|
Histoplasma Antibody
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
977978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$57.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$14.34
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Histoplasma Antibody
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5598647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$63.10 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Histoplasma Antibody
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
977978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Histoplasma Antibody ID
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$63.10 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Histoplasma Antibody ID
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$57.37 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$57.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$14.34
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Histoplasma Antibody ID
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Histoplasma Antibody Panel, CF and ID
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$57.37 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$57.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Healthcare PPO |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: Wellcare Medicare |
$14.34
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Histoplasma Antibody Panel, CF and ID
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Histoplasma Antibody Panel, CF and ID
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$63.10 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$753.84 |
| Rate for Payer: Aetna Commercial |
$753.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| 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 |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$753.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$396.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$722.10
|
| Rate for Payer: HFN Commercial |
$753.84
|
| 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 |
$634.82
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$753.84
|
| Rate for Payer: Quartz Beloit One Network |
$349.15
|
| Rate for Payer: Quartz Commercial |
$452.31
|
| 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 |
$436.44
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$730.04 |
| Rate for Payer: Aetna Commercial |
$714.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| 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 |
$420.57
|
| 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 |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$730.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$444.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$706.23
|
| Rate for Payer: HFN Commercial |
$730.04
|
| 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 |
$634.82
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$730.04
|
| Rate for Payer: Quartz Beloit One Network |
$388.82
|
| Rate for Payer: Quartz Commercial |
$515.79
|
| 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 |
$595.14
|
| Rate for Payer: WEA Trust Commercial |
$436.44
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$587.74
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$388.82 |
| Max. Negotiated Rate |
$730.04 |
| Rate for Payer: Aetna Commercial |
$714.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.57
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$730.04
|
| Rate for Payer: Health EOS Commercial |
$706.23
|
| Rate for Payer: HFN Commercial |
$730.04
|
| Rate for Payer: Multiplan Commercial |
$634.82
|
| Rate for Payer: Preferred Network Access Commercial |
$730.04
|
| Rate for Payer: Quartz Beloit One Network |
$388.82
|
| Rate for Payer: Quartz Commercial |
$476.11
|
| Rate for Payer: WEA Trust Commercial |
$436.44
|
| Rate for Payer: WPS Commercial |
$587.74
|
|
|
Histoplasma Galactomannan AG, Urine
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Histoplasma Galactomannan AG, Urine
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Histoplasma Galactomannan AG, Urine
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| 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 |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| 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 |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$193.07
|
| Rate for Payer: HFN Commercial |
$201.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| 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 |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
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
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| 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 |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| 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 |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| 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 |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| 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 |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
HIV 1 and 2 Antibodies, Antigen Screen
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
977980
|
|
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
|
|
|
HIV 1 and 2 Antibodies, Antigen Screen
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
977980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.26 |
| 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 |
$14.26
|
| Rate for Payer: Anthem Medicare Advantage |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.26
|
| 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 |
$14.26
|
| Rate for Payer: Health EOS Commercial |
$250.80
|
| Rate for Payer: HFN Commercial |
$261.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.26
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$21.39
|
| 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 |
$14.26
|
| Rate for Payer: The Alliance Commercial |
$56.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.26
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$62.74
|
|
|
HIV 1 and 2 Antibodies, Antigen Screen
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
977980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.26 |
| 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 |
$14.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.67
|
| Rate for Payer: Anthem Medicare Advantage |
$14.26
|
| 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 |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.26
|
| 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 |
$14.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.26
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.26
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$21.39
|
| 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 |
$14.26
|
| Rate for Payer: The Alliance Commercial |
$57.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.26
|
| Rate for Payer: United Healthcare PPO |
$206.70
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: Wellcare Medicare |
$14.26
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
HIV 1 DNA, Qualitative PCR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.56
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
HIV 1 DNA, Qualitative PCR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| 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 |
$140.56
|
| 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 |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| 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 |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$172.38
|
| 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 |
$198.90
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
HIV 1 DNA, Qualitative PCR
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$251.94 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| 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 |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| 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 |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| 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 |
$145.86
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
HIV-1 Genotype
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,070.99 |
| Rate for Payer: Aetna Commercial |
$618.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$591.20
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$632.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$611.82
|
| Rate for Payer: HFN Commercial |
$632.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$549.95
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$632.44
|
| Rate for Payer: Quartz Beloit One Network |
$336.85
|
| Rate for Payer: Quartz Commercial |
$446.84
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$515.58
|
| Rate for Payer: WEA Trust Commercial |
$378.09
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$509.17
|
|
