|
Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA)
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
5569256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$83.01 |
| Rate for Payer: Aetna Commercial |
$65.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$65.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$62.46
|
| Rate for Payer: HFN Commercial |
$65.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$65.21
|
| Rate for Payer: Quartz Beloit One Network |
$30.20
|
| Rate for Payer: Quartz Commercial |
$39.12
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$83.01
|
|
|
Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
5569256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
5569256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$75.46 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: United Healthcare PPO |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: Wellcare Medicare |
$18.87
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Epstein Barr Virus Capsid Antibody IgG
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: Aetna Commercial |
$261.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$261.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$250.80
|
| Rate for Payer: HFN Commercial |
$261.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$261.82
|
| Rate for Payer: Quartz Beloit One Network |
$121.26
|
| Rate for Payer: Quartz Commercial |
$157.09
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$83.01
|
|
|
Epstein Barr Virus Capsid Antibody IgG
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Capsid Antibody IgG
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: United Healthcare PPO |
$206.70
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: Wellcare Medicare |
$18.87
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: Aetna Commercial |
$261.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$261.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$250.80
|
| Rate for Payer: HFN Commercial |
$261.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$261.82
|
| Rate for Payer: Quartz Beloit One Network |
$121.26
|
| Rate for Payer: Quartz Commercial |
$157.09
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$83.01
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: United Healthcare PPO |
$206.70
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: Wellcare Medicare |
$18.87
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$137.90
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: United Healthcare PPO |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: Wellcare Medicare |
$18.87
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$201.55 |
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$201.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$193.07
|
| Rate for Payer: HFN Commercial |
$201.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$201.55
|
| Rate for Payer: Quartz Beloit One Network |
$93.35
|
| Rate for Payer: Quartz Commercial |
$120.93
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$83.01
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$127.30
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.08 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.92
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$297.65
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$471.28 |
| Rate for Payer: Aetna Commercial |
$471.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| 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 |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$471.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$451.43
|
| Rate for Payer: HFN Commercial |
$471.28
|
| 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 |
$396.86
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$471.28
|
| Rate for Payer: Quartz Beloit One Network |
$218.28
|
| Rate for Payer: Quartz Commercial |
$282.77
|
| 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 |
$272.84
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| 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 |
$262.92
|
| 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 |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| 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 |
$396.86
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$322.45
|
| 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 |
$372.06
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$331.50
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| Rate for Payer: HFN Commercial |
$419.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$15.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.90
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.90
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$23.85
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$15.90
|
| Rate for Payer: The Alliance Commercial |
$63.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.90
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$15.90
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$186.73 |
| Rate for Payer: Aetna Commercial |
$186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$15.90
|
| Rate for Payer: Anthem Medicare Advantage |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.90
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$186.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.90
|
| Rate for Payer: Health EOS Commercial |
$178.87
|
| Rate for Payer: HFN Commercial |
$186.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$23.85
|
| Rate for Payer: Preferred Network Access Commercial |
$186.73
|
| Rate for Payer: Quartz Beloit One Network |
$86.49
|
| Rate for Payer: Quartz Commercial |
$112.04
|
| Rate for Payer: Quartz Medicare Advantage |
$15.90
|
| Rate for Payer: The Alliance Commercial |
$62.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.90
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$69.97
|
|
|
Epstein Barr Virus Panel
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: United Healthcare PPO |
$206.70
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: Wellcare Medicare |
$18.87
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Panel
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Epstein Barr Virus Panel
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: Aetna Commercial |
$261.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$18.87
|
| Rate for Payer: Anthem Medicare Advantage |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.87
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$261.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Health EOS Commercial |
$250.80
|
| Rate for Payer: HFN Commercial |
$261.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.30
|
| Rate for Payer: Preferred Network Access Commercial |
$261.82
|
| Rate for Payer: Quartz Beloit One Network |
$121.26
|
| Rate for Payer: Quartz Commercial |
$157.09
|
| Rate for Payer: Quartz Medicare Advantage |
$18.87
|
| Rate for Payer: The Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$83.01
|
|
|
EP Stim/Pace Post IV Drug Infusion +
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
3052510
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$329.93 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
