|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$221.31 |
| Rate for Payer: Aetna Commercial |
$221.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$221.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$211.99
|
| Rate for Payer: HFN Commercial |
$221.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$221.31
|
| Rate for Payer: Quartz Beloit One Network |
$102.50
|
| Rate for Payer: Quartz Commercial |
$132.79
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: The Alliance Commercial |
$63.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$70.88
|
|
|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$139.78
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$151.42
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: The Alliance Commercial |
$64.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare PPO |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
Lyme Disease Antibody IgM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: The Alliance Commercial |
$64.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Lyme Disease Antibody IgM
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: The Alliance Commercial |
$63.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$70.88
|
|
|
Lyme Disease Antibody IgM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$141.96
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$179.82 |
| Rate for Payer: Aetna Commercial |
$179.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$179.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$172.24
|
| Rate for Payer: HFN Commercial |
$179.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$179.82
|
| Rate for Payer: Quartz Beloit One Network |
$83.28
|
| Rate for Payer: Quartz Commercial |
$107.89
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$593.79 |
| Rate for Payer: Aetna Commercial |
$593.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$593.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$568.79
|
| Rate for Payer: HFN Commercial |
$593.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$593.79
|
| Rate for Payer: Quartz Beloit One Network |
$275.02
|
| Rate for Payer: Quartz Commercial |
$356.27
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$288.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$321.24
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$306.27 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Quartz Beloit One Network |
$306.27
|
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.27
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$556.29
|
| Rate for Payer: HFN Commercial |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: Preferred Network Access Commercial |
$575.04
|
| Rate for Payer: Quartz Commercial |
$375.02
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$462.95
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.19
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$575.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$556.29
|
| Rate for Payer: HFN Commercial |
$575.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$575.04
|
| Rate for Payer: Quartz Beloit One Network |
$306.27
|
| Rate for Payer: Quartz Commercial |
$406.28
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$292.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: United Healthcare PPO |
$468.78
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: Wellcare Medicare |
$73.01
|
| Rate for Payer: WPS Commercial |
$462.95
|
|
|
Lyme Disease DNA, Qual, Tick
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.19
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$292.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$73.01
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Lyme Disease DNA, Qual, Tick
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Lyme Disease DNA, Qual, Tick
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$288.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$321.24
|
|
|
Lyme Disease Serology/C6 Peptide
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$130.42 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$130.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$124.92
|
| Rate for Payer: HFN Commercial |
$130.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$130.42
|
| Rate for Payer: Quartz Beloit One Network |
$60.40
|
| Rate for Payer: Quartz Commercial |
$78.25
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
Lyme Disease Serology/C6 Peptide
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Lyme Disease Serology/C6 Peptide
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: The Alliance Commercial |
$63.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$70.88
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$16.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.11
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.11
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$24.16
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$16.11
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: The Alliance Commercial |
$64.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$20,868.58
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$18,536.77 |
| Max. Negotiated Rate |
$20,868.58 |
| Rate for Payer: Anthem Medicaid |
$19,982.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,982.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,982.81
|
| Rate for Payer: Dean Health Medicaid |
$19,982.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,536.77
|
| Rate for Payer: Managed Health Services Medicaid |
$20,868.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,982.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,982.81
|
| Rate for Payer: United Healthcare Medicaid |
$19,982.81
|
|
