|
Herpes Simplex PCR Occular
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
6196142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$316.16 |
| Rate for Payer: Aetna Commercial |
$316.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$316.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$302.85
|
| Rate for Payer: HFN Commercial |
$316.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$316.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.43
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Herpes Simplex PCR Occular
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
6196142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
Herpes Simplex Type I IgG
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$159.74
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Herpes Simplex Type I IgG
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$173.06
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Herpes Simplex Type I IgG
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$252.93 |
| Rate for Payer: Aetna Commercial |
$252.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$252.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$242.28
|
| Rate for Payer: HFN Commercial |
$252.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$252.93
|
| Rate for Payer: Quartz Beloit One Network |
$117.15
|
| Rate for Payer: Quartz Commercial |
$151.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.41
|
| Rate for Payer: Anthem Medicare Advantage |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.12
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.12
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$30.19
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$20.12
|
| Rate for Payer: The Alliance Commercial |
$80.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.12
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$20.12
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$20.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.41
|
| Rate for Payer: Anthem Medicare Advantage |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.12
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.12
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$30.19
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$20.12
|
| Rate for Payer: The Alliance Commercial |
$80.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.12
|
| Rate for Payer: United Healthcare PPO |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: Wellcare Medicare |
$20.12
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
Herpes Simplex Type II IgG
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Aetna Commercial |
$137.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.12
|
| Rate for Payer: Anthem Medicare Advantage |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.12
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$137.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.12
|
| Rate for Payer: Health EOS Commercial |
$131.55
|
| Rate for Payer: HFN Commercial |
$137.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$30.19
|
| Rate for Payer: Preferred Network Access Commercial |
$137.33
|
| Rate for Payer: Quartz Beloit One Network |
$63.61
|
| Rate for Payer: Quartz Commercial |
$82.40
|
| Rate for Payer: Quartz Medicare Advantage |
$20.12
|
| Rate for Payer: The Alliance Commercial |
$79.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.12
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$88.55
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
Herpes Simplex Type II IgG
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$20.12
|
| Rate for Payer: Anthem Medicare Advantage |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.12
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.12
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$30.19
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: Quartz Medicare Advantage |
$20.12
|
| Rate for Payer: The Alliance Commercial |
$79.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.12
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$88.55
|
|
|
Herpes Simplex Virus Culture
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Herpes Simplex Virus Culture
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$35.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.46
|
| Rate for Payer: Anthem Medicare Advantage |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.21
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$52.82
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$35.21
|
| Rate for Payer: The Alliance Commercial |
$140.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.21
|
| Rate for Payer: United Healthcare PPO |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: Wellcare Medicare |
$35.21
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Herpes Simplex Virus Culture
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$35.21
|
| Rate for Payer: Anthem Medicare Advantage |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.21
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$52.82
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: Quartz Medicare Advantage |
$35.21
|
| Rate for Payer: The Alliance Commercial |
$139.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.21
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$154.94
|
|
|
Herpes Simplex Virus Culture w/ Typing
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$35.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.46
|
| Rate for Payer: Anthem Medicare Advantage |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.21
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$52.82
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$35.21
|
| Rate for Payer: The Alliance Commercial |
$140.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.21
|
| Rate for Payer: United Healthcare PPO |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: Wellcare Medicare |
$35.21
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Herpes Simplex Virus Culture w/ Typing
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Herpes Simplex Virus Culture w/ Typing
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$35.21
|
| Rate for Payer: Anthem Medicare Advantage |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.21
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$52.82
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: Quartz Medicare Advantage |
$35.21
|
| Rate for Payer: The Alliance Commercial |
$139.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.21
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$154.94
|
|
|
Herpes Simplex Virus Type 2 DNA
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
2942915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Herpes Simplex Virus Type 2 DNA
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
2942915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$268.74 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Herpes Simplex Virus Type 2 DNA
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
2942915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Herpes Simplex Virus Type I & II IgG
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
1039241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$252.93 |
| Rate for Payer: Aetna Commercial |
$252.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$252.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$242.28
|
| Rate for Payer: HFN Commercial |
$252.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$252.93
|
| Rate for Payer: Quartz Beloit One Network |
$117.15
|
| Rate for Payer: Quartz Commercial |
$151.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Herpes Simplex Virus Type I & II IgG
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
1039241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$173.06
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Herpes Simplex Virus Type I & II IgG
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
1039241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$159.74
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Herpesvirus 6 Antibodies (IgG, IgM)
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Herpesvirus 6 Antibodies (IgG, IgM)
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
