|
Herpes Simplex PCR Occular
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
6196142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.00
|
| Rate for Payer: Health EOS Commercial |
$291.20
|
| Rate for Payer: HFN Commercial |
$304.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Preferred Network Access Commercial |
$304.00
|
| Rate for Payer: Quartz Beloit One Network |
$140.80
|
| Rate for Payer: Quartz Commercial |
$182.40
|
| Rate for Payer: The Alliance Commercial |
$160.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Herpes Simplex PCR Occular
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
6196142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.07
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$208.00
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Herpes Simplex Type I IgG
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$13.63
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Dean Health Medicaid |
$13.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.63
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$13.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$13.63
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Herpes Simplex Type I IgG
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.60
|
| Rate for Payer: Health EOS Commercial |
$232.96
|
| Rate for Payer: HFN Commercial |
$243.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$243.20
|
| Rate for Payer: Quartz Beloit One Network |
$112.64
|
| Rate for Payer: Quartz Commercial |
$145.92
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Herpes Simplex Type I IgG
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
983197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.92
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$130.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Herpes Simplex Type II IgG
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2942914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Herpes Simplex Type II IgG
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Herpes Simplex Type II IgG
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
983198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: HFN Commercial |
$190.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Herpes Simplex Virus Culture
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.53 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.53
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Herpes Simplex Virus Culture
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$33.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$34.99
|
| Rate for Payer: Anthem Medicare Advantage |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.86
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Dean Health Medicaid |
$34.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.86
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.86
|
| Rate for Payer: Managed Health Services Medicaid |
$36.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$50.79
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34.99
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.86
|
| Rate for Payer: The Alliance Commercial |
$135.44
|
| Rate for Payer: United Healthcare Medicaid |
$34.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.86
|
| Rate for Payer: United Healthcare PPO |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: Wellcare Medicare |
$33.86
|
| Rate for Payer: WMAP Medicaid |
$34.99
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Herpes Simplex Virus Culture
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1039224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
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 |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
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 |
$33.86 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$33.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$34.99
|
| Rate for Payer: Anthem Medicare Advantage |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.86
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Dean Health Medicaid |
$34.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.86
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.86
|
| Rate for Payer: Managed Health Services Medicaid |
$36.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$50.79
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34.99
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.86
|
| Rate for Payer: The Alliance Commercial |
$135.44
|
| Rate for Payer: United Healthcare Medicaid |
$34.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.86
|
| Rate for Payer: United Healthcare PPO |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: Wellcare Medicare |
$33.86
|
| Rate for Payer: WMAP Medicaid |
$34.99
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
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 |
$119.53 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.53
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
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 |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
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 |
$119.68 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.20
|
| Rate for Payer: Health EOS Commercial |
$247.52
|
| Rate for Payer: HFN Commercial |
$258.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.40
|
| Rate for Payer: Quartz Beloit One Network |
$119.68
|
| Rate for Payer: Quartz Commercial |
$155.04
|
| Rate for Payer: The Alliance Commercial |
$136.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
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 |
$35.09 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
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 |
$13.19 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$13.63
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Dean Health Medicaid |
$13.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.63
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$13.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$13.63
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
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 |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
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 |
$46.56 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.60
|
| Rate for Payer: Health EOS Commercial |
$232.96
|
| Rate for Payer: HFN Commercial |
$243.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$243.20
|
| Rate for Payer: Quartz Beloit One Network |
$112.64
|
| Rate for Payer: Quartz Commercial |
$145.92
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Herpesvirus 6 Antibodies (IgG, IgM)
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.80
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Herpesvirus 6 Antibodies (IgG, IgM)
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
