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Service Code HCPCS C1713
Hospital Charge Code 5415948
Hospital Revenue Code 278
Min. Negotiated Rate $1,173.06
Max. Negotiated Rate $2,202.48
Rate for Payer: Aetna Commercial $2,154.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,058.84
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: Health EOS Commercial $2,130.66
Rate for Payer: HFN Commercial $2,202.48
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 $1,436.40
Rate for Payer: WEA Trust Commercial $1,316.70
Rate for Payer: WPS Commercial $1,773.24
Hospital Charge Code 2972326
Hospital Revenue Code 272
Min. Negotiated Rate $28.56
Max. Negotiated Rate $408.00
Rate for Payer: Aetna Commercial $91.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $87.72
Rate for Payer: Aetna Managed Medicare $28.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $66.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $51.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $48.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $54.06
Rate for Payer: Cash Price $30.60
Rate for Payer: Cigna Commercial $93.84
Rate for Payer: Dean Health DHI/DHP/ASO $57.08
Rate for Payer: Health EOS Commercial $90.78
Rate for Payer: HFN Commercial $93.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $76.50
Rate for Payer: Multiplan Commercial $81.60
Rate for Payer: NAPHCARE Commercial $61.20
Rate for Payer: Preferred Network Access Commercial $93.84
Rate for Payer: Quartz Beloit One Network $49.98
Rate for Payer: Quartz Commercial $66.30
Rate for Payer: Quartz Medicare Advantage $61.20
Rate for Payer: The Alliance Commercial $408.00
Rate for Payer: WEA Trust Commercial $56.10
Rate for Payer: WPS Commercial $75.55
Hospital Charge Code 2972326
Hospital Revenue Code 272
Min. Negotiated Rate $49.98
Max. Negotiated Rate $93.84
Rate for Payer: Aetna Commercial $91.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $87.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $54.06
Rate for Payer: Cash Price $30.60
Rate for Payer: Cigna Commercial $93.84
Rate for Payer: Health EOS Commercial $90.78
Rate for Payer: HFN Commercial $93.84
Rate for Payer: Multiplan Commercial $81.60
Rate for Payer: NAPHCARE Commercial $61.20
Rate for Payer: Preferred Network Access Commercial $93.84
Rate for Payer: Quartz Beloit One Network $49.98
Rate for Payer: Quartz Commercial $61.20
Rate for Payer: WEA Trust Commercial $56.10
Rate for Payer: WPS Commercial $75.55
Hospital Charge Code 4494206
Hospital Revenue Code 272
Min. Negotiated Rate $53.90
Max. Negotiated Rate $101.20
Rate for Payer: Aetna Commercial $99.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $94.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $58.30
Rate for Payer: Cash Price $33.00
Rate for Payer: Cigna Commercial $101.20
Rate for Payer: Health EOS Commercial $97.90
Rate for Payer: HFN Commercial $101.20
Rate for Payer: Multiplan Commercial $88.00
Rate for Payer: NAPHCARE Commercial $66.00
Rate for Payer: Preferred Network Access Commercial $101.20
Rate for Payer: Quartz Beloit One Network $53.90
Rate for Payer: Quartz Commercial $66.00
Rate for Payer: WEA Trust Commercial $60.50
Rate for Payer: WPS Commercial $81.48
Hospital Charge Code 4494206
Hospital Revenue Code 272
Min. Negotiated Rate $30.80
Max. Negotiated Rate $440.00
Rate for Payer: Aetna Commercial $99.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $94.60
Rate for Payer: Aetna Managed Medicare $30.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $71.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $55.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $52.80
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $58.30
Rate for Payer: Cash Price $33.00
Rate for Payer: Cigna Commercial $101.20
Rate for Payer: Dean Health DHI/DHP/ASO $61.56
Rate for Payer: Health EOS Commercial $97.90
Rate for Payer: HFN Commercial $101.20
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $82.50
Rate for Payer: Multiplan Commercial $88.00
Rate for Payer: NAPHCARE Commercial $66.00
Rate for Payer: Preferred Network Access Commercial $101.20
Rate for Payer: Quartz Beloit One Network $53.90
Rate for Payer: Quartz Commercial $71.50
Rate for Payer: Quartz Medicare Advantage $66.00
Rate for Payer: The Alliance Commercial $440.00
Rate for Payer: WEA Trust Commercial $60.50
Rate for Payer: WPS Commercial $81.48
Hospital Charge Code 3040293
Hospital Revenue Code 271
Min. Negotiated Rate $3.43
Max. Negotiated Rate $6.44
Rate for Payer: Aetna Commercial $6.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6.02
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3.71
Rate for Payer: Cash Price $2.10
Rate for Payer: Cigna Commercial $6.44
Rate for Payer: Health EOS Commercial $6.23
Rate for Payer: HFN Commercial $6.44
Rate for Payer: Multiplan Commercial $5.60
Rate for Payer: NAPHCARE Commercial $4.20
Rate for Payer: Preferred Network Access Commercial $6.44
Rate for Payer: Quartz Beloit One Network $3.43
Rate for Payer: Quartz Commercial $4.20
Rate for Payer: WEA Trust Commercial $3.85
Rate for Payer: WPS Commercial $5.18
Hospital Charge Code 3040293
Hospital Revenue Code 271
Min. Negotiated Rate $1.96
Max. Negotiated Rate $28.00
Rate for Payer: Aetna Commercial $6.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6.02
Rate for Payer: Aetna Managed Medicare $1.96
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4.55
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $3.71
Rate for Payer: Cash Price $2.10
Rate for Payer: Cigna Commercial $6.44
Rate for Payer: Dean Health DHI/DHP/ASO $3.92
Rate for Payer: Health EOS Commercial $6.23
Rate for Payer: HFN Commercial $6.44
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $5.25
Rate for Payer: Multiplan Commercial $5.60
Rate for Payer: NAPHCARE Commercial $4.20
Rate for Payer: Preferred Network Access Commercial $6.44
Rate for Payer: Quartz Beloit One Network $3.43
Rate for Payer: Quartz Commercial $4.55
Rate for Payer: Quartz Medicare Advantage $4.20
Rate for Payer: The Alliance Commercial $28.00
Rate for Payer: WEA Trust Commercial $3.85
Rate for Payer: WPS Commercial $5.18
Hospital Charge Code 3003558
Hospital Revenue Code 271
Min. Negotiated Rate $21.56
Max. Negotiated Rate $40.48
Rate for Payer: Aetna Commercial $39.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $37.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $23.32
Rate for Payer: Cash Price $13.20
Rate for Payer: Cigna Commercial $40.48
Rate for Payer: Health EOS Commercial $39.16
Rate for Payer: HFN Commercial $40.48
Rate for Payer: Multiplan Commercial $35.20
Rate for Payer: NAPHCARE Commercial $26.40
Rate for Payer: Preferred Network Access Commercial $40.48
Rate for Payer: Quartz Beloit One Network $21.56
Rate for Payer: Quartz Commercial $26.40
Rate for Payer: WEA Trust Commercial $24.20
Rate for Payer: WPS Commercial $32.59
Hospital Charge Code 3003558
Hospital Revenue Code 271
Min. Negotiated Rate $12.32
Max. Negotiated Rate $176.00
Rate for Payer: Aetna Commercial $39.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $37.84
Rate for Payer: Aetna Managed Medicare $12.32
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $28.60
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $22.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $21.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $23.32
Rate for Payer: Cash Price $13.20
Rate for Payer: Cigna Commercial $40.48
Rate for Payer: Dean Health DHI/DHP/ASO $24.62
Rate for Payer: Health EOS Commercial $39.16
Rate for Payer: HFN Commercial $40.48
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $33.00
Rate for Payer: Multiplan Commercial $35.20
Rate for Payer: NAPHCARE Commercial $26.40
Rate for Payer: Preferred Network Access Commercial $40.48
Rate for Payer: Quartz Beloit One Network $21.56
Rate for Payer: Quartz Commercial $28.60
Rate for Payer: Quartz Medicare Advantage $26.40
Rate for Payer: The Alliance Commercial $176.00
Rate for Payer: WEA Trust Commercial $24.20
Rate for Payer: WPS Commercial $32.59
Service Code MSDRG 933
Min. Negotiated Rate $29,111.18
Max. Negotiated Rate $80,929.00
Rate for Payer: Aetna Managed Medicare $29,111.18
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $63,569.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $48,725.43
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $46,292.34
Rate for Payer: Anthem Medicare Advantage $29,111.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $29,111.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $29,111.18
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $29,111.18
Rate for Payer: Dean Health DHI/DHP/ASO $51,388.74
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $29,111.18
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $59,124.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $29,111.18
Rate for Payer: Independent Care Health Plan Medicare $29,111.18
Rate for Payer: Managed Health Services Medicare Advantage $29,111.18
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $29,111.18
Rate for Payer: NAPHCARE Commercial $43,666.77
Rate for Payer: Quartz Medicare Advantage $29,111.18
Rate for Payer: The Alliance Commercial $80,929.00
Rate for Payer: United Healthcare Medicare Advantage $29,111.18
Rate for Payer: United Healthcare PPO $46,028.79
Rate for Payer: Wellcare Medicare $29,111.18
Service Code MSDRG 927
Min. Negotiated Rate $252,191.28
Max. Negotiated Rate $701,092.00
Rate for Payer: Aetna Managed Medicare $252,191.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $553,032.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $423,895.16
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $402,728.08
Rate for Payer: Anthem Medicare Advantage $252,191.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $252,191.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $252,191.28
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $252,191.28
Rate for Payer: Dean Health DHI/DHP/ASO $447,065.07
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $252,191.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $513,994.70
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $252,191.28
Rate for Payer: Independent Care Health Plan Medicare $252,191.28
Rate for Payer: Managed Health Services Medicare Advantage $252,191.28
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $252,191.28
Rate for Payer: NAPHCARE Commercial $378,286.92
Rate for Payer: Quartz Medicare Advantage $252,191.28
Rate for Payer: The Alliance Commercial $701,092.00
Rate for Payer: United Healthcare Medicare Advantage $252,191.28
Rate for Payer: United Healthcare PPO $400,151.42
Rate for Payer: Wellcare Medicare $252,191.28
Service Code MSDRG 982
Min. Negotiated Rate $23,889.62
Max. Negotiated Rate $66,413.00
Rate for Payer: Aetna Managed Medicare $23,889.62
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $52,240.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $40,041.69
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $38,042.22
Rate for Payer: Anthem Medicare Advantage $23,889.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $23,889.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $23,889.62
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $23,889.62
Rate for Payer: Dean Health DHI/DHP/ASO $42,230.35
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $23,889.62
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $48,477.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $23,889.62
Rate for Payer: Independent Care Health Plan Medicare $23,889.62
Rate for Payer: Managed Health Services Medicare Advantage $23,889.62
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $23,889.62
Rate for Payer: NAPHCARE Commercial $35,834.43
Rate for Payer: Quartz Medicare Advantage $23,889.62
Rate for Payer: The Alliance Commercial $66,413.00
Rate for Payer: United Healthcare Medicare Advantage $23,889.62
Rate for Payer: United Healthcare PPO $37,739.97
Rate for Payer: Wellcare Medicare $23,889.62
Service Code MSDRG 981
Min. Negotiated Rate $45,449.11
Max. Negotiated Rate $126,349.00
Rate for Payer: Aetna Managed Medicare $45,449.11
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $99,445.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $76,223.94
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $72,417.72
Rate for Payer: Anthem Medicare Advantage $45,449.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $45,449.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $45,449.11
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $45,449.11
Rate for Payer: Dean Health DHI/DHP/ASO $80,390.31
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $45,449.11
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $92,437.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $45,449.11
Rate for Payer: Independent Care Health Plan Medicare $45,449.11
Rate for Payer: Managed Health Services Medicare Advantage $45,449.11
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $45,449.11
Rate for Payer: NAPHCARE Commercial $68,173.66
Rate for Payer: Quartz Medicare Advantage $45,449.11
Rate for Payer: The Alliance Commercial $126,349.00
Rate for Payer: United Healthcare Medicare Advantage $45,449.11
Rate for Payer: United Healthcare PPO $71,964.01
Rate for Payer: Wellcare Medicare $45,449.11
Service Code MSDRG 983
Min. Negotiated Rate $15,753.16
Max. Negotiated Rate $43,794.00
Rate for Payer: Aetna Managed Medicare $15,753.16
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $34,407.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,372.84
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,055.92
Rate for Payer: Anthem Medicare Advantage $15,753.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $15,753.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $15,753.16
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $15,753.16
Rate for Payer: Dean Health DHI/DHP/ASO $27,814.37
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $15,753.16
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $31,886.40
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $15,753.16
Rate for Payer: Independent Care Health Plan Medicare $15,753.16
Rate for Payer: Managed Health Services Medicare Advantage $15,753.16
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $15,753.16
Rate for Payer: NAPHCARE Commercial $23,629.74
Rate for Payer: Quartz Medicare Advantage $15,753.16
Rate for Payer: The Alliance Commercial $43,794.00
Rate for Payer: United Healthcare Medicare Advantage $15,753.16
Rate for Payer: United Healthcare PPO $24,823.97
Rate for Payer: Wellcare Medicare $15,753.16
Hospital Charge Code 2960414
Hospital Revenue Code 360
Min. Negotiated Rate $374.36
Max. Negotiated Rate $5,348.00
Rate for Payer: Aetna Commercial $1,203.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,149.82
Rate for Payer: Aetna Managed Medicare $374.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $869.05
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $668.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $641.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $708.61
Rate for Payer: Cash Price $401.10
Rate for Payer: Cigna Commercial $1,230.04
Rate for Payer: Dean Health DHI/DHP/ASO $748.19
Rate for Payer: Health EOS Commercial $1,189.93
Rate for Payer: HFN Commercial $1,230.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,002.75
Rate for Payer: Multiplan Commercial $1,069.60
Rate for Payer: NAPHCARE Commercial $802.20
Rate for Payer: Preferred Network Access Commercial $1,230.04
Rate for Payer: Quartz Beloit One Network $655.13
Rate for Payer: Quartz Commercial $869.05
Rate for Payer: Quartz Medicare Advantage $802.20
Rate for Payer: The Alliance Commercial $5,348.00
Rate for Payer: WEA Trust Commercial $735.35
Rate for Payer: WPS Commercial $990.32
Hospital Charge Code 2960414
Hospital Revenue Code 360
Min. Negotiated Rate $655.13
Max. Negotiated Rate $1,230.04
Rate for Payer: Aetna Commercial $1,203.30
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,149.82
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $708.61
Rate for Payer: Cash Price $401.10
Rate for Payer: Cigna Commercial $1,230.04
Rate for Payer: Health EOS Commercial $1,189.93
Rate for Payer: HFN Commercial $1,230.04
Rate for Payer: Multiplan Commercial $1,069.60
Rate for Payer: NAPHCARE Commercial $802.20
Rate for Payer: Preferred Network Access Commercial $1,230.04
Rate for Payer: Quartz Beloit One Network $655.13
Rate for Payer: Quartz Commercial $802.20
Rate for Payer: WEA Trust Commercial $735.35
Rate for Payer: WPS Commercial $990.32
Hospital Charge Code 5729897
Hospital Revenue Code 272
Min. Negotiated Rate $119.07
Max. Negotiated Rate $223.56
Rate for Payer: Aetna Commercial $218.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $208.98
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $128.79
Rate for Payer: Cash Price $72.90
Rate for Payer: Cigna Commercial $223.56
Rate for Payer: Health EOS Commercial $216.27
Rate for Payer: HFN Commercial $223.56
Rate for Payer: Multiplan Commercial $194.40
Rate for Payer: NAPHCARE Commercial $145.80
Rate for Payer: Preferred Network Access Commercial $223.56
Rate for Payer: Quartz Beloit One Network $119.07
Rate for Payer: Quartz Commercial $145.80
Rate for Payer: WEA Trust Commercial $133.65
Rate for Payer: WPS Commercial $179.99
Hospital Charge Code 5729897
Hospital Revenue Code 272
Min. Negotiated Rate $68.04
Max. Negotiated Rate $972.00
Rate for Payer: Aetna Commercial $218.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $208.98
Rate for Payer: Aetna Managed Medicare $68.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $157.95
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $121.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $116.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $128.79
Rate for Payer: Cash Price $72.90
Rate for Payer: Cigna Commercial $223.56
Rate for Payer: Dean Health DHI/DHP/ASO $135.98
Rate for Payer: Health EOS Commercial $216.27
Rate for Payer: HFN Commercial $223.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $182.25
Rate for Payer: Multiplan Commercial $194.40
Rate for Payer: NAPHCARE Commercial $145.80
Rate for Payer: Preferred Network Access Commercial $223.56
Rate for Payer: Quartz Beloit One Network $119.07
Rate for Payer: Quartz Commercial $157.95
Rate for Payer: Quartz Medicare Advantage $145.80
Rate for Payer: The Alliance Commercial $972.00
Rate for Payer: WEA Trust Commercial $133.65
Rate for Payer: WPS Commercial $179.99
Service Code CPT 93242
Hospital Charge Code 5727950
Hospital Revenue Code 730
Min. Negotiated Rate $39.64
Max. Negotiated Rate $158.56
Rate for Payer: Aetna Commercial $90.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $86.00
Rate for Payer: Aetna Managed Medicare $39.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $65.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $50.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $48.00
Rate for Payer: Anthem Medicare Advantage $39.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $53.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $39.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $39.64
Rate for Payer: Cash Price $30.00
Rate for Payer: Cash Price $30.00
Rate for Payer: Cigna Commercial $92.00
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $39.64
Rate for Payer: Dean Health DHI/DHP/ASO $55.96
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $39.64
Rate for Payer: Health EOS Commercial $89.00
Rate for Payer: HFN Commercial $92.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $147.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $39.64
Rate for Payer: Independent Care Health Plan Medicare $39.64
Rate for Payer: Managed Health Services Medicare Advantage $39.64
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $39.64
Rate for Payer: Multiplan Commercial $80.00
Rate for Payer: NAPHCARE Commercial $59.46
Rate for Payer: Preferred Network Access Commercial $92.00
Rate for Payer: Quartz Beloit One Network $49.00
Rate for Payer: Quartz Commercial $65.00
Rate for Payer: Quartz Medicare Advantage $39.64
Rate for Payer: The Alliance Commercial $158.56
Rate for Payer: United Healthcare Medicare Advantage $39.64
Rate for Payer: United Healthcare PPO $75.00
Rate for Payer: WEA Trust Commercial $55.00
Rate for Payer: Wellcare Medicare $39.64
Rate for Payer: WPS Commercial $74.07
Service Code CPT 93242
Hospital Charge Code 5727950
Hospital Revenue Code 730
Min. Negotiated Rate $49.00
Max. Negotiated Rate $92.00
Rate for Payer: Aetna Commercial $90.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $86.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $53.00
Rate for Payer: Cash Price $30.00
Rate for Payer: Cigna Commercial $92.00
Rate for Payer: Health EOS Commercial $89.00
Rate for Payer: HFN Commercial $92.00
Rate for Payer: Multiplan Commercial $80.00
Rate for Payer: NAPHCARE Commercial $60.00
Rate for Payer: Preferred Network Access Commercial $92.00
Rate for Payer: Quartz Beloit One Network $49.00
Rate for Payer: Quartz Commercial $60.00
Rate for Payer: WEA Trust Commercial $55.00
Rate for Payer: WPS Commercial $74.07
Service Code CPT 93246
Hospital Charge Code 5727949
Hospital Revenue Code 730
Min. Negotiated Rate $49.00
Max. Negotiated Rate $92.00
Rate for Payer: Aetna Commercial $90.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $86.00
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $53.00
Rate for Payer: Cash Price $30.00
Rate for Payer: Cigna Commercial $92.00
Rate for Payer: Health EOS Commercial $89.00
Rate for Payer: HFN Commercial $92.00
Rate for Payer: Multiplan Commercial $80.00
Rate for Payer: NAPHCARE Commercial $60.00
Rate for Payer: Preferred Network Access Commercial $92.00
Rate for Payer: Quartz Beloit One Network $49.00
Rate for Payer: Quartz Commercial $60.00
Rate for Payer: WEA Trust Commercial $55.00
Rate for Payer: WPS Commercial $74.07
Service Code CPT 93246
Hospital Charge Code 5727949
Hospital Revenue Code 730
Min. Negotiated Rate $39.64
Max. Negotiated Rate $158.56
Rate for Payer: Aetna Commercial $90.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $86.00
Rate for Payer: Aetna Managed Medicare $39.64
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $65.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $50.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $48.00
Rate for Payer: Anthem Medicare Advantage $39.64
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $53.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $39.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $39.64
Rate for Payer: Cash Price $30.00
Rate for Payer: Cash Price $30.00
Rate for Payer: Cigna Commercial $92.00
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $39.64
Rate for Payer: Dean Health DHI/DHP/ASO $55.96
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $39.64
Rate for Payer: Health EOS Commercial $89.00
Rate for Payer: HFN Commercial $92.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $147.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $39.64
Rate for Payer: Independent Care Health Plan Medicare $39.64
Rate for Payer: Managed Health Services Medicare Advantage $39.64
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $39.64
Rate for Payer: Multiplan Commercial $80.00
Rate for Payer: NAPHCARE Commercial $59.46
Rate for Payer: Preferred Network Access Commercial $92.00
Rate for Payer: Quartz Beloit One Network $49.00
Rate for Payer: Quartz Commercial $65.00
Rate for Payer: Quartz Medicare Advantage $39.64
Rate for Payer: The Alliance Commercial $158.56
Rate for Payer: United Healthcare Medicare Advantage $39.64
Rate for Payer: United Healthcare PPO $75.00
Rate for Payer: WEA Trust Commercial $55.00
Rate for Payer: Wellcare Medicare $39.64
Rate for Payer: WPS Commercial $74.07
Service Code HCPCS C1787
Hospital Charge Code 5349490
Hospital Revenue Code 272
Min. Negotiated Rate $1,363.88
Max. Negotiated Rate $19,484.00
Rate for Payer: Aetna Commercial $4,383.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,189.06
Rate for Payer: Aetna Managed Medicare $1,363.88
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,166.15
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,435.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,338.08
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,581.63
Rate for Payer: Cash Price $1,461.30
Rate for Payer: Cigna Commercial $4,481.32
Rate for Payer: Dean Health DHI/DHP/ASO $2,725.81
Rate for Payer: Health EOS Commercial $4,335.19
Rate for Payer: HFN Commercial $4,481.32
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,653.25
Rate for Payer: Multiplan Commercial $3,896.80
Rate for Payer: NAPHCARE Commercial $2,922.60
Rate for Payer: Preferred Network Access Commercial $4,481.32
Rate for Payer: Quartz Beloit One Network $2,386.79
Rate for Payer: Quartz Commercial $3,166.15
Rate for Payer: Quartz Medicare Advantage $2,922.60
Rate for Payer: The Alliance Commercial $19,484.00
Rate for Payer: WEA Trust Commercial $2,679.05
Rate for Payer: WPS Commercial $3,607.95
Service Code HCPCS C1787
Hospital Charge Code 5349490
Hospital Revenue Code 272
Min. Negotiated Rate $2,386.79
Max. Negotiated Rate $4,481.32
Rate for Payer: Aetna Commercial $4,383.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,189.06
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,581.63
Rate for Payer: Cash Price $1,461.30
Rate for Payer: Cigna Commercial $4,481.32
Rate for Payer: Health EOS Commercial $4,335.19
Rate for Payer: HFN Commercial $4,481.32
Rate for Payer: Multiplan Commercial $3,896.80
Rate for Payer: NAPHCARE Commercial $2,922.60
Rate for Payer: Preferred Network Access Commercial $4,481.32
Rate for Payer: Quartz Beloit One Network $2,386.79
Rate for Payer: Quartz Commercial $2,922.60
Rate for Payer: WEA Trust Commercial $2,679.05
Rate for Payer: WPS Commercial $3,607.95
Hospital Charge Code 3052550
Hospital Revenue Code 230
Min. Negotiated Rate $398.86
Max. Negotiated Rate $748.88
Rate for Payer: Aetna Commercial $732.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $700.04
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $431.42
Rate for Payer: Cash Price $244.20
Rate for Payer: Cigna Commercial $748.88
Rate for Payer: Health EOS Commercial $724.46
Rate for Payer: HFN Commercial $748.88
Rate for Payer: Multiplan Commercial $651.20
Rate for Payer: NAPHCARE Commercial $488.40
Rate for Payer: Preferred Network Access Commercial $748.88
Rate for Payer: Quartz Beloit One Network $398.86
Rate for Payer: Quartz Commercial $488.40
Rate for Payer: WEA Trust Commercial $447.70
Rate for Payer: WPS Commercial $602.93