CPT 96417
The standard charge for Chemotherapy infusion-additional IV pushes of the same medication is $633.00. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.
To calculate an estimate of your cost, you will need two things:
LOCATION
1969 West Hart Road, Beloit, WI, 53511CONTACT
(608) 364-5011 Visit WebsiteBeloit Memorial Hospital is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.
In compliance with federal law, Beloit Memorial Hospital provides a list of standard charges. These are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient’s unique needs.
I understand that the list of standard charges includes only hospital services and does not contain professional fees for non-Beloit Memorial Hospital physicians or advanced practice providers. It does not contain professional fees for anesthesia, physicians or advanced practice providers.
I understand that a single line item charge may not represent a complete medical service. In general, multiple charge line items are necessary to represent all components of a service (e.g. procedures, supplies, and drugs).
I understand that the list of standard charges is not intended for media use.
I understand prices are the list price of all hospital charges and not necessarily what my insurance company will pay or what I will owe to the hospital. My actual bill may include one or more of list price charges.
The hospital typically accepts a rate that is less than the list charges. Your insurer will determine what you will owe after they have paid their agreed upon amount.
We know that the billing and payment processes may seem overwhelming at times. Please contact our team at 608-364-5011.
Choose a plan to view the insurance rate estimate.
Total estimated charges
$633.00Insurance Discount
-$40.51Price Negotiated by Insurer
$592.49Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$219.02Chemo IV Infusion 1 Hour
$1,138.18Dexamethasone JW Waste Charge
$1.87Diphenhydramine hcl inj <50 mg J1200
$3.74Draw Blood From Venous Device
$166.61Emend 1 mg Charge
$16.85Heparin Flush 100units/ml syringe 10ml [Med]
$7.49IMRT Treatment Complex (all other areas)
$5,343.62Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$363.17Ondansetron 2mg/ml [Med]
$5.62Paclitaxel Injection J9267
$11.23Paraplatin 50 mg Charge
$104.83Sodium Chloride 0.9% IV 500 ML J7040
$93.60This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$66.84Price Negotiated by Insurer
$566.16Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$209.29Chemo IV Infusion 1 Hour
$1,087.59Dexamethasone JW Waste Charge
$1.79Diphenhydramine hcl inj <50 mg J1200
$3.58Draw Blood From Venous Device
$159.20Emend 1 mg Charge
$16.10Heparin Flush 100units/ml syringe 10ml [Med]
$7.16IMRT Treatment Complex (all other areas)
$5,106.13Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$347.03Ondansetron 2mg/ml [Med]
$5.37Paclitaxel Injection J9267
$10.73Paraplatin 50 mg Charge
$100.17Sodium Chloride 0.9% IV 500 ML J7040
$89.44This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Dexamethasone JW Waste Charge
$0.58Diphenhydramine hcl inj <50 mg J1200
$1.16Draw Blood From Venous Device
$140.02Emend 1 mg Charge
$5.24Heparin Flush 100units/ml syringe 10ml [Med]
$2.33IMRT Treatment Complex (all other areas)
$1,662.46Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77Ondansetron 2mg/ml [Med]
$1.75Paclitaxel Injection J9267
$3.49Paraplatin 50 mg Charge
$32.61Sodium Chloride 0.9% IV 500 ML J7040
$29.12This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$205.09Price Negotiated by Insurer
$427.91Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$158.18Chemo IV Infusion 1 Hour
$822.02Dexamethasone JW Waste Charge
$1.35Diphenhydramine hcl inj <50 mg J1200
$2.70Draw Blood From Venous Device
$120.33Emend 1 mg Charge
$12.17Heparin Flush 100units/ml syringe 10ml [Med]
$5.41IMRT Treatment Complex (all other areas)
$2,269.18Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$262.29Ondansetron 2mg/ml [Med]
$4.06Paclitaxel Injection J9267
$8.11Paraplatin 50 mg Charge
$75.71Sodium Chloride 0.9% IV 500 ML J7040
$67.60This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$303.84Price Negotiated by Insurer
$329.16Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$121.68Chemo IV Infusion 1 Hour
$632.32Dexamethasone JW Waste Charge
$1.04Diphenhydramine hcl inj <50 mg J1200
$2.08Draw Blood From Venous Device
$92.56Emend 1 mg Charge
$9.36Heparin Flush 100units/ml syringe 10ml [Med]
$4.16IMRT Treatment Complex (all other areas)
$1,815.34Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$201.76Ondansetron 2mg/ml [Med]
$3.12Paclitaxel Injection J9267
$6.24Paraplatin 50 mg Charge
$58.24Sodium Chloride 0.9% IV 500 ML J7040
$52.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$317.01Price Negotiated by Insurer
$315.99Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$116.81Chemo IV Infusion 1 Hour
$607.03Dexamethasone JW Waste Charge
$1.00Diphenhydramine hcl inj <50 mg J1200
$2.00Draw Blood From Venous Device
$88.86Emend 1 mg Charge
$8.99Heparin Flush 100units/ml syringe 10ml [Med]
$3.99IMRT Treatment Complex (all other areas)
$1,724.57Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$193.69Ondansetron 2mg/ml [Med]
$3.00Paclitaxel Injection J9267
$5.99Paraplatin 50 mg Charge
$55.91Sodium Chloride 0.9% IV 500 ML J7040
$49.92This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$284.09Price Negotiated by Insurer
$348.91Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$128.98Chemo IV Infusion 1 Hour
$670.26Dexamethasone JW Waste Charge
$1.10Diphenhydramine hcl inj <50 mg J1200
$2.20Draw Blood From Venous Device
$98.11Emend 1 mg Charge
$9.92Heparin Flush 100units/ml syringe 10ml [Med]
$4.41IMRT Treatment Complex (all other areas)
$3,146.80Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$213.87Ondansetron 2mg/ml [Med]
$3.31Paclitaxel Injection J9267
$6.61Paraplatin 50 mg Charge
$61.73Sodium Chloride 0.9% IV 500 ML J7040
$55.12This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$443.10Price Negotiated by Insurer
$189.90Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$70.20Chemo IV Infusion 1 Hour
$364.80Dexamethasone JW Waste Charge
$0.60Diphenhydramine hcl inj <50 mg J1200
$1.20Draw Blood From Venous Device
$53.40Emend 1 mg Charge
$5.40Heparin Flush 100units/ml syringe 10ml [Med]
$2.40IMRT Treatment Complex (all other areas)
$1,712.70Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$116.40Ondansetron 2mg/ml [Med]
$1.80Paclitaxel Injection J9267
$3.60Paraplatin 50 mg Charge
$33.60Sodium Chloride 0.9% IV 500 ML J7040
$30.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$27.35Price Negotiated by Insurer
$605.65Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$223.89Chemo IV Infusion 1 Hour
$1,163.47Dexamethasone JW Waste Charge
$1.91Diphenhydramine hcl inj <50 mg J1200
$3.83Draw Blood From Venous Device
$170.31Emend 1 mg Charge
$17.22Heparin Flush 100units/ml syringe 10ml [Med]
$7.65IMRT Treatment Complex (all other areas)
$5,462.37Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$371.24Ondansetron 2mg/ml [Med]
$5.74Paclitaxel Injection J9267
$11.48Paraplatin 50 mg Charge
$107.16Sodium Chloride 0.9% IV 500 ML J7040
$95.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$264.59Price Negotiated by Insurer
$368.41Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$136.19Chemo IV Infusion 1 Hour
$707.71Dexamethasone JW Waste Charge
$0.16Diphenhydramine hcl inj <50 mg J1200
$1.13Emend 1 mg Charge
$0.18Heparin Flush 100units/ml syringe 10ml [Med]
$0.02IMRT Treatment Complex (all other areas)
$3,322.64Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$225.82Ondansetron 2mg/ml [Med]
$0.13Paclitaxel Injection J9267
$0.15Paraplatin 50 mg Charge
$5.12Sodium Chloride 0.9% IV 500 ML J7040
$1.79This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$47.10Price Negotiated by Insurer
$585.90Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$216.59Chemo IV Infusion 1 Hour
$1,125.53Dexamethasone JW Waste Charge
$1.85Diphenhydramine hcl inj <50 mg J1200
$3.70Draw Blood From Venous Device
$164.76Emend 1 mg Charge
$16.66Heparin Flush 100units/ml syringe 10ml [Med]
$7.40IMRT Treatment Complex (all other areas)
$5,284.25Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$359.13Ondansetron 2mg/ml [Med]
$5.55Paclitaxel Injection J9267
$11.11Paraplatin 50 mg Charge
$103.67Sodium Chloride 0.9% IV 500 ML J7040
$92.56This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$27.35Price Negotiated by Insurer
$605.65Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$223.89Chemo IV Infusion 1 Hour
$1,163.47Dexamethasone JW Waste Charge
$1.91Diphenhydramine hcl inj <50 mg J1200
$3.83Draw Blood From Venous Device
$170.31Emend 1 mg Charge
$17.22Heparin Flush 100units/ml syringe 10ml [Med]
$7.65IMRT Treatment Complex (all other areas)
$5,462.37Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$371.24Ondansetron 2mg/ml [Med]
$5.74Paclitaxel Injection J9267
$11.48Paraplatin 50 mg Charge
$107.16Sodium Chloride 0.9% IV 500 ML J7040
$95.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$351.12Price Negotiated by Insurer
$281.88Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$183.30Chemo IV Infusion 1 Hour
$1,293.11Dexamethasone JW Waste Charge
$1.56Diphenhydramine hcl inj <50 mg J1200
$3.12Draw Blood From Venous Device
$520.86Emend 1 mg Charge
$14.04Heparin Flush 100units/ml syringe 10ml [Med]
$6.24IMRT Treatment Complex (all other areas)
$4,453.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$281.88Ondansetron 2mg/ml [Med]
$4.68Paclitaxel Injection J9267
$9.36Paraplatin 50 mg Charge
$87.36Sodium Chloride 0.9% IV 500 ML J7040
$78.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$106.34Price Negotiated by Insurer
$526.66Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$194.69Chemo IV Infusion 1 Hour
$1,011.71Dexamethasone JW Waste Charge
$1.66Diphenhydramine hcl inj <50 mg J1200
$3.33Draw Blood From Venous Device
$148.10Emend 1 mg Charge
$14.98Heparin Flush 100units/ml syringe 10ml [Med]
$6.66IMRT Treatment Complex (all other areas)
$4,749.89Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$322.82Ondansetron 2mg/ml [Med]
$4.99Paclitaxel Injection J9267
$9.98Paraplatin 50 mg Charge
$93.18Sodium Chloride 0.9% IV 500 ML J7040
$83.20This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$519.34Price Negotiated by Insurer
$113.66Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$73.91Chemo IV Infusion 1 Hour
$521.41Dexamethasone JW Waste Charge
$1.25Diphenhydramine hcl inj <50 mg J1200
$2.50Draw Blood From Venous Device
$210.02Emend 1 mg Charge
$11.23Heparin Flush 100units/ml syringe 10ml [Med]
$4.99IMRT Treatment Complex (all other areas)
$3,562.42Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$113.66Ondansetron 2mg/ml [Med]
$3.74Paclitaxel Injection J9267
$7.49Paraplatin 50 mg Charge
$69.89Sodium Chloride 0.9% IV 500 ML J7040
$62.40This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$27.35Price Negotiated by Insurer
$605.65Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$223.89Chemo IV Infusion 1 Hour
$1,163.47Dexamethasone JW Waste Charge
$1.91Diphenhydramine hcl inj <50 mg J1200
$3.83Draw Blood From Venous Device
$170.31Emend 1 mg Charge
$17.22Heparin Flush 100units/ml syringe 10ml [Med]
$7.65IMRT Treatment Complex (all other areas)
$5,462.37Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$371.24Ondansetron 2mg/ml [Med]
$5.74Paclitaxel Injection J9267
$11.48Paraplatin 50 mg Charge
$107.16Sodium Chloride 0.9% IV 500 ML J7040
$95.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$310.42Price Negotiated by Insurer
$322.58Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$119.25Chemo IV Infusion 1 Hour
$619.67Dexamethasone JW Waste Charge
$1.02Diphenhydramine hcl inj <50 mg J1200
$2.04Draw Blood From Venous Device
$90.71Emend 1 mg Charge
$9.17Heparin Flush 100units/ml syringe 10ml [Med]
$4.08IMRT Treatment Complex (all other areas)
$2,909.31Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$197.72Ondansetron 2mg/ml [Med]
$3.06Paclitaxel Injection J9267
$6.12Paraplatin 50 mg Charge
$57.08Sodium Chloride 0.9% IV 500 ML J7040
$50.96This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$205.09Price Negotiated by Insurer
$427.91Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$158.18Chemo IV Infusion 1 Hour
$822.02Dexamethasone JW Waste Charge
$1.35Diphenhydramine hcl inj <50 mg J1200
$2.70Draw Blood From Venous Device
$120.33Emend 1 mg Charge
$12.17Heparin Flush 100units/ml syringe 10ml [Med]
$5.41IMRT Treatment Complex (all other areas)
$3,859.28Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$262.29Ondansetron 2mg/ml [Med]
$4.06Paclitaxel Injection J9267
$8.11Paraplatin 50 mg Charge
$75.71Sodium Chloride 0.9% IV 500 ML J7040
$67.60This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Dexamethasone JW Waste Charge
$1.25Diphenhydramine hcl inj <50 mg J1200
$2.50Draw Blood From Venous Device
$140.02Emend 1 mg Charge
$11.23Heparin Flush 100units/ml syringe 10ml [Med]
$4.99IMRT Treatment Complex (all other areas)
$3,562.42Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77Ondansetron 2mg/ml [Med]
$3.74Paclitaxel Injection J9267
$7.49Paraplatin 50 mg Charge
$69.89Sodium Chloride 0.9% IV 500 ML J7040
$62.40This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$329.90Price Negotiated by Insurer
$303.10Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$197.10Chemo IV Infusion 1 Hour
$1,390.44Dexamethasone JW Waste Charge
$1.04Diphenhydramine hcl inj <50 mg J1200
$2.95Draw Blood From Venous Device
$560.06Emend 1 mg Charge
$0.46Heparin Flush 100units/ml syringe 10ml [Med]
$0.08IMRT Treatment Complex (all other areas)
$2,968.68Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$303.10Ondansetron 2mg/ml [Med]
$0.37Paclitaxel Injection J9267
$0.42Paraplatin 50 mg Charge
$12.19Sodium Chloride 0.9% IV 500 ML J7040
$5.37This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$270.92Price Negotiated by Insurer
$362.08Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$133.85Chemo IV Infusion 1 Hour
$695.55Dexamethasone JW Waste Charge
$1.14Diphenhydramine hcl inj <50 mg J1200
$2.29Draw Blood From Venous Device
$101.82Emend 1 mg Charge
$10.30Heparin Flush 100units/ml syringe 10ml [Med]
$4.58IMRT Treatment Complex (all other areas)
$3,265.55Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$221.94Ondansetron 2mg/ml [Med]
$3.43Paclitaxel Injection J9267
$6.86Paraplatin 50 mg Charge
$64.06Sodium Chloride 0.9% IV 500 ML J7040
$57.20This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$557.23Price Negotiated by Insurer
$75.77Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$49.28Chemo IV Infusion 1 Hour
$347.61Draw Blood From Venous Device
$140.02Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$75.77This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$633.00Insurance Discount
-$145.40Price Negotiated by Insurer
$487.60Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Additional Push of Medication - 96375
$180.25Chemo IV Infusion 1 Hour
$936.68Dexamethasone JW Waste Charge
$0.30Diphenhydramine hcl inj <50 mg J1200
$3.08Draw Blood From Venous Device
$137.11Emend 1 mg Charge
$0.34Heparin Flush 100units/ml syringe 10ml [Med]
$0.04IMRT Treatment Complex (all other areas)
$4,397.64Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
$298.88Ondansetron 2mg/ml [Med]
$0.25Paclitaxel Injection J9267
$0.28Paraplatin 50 mg Charge
$9.68Sodium Chloride 0.9% IV 500 ML J7040
$3.39This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.