rate for Payer: WEA Trust Commercial $1,315.60
Rate for Payer: WPS Commercial $1,771.75
Service Code HCPCS C1757
Hospital Charge Code 2549084
Hospital Revenue Code 278
Min. Negotiated Rate $1,615.04
Max. Negotiated Rate $23,072.00
Rate for Payer: Aetna Commercial $5,191.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Aetna Managed Medicare $1,615.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,749.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,884.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,768.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,057.04
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,306.56
Rate for Payer: Dean Health DHI/DHP/ASO $3,227.77
Rate for Payer: Health EOS Commercial $5,133.52
Rate for Payer: HFN Commercial $5,306.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,326.00
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: NAPHCARE Commercial $3,460.80
Rate for Payer: Preferred Network Access Commercial $5,306.56
Rate for Payer: Quartz Beloit One Network $2,826.32
Rate for Payer: Quartz Commercial $3,749.20
Rate for Payer: Quartz Medicare Advantage $3,460.80
Rate for Payer: The Alliance Commercial $23,072.00
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1757
Hospital Charge Code 2549084
Hospital Revenue Code 278
Min. Negotiated Rate $2,537.92
Max. Negotiated Rate $5,479.60
Rate for Payer: Aetna Commercial $5,479.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,479.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $2,884.00
Rate for Payer: Dean Health DHI/DHP/ASO $3,460.80
Rate for Payer: Health EOS Commercial $5,248.88
Rate for Payer: HFN Commercial $5,479.60
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: Preferred Network Access Commercial $5,479.60
Rate for Payer: Quartz Beloit One Network $2,537.92
Rate for Payer: Quartz Commercial $3,287.76
Rate for Payer: The Alliance Commercial $2,884.00
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1757
Hospital Charge Code 2549084
Hospital Revenue Code 278
Min. Negotiated Rate $2,826.32
Max. Negotiated Rate $5,306.56
Rate for Payer: Aetna Commercial $5,191.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,057.04
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,306.56
Rate for Payer: Health EOS Commercial $5,133.52
Rate for Payer: HFN Commercial $5,306.56
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: NAPHCARE Commercial $3,460.80
Rate for Payer: Preferred Network Access Commercial $5,306.56
Rate for Payer: Quartz Beloit One Network $2,826.32
Rate for Payer: Quartz Commercial $3,460.80
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1757
Hospital Charge Code 2549086
Hospital Revenue Code 278
Min. Negotiated Rate $2,826.32
Max. Negotiated Rate $5,306.56
Rate for Payer: Aetna Commercial $5,191.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,057.04
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,306.56
Rate for Payer: Health EOS Commercial $5,133.52
Rate for Payer: HFN Commercial $5,306.56
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: NAPHCARE Commercial $3,460.80
Rate for Payer: Preferred Network Access Commercial $5,306.56
Rate for Payer: Quartz Beloit One Network $2,826.32
Rate for Payer: Quartz Commercial $3,460.80
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1757
Hospital Charge Code 2549086
Hospital Revenue Code 278
Min. Negotiated Rate $2,537.92
Max. Negotiated Rate $5,479.60
Rate for Payer: Aetna Commercial $5,479.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,479.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $2,884.00
Rate for Payer: Dean Health DHI/DHP/ASO $3,460.80
Rate for Payer: Health EOS Commercial $5,248.88
Rate for Payer: HFN Commercial $5,479.60
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: Preferred Network Access Commercial $5,479.60
Rate for Payer: Quartz Beloit One Network $2,537.92
Rate for Payer: Quartz Commercial $3,287.76
Rate for Payer: The Alliance Commercial $2,884.00
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1757
Hospital Charge Code 2549086
Hospital Revenue Code 278
Min. Negotiated Rate $1,615.04
Max. Negotiated Rate $23,072.00
Rate for Payer: Aetna Commercial $5,191.20
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,960.48
Rate for Payer: Aetna Managed Medicare $1,615.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,749.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,884.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,768.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,057.04
Rate for Payer: Cash Price $1,730.40
Rate for Payer: Cigna Commercial $5,306.56
Rate for Payer: Dean Health DHI/DHP/ASO $3,227.77
Rate for Payer: Health EOS Commercial $5,133.52
Rate for Payer: HFN Commercial $5,306.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,326.00
Rate for Payer: Multiplan Commercial $4,614.40
Rate for Payer: NAPHCARE Commercial $3,460.80
Rate for Payer: Preferred Network Access Commercial $5,306.56
Rate for Payer: Quartz Beloit One Network $2,826.32
Rate for Payer: Quartz Commercial $3,749.20
Rate for Payer: Quartz Medicare Advantage $3,460.80
Rate for Payer: The Alliance Commercial $23,072.00
Rate for Payer: WEA Trust Commercial $3,172.40
Rate for Payer: WPS Commercial $4,272.36
Service Code HCPCS C1876
Hospital Charge Code 4606631
Hospital Revenue Code 278
Min. Negotiated Rate $1,927.24
Max. Negotiated Rate $27,532.00
Rate for Payer: Aetna Commercial $6,194.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,919.38
Rate for Payer: Aetna Managed Medicare $1,927.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,473.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,441.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,303.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,647.99
Rate for Payer: Cash Price $2,064.90
Rate for Payer: Cigna Commercial $6,332.36
Rate for Payer: Dean Health DHI/DHP/ASO $3,851.73
Rate for Payer: Health EOS Commercial $6,125.87
Rate for Payer: HFN Commercial $6,332.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5,162.25
Rate for Payer: Multiplan Commercial $5,506.40
Rate for Payer: NAPHCARE Commercial $4,129.80
Rate for Payer: Preferred Network Access Commercial $6,332.36
Rate for Payer: Quartz Beloit One Network $3,372.67
Rate for Payer: Quartz Commercial $4,473.95
Rate for Payer: Quartz Medicare Advantage $4,129.80
Rate for Payer: The Alliance Commercial $27,532.00
Rate for Payer: WEA Trust Commercial $3,785.65
Rate for Payer: WPS Commercial $5,098.24
Service Code HCPCS C1876
Hospital Charge Code 4606631
Hospital Revenue Code 278
Min. Negotiated Rate $3,372.67
Max. Negotiated Rate $6,332.36
Rate for Payer: Aetna Commercial $6,194.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $5,919.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3,647.99
Rate for Payer: Cash Price $2,064.90
Rate for Payer: Cigna Commercial $6,332.36
Rate for Payer: Health EOS Commercial $6,125.87
Rate for Payer: HFN Commercial $6,332.36
Rate for Payer: Multiplan Commercial $5,506.40
Rate for Payer: NAPHCARE Commercial $4,129.80
Rate for Payer: Preferred Network Access Commercial $6,332.36
Rate for Payer: Quartz Beloit One Network $3,372.67
Rate for Payer: Quartz Commercial $4,129.80
Rate for Payer: WEA Trust Commercial $3,785.65
Rate for Payer: WPS Commercial $5,098.24
Service Code HCPCS C1713
Hospital Charge Code 5415948
Hospital Revenue Code 278
Min. Negotiated Rate $670.32
Max. Negotiated Rate $9,576.00
Rate for Payer: Aetna Commercial $2,154.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,058.84
Rate for Payer: Aetna Managed Medicare $670.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,556.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,197.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,149.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,268.82
Rate for Payer: Cash Price $718.20
Rate for Payer: Cigna Commercial $2,202.48
Rate for Payer: Dean Health DHI/DHP/ASO $1,339.68
Rate for Payer: Health EOS Commercial $2,130.66
Rate for Payer: HFN Commercial $2,202.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,795.50
Rate for Payer: Multiplan Commercial $1,915.20
Rate for Payer: NAPHCARE Commercial $1,436.40
Rate for Payer: Preferred Network Access Commercial $2,202.48
Rate for Payer: Quartz Beloit One Network $1,173.06
Rate for Payer: Quartz Commercial $1,556.10
Rate for Payer: Quartz Medicare Advantage $1,436.40
Rate for Payer: The Alliance Commercial $9,576.00
Rate for Payer: WEA Trust Commercial $1,316.70
Rate for Payer: WPS Commercial $1,773.24