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Charge Type Setting Price  
Hospital Charge Code 3052550
Hospital Revenue Code 230
Min. Negotiated Rate $227.92
Max. Negotiated Rate $3,256.00
Rate for Payer: Aetna Commercial $732.60
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $700.04
Rate for Payer: Aetna Managed Medicare $227.92
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $529.10
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $407.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $390.72
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: Dean Health DHI/DHP/ASO $455.51
Rate for Payer: Health EOS Commercial $724.46
Rate for Payer: HFN Commercial $748.88
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $610.50
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 $529.10
Rate for Payer: Quartz Medicare Advantage $488.40
Rate for Payer: The Alliance Commercial $3,256.00
Rate for Payer: WEA Trust Commercial $447.70
Rate for Payer: WPS Commercial $602.93
Service Code CPT 66982
Hospital Revenue Code 360
Min. Negotiated Rate $2,303.35
Max. Negotiated Rate $11,874.87
Rate for Payer: Aetna Managed Medicare $2,303.35
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 $2,303.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $2,303.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $2,303.35
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $2,303.35
Rate for Payer: Dean Health DHI/DHP/ASO $11,874.87
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $2,303.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,568.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,303.35
Rate for Payer: Independent Care Health Plan Medicare $2,303.35
Rate for Payer: Managed Health Services Medicare Advantage $2,303.35
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $2,303.35
Rate for Payer: NAPHCARE Commercial $3,455.02
Rate for Payer: Quartz Medicare Advantage $2,303.35
Rate for Payer: The Alliance Commercial $9,213.40
Rate for Payer: United Healthcare Medicare Advantage $2,303.35
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $2,303.35
Service Code CPT 66991
Hospital Revenue Code 360
Min. Negotiated Rate $5,165.94
Max. Negotiated Rate $20,663.76
Rate for Payer: Aetna Managed Medicare $5,165.94
Rate for Payer: Anthem Medicare Advantage $5,165.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $5,165.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $5,165.94
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $5,165.94
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $5,165.94
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $19,217.30
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $5,165.94
Rate for Payer: Independent Care Health Plan Medicare $5,165.94
Rate for Payer: Managed Health Services Medicare Advantage $5,165.94
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $5,165.94
Rate for Payer: NAPHCARE Commercial $7,748.91
Rate for Payer: Quartz Medicare Advantage $5,165.94
Rate for Payer: The Alliance Commercial $20,663.76
Rate for Payer: United Healthcare Medicare Advantage $5,165.94
Rate for Payer: Wellcare Medicare $5,165.94
Service Code CPT 66984
Hospital Revenue Code 360
Min. Negotiated Rate $2,303.35
Max. Negotiated Rate $11,874.87
Rate for Payer: Aetna Managed Medicare $2,303.35
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 $2,303.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $2,303.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $2,303.35
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $2,303.35
Rate for Payer: Dean Health DHI/DHP/ASO $11,874.87
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $2,303.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $8,568.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,303.35
Rate for Payer: Independent Care Health Plan Medicare $2,303.35
Rate for Payer: Managed Health Services Medicare Advantage $2,303.35
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $2,303.35
Rate for Payer: NAPHCARE Commercial $3,455.02
Rate for Payer: Quartz Medicare Advantage $2,303.35
Rate for Payer: The Alliance Commercial $9,213.40
Rate for Payer: United Healthcare Medicare Advantage $2,303.35
Rate for Payer: United Healthcare PPO $3,583.00
Rate for Payer: Wellcare Medicare $2,303.35
Hospital Charge Code 2950489
Hospital Revenue Code 360
Min. Negotiated Rate $19,600.98
Max. Negotiated Rate $36,801.84
Rate for Payer: Aetna Commercial $36,001.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $34,401.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21,201.06
Rate for Payer: Cash Price $12,000.60
Rate for Payer: Cigna Commercial $36,801.84
Rate for Payer: Health EOS Commercial $35,601.78
Rate for Payer: HFN Commercial $36,801.84
Rate for Payer: Multiplan Commercial $32,001.60
Rate for Payer: NAPHCARE Commercial $24,001.20
Rate for Payer: Preferred Network Access Commercial $36,801.84
Rate for Payer: Quartz Beloit One Network $19,600.98
Rate for Payer: Quartz Commercial $24,001.20
Rate for Payer: WEA Trust Commercial $22,001.10
Rate for Payer: WPS Commercial $29,629.48
Hospital Charge Code 2950489
Hospital Revenue Code 360
Min. Negotiated Rate $11,200.56
Max. Negotiated Rate $160,008.00
Rate for Payer: Aetna Commercial $36,001.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $34,401.72
Rate for Payer: Aetna Managed Medicare $11,200.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $26,001.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $20,001.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $19,200.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $21,201.06
Rate for Payer: Cash Price $12,000.60
Rate for Payer: Cigna Commercial $36,801.84
Rate for Payer: Dean Health DHI/DHP/ASO $22,385.12
Rate for Payer: Health EOS Commercial $35,601.78
Rate for Payer: HFN Commercial $36,801.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $30,001.50
Rate for Payer: Multiplan Commercial $32,001.60
Rate for Payer: NAPHCARE Commercial $24,001.20
Rate for Payer: Preferred Network Access Commercial $36,801.84
Rate for Payer: Quartz Beloit One Network $19,600.98
Rate for Payer: Quartz Commercial $26,001.30
Rate for Payer: Quartz Medicare Advantage $24,001.20
Rate for Payer: The Alliance Commercial $160,008.00
Rate for Payer: WEA Trust Commercial $22,001.10
Rate for Payer: WPS Commercial $29,629.48
Service Code MSDRG 038
Min. Negotiated Rate $15,415.57
Max. Negotiated Rate $42,855.00
Rate for Payer: Aetna Managed Medicare $15,415.57
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $33,568.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $25,729.60
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $24,444.80
Rate for Payer: Anthem Medicare Advantage $15,415.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $15,415.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $15,415.57
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $15,415.57
Rate for Payer: Dean Health DHI/DHP/ASO $27,135.97
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $15,415.57
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $31,198.05
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $15,415.57
Rate for Payer: Independent Care Health Plan Medicare $15,415.57
Rate for Payer: Managed Health Services Medicare Advantage $15,415.57
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $15,415.57
Rate for Payer: NAPHCARE Commercial $23,123.36
Rate for Payer: Quartz Medicare Advantage $15,415.57
Rate for Payer: The Alliance Commercial $42,855.00
Rate for Payer: United Healthcare Medicare Advantage $15,415.57
Rate for Payer: United Healthcare PPO $24,288.08
Rate for Payer: Wellcare Medicare $15,415.57
Service Code MSDRG 037
Min. Negotiated Rate $32,397.12
Max. Negotiated Rate $90,064.00
Rate for Payer: Aetna Managed Medicare $32,397.12
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $70,912.40
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $54,353.78
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $51,639.64
Rate for Payer: Anthem Medicare Advantage $32,397.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $32,397.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $32,397.12
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $32,397.12
Rate for Payer: Dean Health DHI/DHP/ASO $57,324.73
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $32,397.12
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $65,824.20
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $32,397.12
Rate for Payer: Independent Care Health Plan Medicare $32,397.12
Rate for Payer: Managed Health Services Medicare Advantage $32,397.12
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $32,397.12
Rate for Payer: NAPHCARE Commercial $48,595.68
Rate for Payer: Quartz Medicare Advantage $32,397.12
Rate for Payer: The Alliance Commercial $90,064.00
Rate for Payer: United Healthcare Medicare Advantage $32,397.12
Rate for Payer: United Healthcare PPO $51,244.98
Rate for Payer: Wellcare Medicare $32,397.12
Service Code MSDRG 039
Min. Negotiated Rate $11,026.99
Max. Negotiated Rate $30,655.00
Rate for Payer: Aetna Managed Medicare $11,026.99
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $23,917.20
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $18,332.34
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $17,416.92
Rate for Payer: Anthem Medicare Advantage $11,026.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $11,026.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $11,026.99
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $11,026.99
Rate for Payer: Dean Health DHI/DHP/ASO $19,334.38
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $11,026.99
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $22,249.50
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $11,026.99
Rate for Payer: Independent Care Health Plan Medicare $11,026.99
Rate for Payer: Managed Health Services Medicare Advantage $11,026.99
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $11,026.99
Rate for Payer: NAPHCARE Commercial $16,540.48
Rate for Payer: Quartz Medicare Advantage $11,026.99
Rate for Payer: The Alliance Commercial $30,655.00
Rate for Payer: United Healthcare Medicare Advantage $11,026.99
Rate for Payer: United Healthcare PPO $17,321.52
Rate for Payer: Wellcare Medicare $11,026.99
Hospital Charge Code 2965857
Hospital Revenue Code 272
Min. Negotiated Rate $1,181.88
Max. Negotiated Rate $2,219.04
Rate for Payer: Aetna Commercial $2,170.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,074.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,278.36
Rate for Payer: Cash Price $723.60
Rate for Payer: Cigna Commercial $2,219.04
Rate for Payer: Health EOS Commercial $2,146.68
Rate for Payer: HFN Commercial $2,219.04
Rate for Payer: Multiplan Commercial $1,929.60
Rate for Payer: NAPHCARE Commercial $1,447.20
Rate for Payer: Preferred Network Access Commercial $2,219.04
Rate for Payer: Quartz Beloit One Network $1,181.88
Rate for Payer: Quartz Commercial $1,447.20
Rate for Payer: WEA Trust Commercial $1,326.60
Rate for Payer: WPS Commercial $1,786.57
Hospital Charge Code 2965857
Hospital Revenue Code 272
Min. Negotiated Rate $675.36
Max. Negotiated Rate $9,648.00
Rate for Payer: Aetna Commercial $2,170.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,074.32
Rate for Payer: Aetna Managed Medicare $675.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,567.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,206.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,157.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,278.36
Rate for Payer: Cash Price $723.60
Rate for Payer: Cigna Commercial $2,219.04
Rate for Payer: Dean Health DHI/DHP/ASO $1,349.76
Rate for Payer: Health EOS Commercial $2,146.68
Rate for Payer: HFN Commercial $2,219.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,809.00
Rate for Payer: Multiplan Commercial $1,929.60
Rate for Payer: NAPHCARE Commercial $1,447.20
Rate for Payer: Preferred Network Access Commercial $2,219.04
Rate for Payer: Quartz Beloit One Network $1,181.88
Rate for Payer: Quartz Commercial $1,567.80
Rate for Payer: Quartz Medicare Advantage $1,447.20
Rate for Payer: The Alliance Commercial $9,648.00
Rate for Payer: WEA Trust Commercial $1,326.60
Rate for Payer: WPS Commercial $1,786.57
Hospital Charge Code 2965858
Hospital Revenue Code 272
Min. Negotiated Rate $675.36
Max. Negotiated Rate $9,648.00
Rate for Payer: Aetna Commercial $2,170.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,074.32
Rate for Payer: Aetna Managed Medicare $675.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,567.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,206.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,157.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,278.36
Rate for Payer: Cash Price $723.60
Rate for Payer: Cigna Commercial $2,219.04
Rate for Payer: Dean Health DHI/DHP/ASO $1,349.76
Rate for Payer: Health EOS Commercial $2,146.68
Rate for Payer: HFN Commercial $2,219.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,809.00
Rate for Payer: Multiplan Commercial $1,929.60
Rate for Payer: NAPHCARE Commercial $1,447.20
Rate for Payer: Preferred Network Access Commercial $2,219.04
Rate for Payer: Quartz Beloit One Network $1,181.88
Rate for Payer: Quartz Commercial $1,567.80
Rate for Payer: Quartz Medicare Advantage $1,447.20
Rate for Payer: The Alliance Commercial $9,648.00
Rate for Payer: WEA Trust Commercial $1,326.60
Rate for Payer: WPS Commercial $1,786.57
Hospital Charge Code 2965858
Hospital Revenue Code 272
Min. Negotiated Rate $1,181.88
Max. Negotiated Rate $2,219.04
Rate for Payer: Aetna Commercial $2,170.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,074.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,278.36
Rate for Payer: Cash Price $723.60
Rate for Payer: Cigna Commercial $2,219.04
Rate for Payer: Health EOS Commercial $2,146.68
Rate for Payer: HFN Commercial $2,219.04
Rate for Payer: Multiplan Commercial $1,929.60
Rate for Payer: NAPHCARE Commercial $1,447.20
Rate for Payer: Preferred Network Access Commercial $2,219.04
Rate for Payer: Quartz Beloit One Network $1,181.88
Rate for Payer: Quartz Commercial $1,447.20
Rate for Payer: WEA Trust Commercial $1,326.60
Rate for Payer: WPS Commercial $1,786.57
Hospital Charge Code 2965859
Hospital Revenue Code 272
Min. Negotiated Rate $593.88
Max. Negotiated Rate $1,115.04
Rate for Payer: Aetna Commercial $1,090.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,042.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $642.36
Rate for Payer: Cash Price $363.60
Rate for Payer: Cigna Commercial $1,115.04
Rate for Payer: Health EOS Commercial $1,078.68
Rate for Payer: HFN Commercial $1,115.04
Rate for Payer: Multiplan Commercial $969.60
Rate for Payer: NAPHCARE Commercial $727.20
Rate for Payer: Preferred Network Access Commercial $1,115.04
Rate for Payer: Quartz Beloit One Network $593.88
Rate for Payer: Quartz Commercial $727.20
Rate for Payer: WEA Trust Commercial $666.60
Rate for Payer: WPS Commercial $897.73
Hospital Charge Code 2965859
Hospital Revenue Code 272
Min. Negotiated Rate $339.36
Max. Negotiated Rate $4,848.00
Rate for Payer: Aetna Commercial $1,090.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,042.32
Rate for Payer: Aetna Managed Medicare $339.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $787.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $606.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $581.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $642.36
Rate for Payer: Cash Price $363.60
Rate for Payer: Cigna Commercial $1,115.04
Rate for Payer: Dean Health DHI/DHP/ASO $678.24
Rate for Payer: Health EOS Commercial $1,078.68
Rate for Payer: HFN Commercial $1,115.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $909.00
Rate for Payer: Multiplan Commercial $969.60
Rate for Payer: NAPHCARE Commercial $727.20
Rate for Payer: Preferred Network Access Commercial $1,115.04
Rate for Payer: Quartz Beloit One Network $593.88
Rate for Payer: Quartz Commercial $787.80
Rate for Payer: Quartz Medicare Advantage $727.20
Rate for Payer: The Alliance Commercial $4,848.00
Rate for Payer: WEA Trust Commercial $666.60
Rate for Payer: WPS Commercial $897.73
Hospital Charge Code 2965860
Hospital Revenue Code 272
Min. Negotiated Rate $845.74
Max. Negotiated Rate $1,587.92
Rate for Payer: Aetna Commercial $1,553.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,484.36
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $914.78
Rate for Payer: Cash Price $517.80
Rate for Payer: Cigna Commercial $1,587.92
Rate for Payer: Health EOS Commercial $1,536.14
Rate for Payer: HFN Commercial $1,587.92
Rate for Payer: Multiplan Commercial $1,380.80
Rate for Payer: NAPHCARE Commercial $1,035.60
Rate for Payer: Preferred Network Access Commercial $1,587.92
Rate for Payer: Quartz Beloit One Network $845.74
Rate for Payer: Quartz Commercial $1,035.60
Rate for Payer: WEA Trust Commercial $949.30
Rate for Payer: WPS Commercial $1,278.45
Hospital Charge Code 2965860
Hospital Revenue Code 272
Min. Negotiated Rate $483.28
Max. Negotiated Rate $6,904.00
Rate for Payer: Aetna Commercial $1,553.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,484.36
Rate for Payer: Aetna Managed Medicare $483.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,121.90
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $863.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $828.48
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $914.78
Rate for Payer: Cash Price $517.80
Rate for Payer: Cigna Commercial $1,587.92
Rate for Payer: Dean Health DHI/DHP/ASO $965.87
Rate for Payer: Health EOS Commercial $1,536.14
Rate for Payer: HFN Commercial $1,587.92
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,294.50
Rate for Payer: Multiplan Commercial $1,380.80
Rate for Payer: NAPHCARE Commercial $1,035.60
Rate for Payer: Preferred Network Access Commercial $1,587.92
Rate for Payer: Quartz Beloit One Network $845.74
Rate for Payer: Quartz Commercial $1,121.90
Rate for Payer: Quartz Medicare Advantage $1,035.60
Rate for Payer: The Alliance Commercial $6,904.00
Rate for Payer: WEA Trust Commercial $949.30
Rate for Payer: WPS Commercial $1,278.45
Hospital Charge Code 2965861
Hospital Revenue Code 272
Min. Negotiated Rate $793.24
Max. Negotiated Rate $11,332.00
Rate for Payer: Aetna Commercial $2,549.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,436.38
Rate for Payer: Aetna Managed Medicare $793.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,841.45
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,416.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,359.84
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,501.49
Rate for Payer: Cash Price $849.90
Rate for Payer: Cigna Commercial $2,606.36
Rate for Payer: Dean Health DHI/DHP/ASO $1,585.35
Rate for Payer: Health EOS Commercial $2,521.37
Rate for Payer: HFN Commercial $2,606.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,124.75
Rate for Payer: Multiplan Commercial $2,266.40
Rate for Payer: NAPHCARE Commercial $1,699.80
Rate for Payer: Preferred Network Access Commercial $2,606.36
Rate for Payer: Quartz Beloit One Network $1,388.17
Rate for Payer: Quartz Commercial $1,841.45
Rate for Payer: Quartz Medicare Advantage $1,699.80
Rate for Payer: The Alliance Commercial $11,332.00
Rate for Payer: WEA Trust Commercial $1,558.15
Rate for Payer: WPS Commercial $2,098.40
Hospital Charge Code 2965861
Hospital Revenue Code 272
Min. Negotiated Rate $1,388.17
Max. Negotiated Rate $2,606.36
Rate for Payer: Aetna Commercial $2,549.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,436.38
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,501.49
Rate for Payer: Cash Price $849.90
Rate for Payer: Cigna Commercial $2,606.36
Rate for Payer: Health EOS Commercial $2,521.37
Rate for Payer: HFN Commercial $2,606.36
Rate for Payer: Multiplan Commercial $2,266.40
Rate for Payer: NAPHCARE Commercial $1,699.80
Rate for Payer: Preferred Network Access Commercial $2,606.36
Rate for Payer: Quartz Beloit One Network $1,388.17
Rate for Payer: Quartz Commercial $1,699.80
Rate for Payer: WEA Trust Commercial $1,558.15
Rate for Payer: WPS Commercial $2,098.40
Hospital Charge Code 2965862
Hospital Revenue Code 272
Min. Negotiated Rate $1,406.30
Max. Negotiated Rate $2,640.40
Rate for Payer: Aetna Commercial $2,583.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,468.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,521.10
Rate for Payer: Cash Price $861.00
Rate for Payer: Cigna Commercial $2,640.40
Rate for Payer: Health EOS Commercial $2,554.30
Rate for Payer: HFN Commercial $2,640.40
Rate for Payer: Multiplan Commercial $2,296.00
Rate for Payer: NAPHCARE Commercial $1,722.00
Rate for Payer: Preferred Network Access Commercial $2,640.40
Rate for Payer: Quartz Beloit One Network $1,406.30
Rate for Payer: Quartz Commercial $1,722.00
Rate for Payer: WEA Trust Commercial $1,578.50
Rate for Payer: WPS Commercial $2,125.81
Hospital Charge Code 2965862
Hospital Revenue Code 272
Min. Negotiated Rate $803.60
Max. Negotiated Rate $11,480.00
Rate for Payer: Aetna Commercial $2,583.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,468.20
Rate for Payer: Aetna Managed Medicare $803.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,865.50
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,435.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,377.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,521.10
Rate for Payer: Cash Price $861.00
Rate for Payer: Cigna Commercial $2,640.40
Rate for Payer: Dean Health DHI/DHP/ASO $1,606.05
Rate for Payer: Health EOS Commercial $2,554.30
Rate for Payer: HFN Commercial $2,640.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,152.50
Rate for Payer: Multiplan Commercial $2,296.00
Rate for Payer: NAPHCARE Commercial $1,722.00
Rate for Payer: Preferred Network Access Commercial $2,640.40
Rate for Payer: Quartz Beloit One Network $1,406.30
Rate for Payer: Quartz Commercial $1,865.50
Rate for Payer: Quartz Medicare Advantage $1,722.00
Rate for Payer: The Alliance Commercial $11,480.00
Rate for Payer: WEA Trust Commercial $1,578.50
Rate for Payer: WPS Commercial $2,125.81
Hospital Charge Code 2965863
Hospital Revenue Code 272
Min. Negotiated Rate $826.56
Max. Negotiated Rate $11,808.00
Rate for Payer: Aetna Commercial $2,656.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,538.72
Rate for Payer: Aetna Managed Medicare $826.56
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,918.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,476.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,416.96
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,564.56
Rate for Payer: Cash Price $885.60
Rate for Payer: Cigna Commercial $2,715.84
Rate for Payer: Dean Health DHI/DHP/ASO $1,651.94
Rate for Payer: Health EOS Commercial $2,627.28
Rate for Payer: HFN Commercial $2,715.84
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,214.00
Rate for Payer: Multiplan Commercial $2,361.60
Rate for Payer: NAPHCARE Commercial $1,771.20
Rate for Payer: Preferred Network Access Commercial $2,715.84
Rate for Payer: Quartz Beloit One Network $1,446.48
Rate for Payer: Quartz Commercial $1,918.80
Rate for Payer: Quartz Medicare Advantage $1,771.20
Rate for Payer: The Alliance Commercial $11,808.00
Rate for Payer: WEA Trust Commercial $1,623.60
Rate for Payer: WPS Commercial $2,186.55
Hospital Charge Code 2965863
Hospital Revenue Code 272
Min. Negotiated Rate $1,446.48
Max. Negotiated Rate $2,715.84
Rate for Payer: Aetna Commercial $2,656.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,538.72
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,564.56
Rate for Payer: Cash Price $885.60
Rate for Payer: Cigna Commercial $2,715.84
Rate for Payer: Health EOS Commercial $2,627.28
Rate for Payer: HFN Commercial $2,715.84
Rate for Payer: Multiplan Commercial $2,361.60
Rate for Payer: NAPHCARE Commercial $1,771.20
Rate for Payer: Preferred Network Access Commercial $2,715.84
Rate for Payer: Quartz Beloit One Network $1,446.48
Rate for Payer: Quartz Commercial $1,771.20
Rate for Payer: WEA Trust Commercial $1,623.60
Rate for Payer: WPS Commercial $2,186.55
Service Code MSDRG 115
Min. Negotiated Rate $15,076.07
Max. Negotiated Rate $41,911.00
Rate for Payer: Aetna Managed Medicare $15,076.07
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $32,728.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $25,086.36
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $23,833.68
Rate for Payer: Anthem Medicare Advantage $15,076.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $15,076.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $15,076.07
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $15,076.07
Rate for Payer: Dean Health DHI/DHP/ASO $26,457.57
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $15,076.07
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $30,505.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $15,076.07
Rate for Payer: Independent Care Health Plan Medicare $15,076.07
Rate for Payer: Managed Health Services Medicare Advantage $15,076.07
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $15,076.07
Rate for Payer: NAPHCARE Commercial $22,614.10
Rate for Payer: Quartz Medicare Advantage $15,076.07
Rate for Payer: The Alliance Commercial $41,911.00
Rate for Payer: United Healthcare Medicare Advantage $15,076.07
Rate for Payer: United Healthcare PPO $23,749.16
Rate for Payer: Wellcare Medicare $15,076.07
Service Code MSDRG 790
Min. Negotiated Rate $3,194.00
Max. Negotiated Rate $159,839.00
Rate for Payer: Aetna Managed Medicare $57,496.00
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $4,079.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $3,446.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,273.00
Rate for Payer: Anthem Medicare Advantage $57,496.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $57,496.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $57,496.00
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $57,496.00
Rate for Payer: Dean Health DHI/DHP/ASO $101,759.88
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $57,496.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $117,002.00
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $57,496.00
Rate for Payer: Independent Care Health Plan Medicare $57,496.00
Rate for Payer: Managed Health Services Medicare Advantage $57,496.00
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $57,496.00
Rate for Payer: NAPHCARE Commercial $86,244.00
Rate for Payer: Quartz Medicare Advantage $57,496.00
Rate for Payer: The Alliance Commercial $159,839.00
Rate for Payer: United Healthcare Medicare Advantage $57,496.00
Rate for Payer: United Healthcare PPO $3,194.00
Rate for Payer: Wellcare Medicare $57,496.00