|
Histoplasma Antibody ID
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$55.16 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.89
|
| Rate for Payer: Anthem Medicaid |
$14.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Dean Health Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Managed Health Services Medicaid |
$14.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.68
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
| Rate for Payer: WMAP Medicaid |
$14.25
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Histoplasma Antibody ID
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$48.68 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: HFN Commercial |
$46.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.68
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: The Alliance Commercial |
$24.50
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
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 |
$10.56 |
| Max. Negotiated Rate |
$48.68 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.40
|
| Rate for Payer: Health EOS Commercial |
$21.84
|
| Rate for Payer: HFN Commercial |
$22.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.68
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22.80
|
| Rate for Payer: Quartz Beloit One Network |
$10.56
|
| Rate for Payer: Quartz Commercial |
$13.68
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
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 |
$11.76 |
| Max. Negotiated Rate |
$55.16 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.89
|
| Rate for Payer: Anthem Medicaid |
$14.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Dean Health Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Managed Health Services Medicaid |
$14.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.68
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.25
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare PPO |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
| Rate for Payer: WMAP Medicaid |
$14.25
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
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 |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Aetna Commercial |
$724.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.18
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$724.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.80
|
| Rate for Payer: Health EOS Commercial |
$694.33
|
| Rate for Payer: HFN Commercial |
$724.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$724.85
|
| Rate for Payer: Quartz Beloit One Network |
$335.72
|
| Rate for Payer: Quartz Commercial |
$434.91
|
| Rate for Payer: The Alliance Commercial |
$381.50
|
| Rate for Payer: WEA Trust Commercial |
$419.65
|
| Rate for Payer: WPS Commercial |
$565.15
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$701.96 |
| Rate for Payer: Aetna Commercial |
$686.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.18
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$701.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.97
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$679.07
|
| Rate for Payer: HFN Commercial |
$701.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$701.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$373.87
|
| Rate for Payer: Quartz Commercial |
$495.95
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$572.25
|
| Rate for Payer: WEA Trust Commercial |
$419.65
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$565.15
|
|
|
Histoplasma Capsulatum/Blastomyces to Mayo
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5072627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$373.87 |
| Max. Negotiated Rate |
$701.96 |
| Rate for Payer: Aetna Commercial |
$686.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.39
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$701.96
|
| Rate for Payer: Health EOS Commercial |
$679.07
|
| Rate for Payer: HFN Commercial |
$701.96
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: NAPHCARE Commercial |
$457.80
|
| Rate for Payer: Preferred Network Access Commercial |
$701.96
|
| Rate for Payer: Quartz Beloit One Network |
$373.87
|
| Rate for Payer: Quartz Commercial |
$457.80
|
| Rate for Payer: WEA Trust Commercial |
$419.65
|
| Rate for Payer: WPS Commercial |
$565.15
|
|
|
Histoplasma Galactomannan AG, Urine
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Histoplasma Galactomannan AG, Urine
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Histoplasma Galactomannan AG, Urine
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
4500714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: HFN Commercial |
$193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Histoplasma Quantitative Antigen, EIA
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
5432851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
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 |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
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 |
$48.40 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$251.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.00
|
| Rate for Payer: Health EOS Commercial |
$241.15
|
| Rate for Payer: HFN Commercial |
$251.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$251.75
|
| Rate for Payer: Quartz Beloit One Network |
$116.60
|
| Rate for Payer: Quartz Commercial |
$151.05
|
| Rate for Payer: The Alliance Commercial |
$132.50
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
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 |
$13.71 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$13.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.76
|
| Rate for Payer: Anthem Medicaid |
$14.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.71
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Dean Health Medicaid |
$14.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.71
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.71
|
| Rate for Payer: Managed Health Services Medicaid |
$14.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.71
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.56
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.17
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.71
|
| Rate for Payer: The Alliance Commercial |
$54.84
|
| Rate for Payer: United Healthcare Medicaid |
$14.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.71
|
| Rate for Payer: United Healthcare PPO |
$198.75
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: Wellcare Medicare |
$13.71
|
| Rate for Payer: WMAP Medicaid |
$14.17
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
HIV 1 DNA, Qualitative PCR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.70
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$165.75
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$191.25
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
HIV 1 DNA, Qualitative PCR
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.00
|
| Rate for Payer: Health EOS Commercial |
$232.05
|
| Rate for Payer: HFN Commercial |
$242.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$242.25
|
| Rate for Payer: Quartz Beloit One Network |
$112.20
|
| Rate for Payer: Quartz Commercial |
$145.35
|
| Rate for Payer: The Alliance Commercial |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
HIV 1 DNA, Qualitative PCR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4056799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
HIV-1 Genotype
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$290.84 |
| Max. Negotiated Rate |
$908.80 |
| Rate for Payer: Aetna Commercial |
$627.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$568.46
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$627.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$330.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.60
|
| Rate for Payer: Health EOS Commercial |
$601.51
|
| Rate for Payer: HFN Commercial |
$627.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$528.80
|
| Rate for Payer: Preferred Network Access Commercial |
$627.95
|
| Rate for Payer: Quartz Beloit One Network |
$290.84
|
| Rate for Payer: Quartz Commercial |
$376.77
|
| Rate for Payer: The Alliance Commercial |
$330.50
|
| Rate for Payer: WEA Trust Commercial |
$363.55
|
| Rate for Payer: WPS Commercial |
$489.60
|
|
|
HIV-1 Genotype
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.89 |
| Max. Negotiated Rate |
$608.12 |
| Rate for Payer: Aetna Commercial |
$594.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$568.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$350.33
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$608.12
|
| Rate for Payer: Health EOS Commercial |
$588.29
|
| Rate for Payer: HFN Commercial |
$608.12
|
| Rate for Payer: Multiplan Commercial |
$528.80
|
| Rate for Payer: NAPHCARE Commercial |
$396.60
|
| Rate for Payer: Preferred Network Access Commercial |
$608.12
|
| Rate for Payer: Quartz Beloit One Network |
$323.89
|
| Rate for Payer: Quartz Commercial |
$396.60
|
| Rate for Payer: WEA Trust Commercial |
$363.55
|
| Rate for Payer: WPS Commercial |
$489.60
|
|
|
HIV-1 Genotype
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Aetna Commercial |
$594.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$568.46
|
| Rate for Payer: Aetna Managed Medicare |
$257.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.37
|
| Rate for Payer: Anthem Medicaid |
$266.02
|
| Rate for Payer: Anthem Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$350.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.45
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$608.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.90
|
| Rate for Payer: Dean Health Medicaid |
$266.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$257.45
|
| Rate for Payer: Health EOS Commercial |
$588.29
|
| Rate for Payer: HFN Commercial |
$608.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$266.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.45
|
| Rate for Payer: Managed Health Services Medicaid |
$276.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$257.45
|
| Rate for Payer: Multiplan Commercial |
$528.80
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$608.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$323.89
|
| Rate for Payer: Quartz Commercial |
$429.65
|
| Rate for Payer: Quartz Medicare Advantage |
$257.45
|
| Rate for Payer: The Alliance Commercial |
$1,029.80
|
| Rate for Payer: United Healthcare Medicaid |
$266.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare PPO |
$495.75
|
| Rate for Payer: WEA Trust Commercial |
$363.55
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$489.60
|
|
|
HIV-1 Genotype / 34949
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$404.80 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
HIV-1 Genotype / 34949
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$521.40 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Aetna Managed Medicare |
$130.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.38
|
| Rate for Payer: Anthem Medicaid |
$134.69
|
| Rate for Payer: Anthem Medicare Advantage |
$130.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.35
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.22
|
| Rate for Payer: Dean Health Medicaid |
$134.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.35
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$134.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.35
|
| Rate for Payer: Managed Health Services Medicaid |
$140.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.35
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$134.69
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$286.00
|
| Rate for Payer: Quartz Medicare Advantage |
$130.35
|
| Rate for Payer: The Alliance Commercial |
$521.40
|
| Rate for Payer: United Healthcare Medicaid |
$134.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare PPO |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: Wellcare Medicare |
$130.35
|
| Rate for Payer: WMAP Medicaid |
$134.69
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
