|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$212.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$212.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.40
|
| Rate for Payer: Health EOS Commercial |
$203.84
|
| Rate for Payer: HFN Commercial |
$212.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.68
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$212.80
|
| Rate for Payer: Quartz Beloit One Network |
$98.56
|
| Rate for Payer: Quartz Commercial |
$127.68
|
| Rate for Payer: The Alliance Commercial |
$112.00
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Aetna Managed Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.71
|
| Rate for Payer: Anthem Medicaid |
$16.01
|
| Rate for Payer: Anthem Medicare Advantage |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.49
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.35
|
| Rate for Payer: Dean Health Medicaid |
$16.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.49
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.49
|
| Rate for Payer: Managed Health Services Medicaid |
$16.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$23.24
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.01
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$145.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15.49
|
| Rate for Payer: The Alliance Commercial |
$61.96
|
| Rate for Payer: United Healthcare Medicaid |
$16.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare PPO |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: Wellcare Medicare |
$15.49
|
| Rate for Payer: WMAP Medicaid |
$16.01
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
Lyme Disease Antibody IgM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.71
|
| Rate for Payer: Anthem Medicaid |
$16.01
|
| Rate for Payer: Anthem Medicare Advantage |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.49
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Dean Health Medicaid |
$16.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.49
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.49
|
| Rate for Payer: Managed Health Services Medicaid |
$16.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$23.24
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.01
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15.49
|
| Rate for Payer: The Alliance Commercial |
$61.96
|
| Rate for Payer: United Healthcare Medicaid |
$16.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: Wellcare Medicare |
$15.49
|
| Rate for Payer: WMAP Medicaid |
$16.01
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Lyme Disease Antibody IgM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Lyme Disease Antibody IgM
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2942944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.68
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.20
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: The Alliance Commercial |
$91.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Lyme Disease Antibody Total w/ Reflex Western Blot
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
983309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$136.50
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Anthem Medicare Advantage |
$70.20
|
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.53
|
| Rate for Payer: Anthem Medicaid |
$50.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.20
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$70.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.32
|
| Rate for Payer: Dean Health Medicaid |
$50.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$70.20
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$50.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.20
|
| Rate for Payer: Managed Health Services Medicaid |
$52.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$70.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$105.30
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50.62
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$390.65
|
| Rate for Payer: Quartz Medicare Advantage |
$70.20
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: United Healthcare Medicaid |
$50.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare PPO |
$450.75
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: Wellcare Medicare |
$70.20
|
| Rate for Payer: WMAP Medicaid |
$50.62
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.49 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$360.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$360.60
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Lyme Disease DNA, Qual, PCR, Misc Fld
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
983310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.81 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.60
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: HFN Commercial |
$570.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.81
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: The Alliance Commercial |
$300.50
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Lyme Disease DNA, Qual, Tick
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.81 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.81
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Lyme Disease DNA, Qual, Tick
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$70.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.53
|
| Rate for Payer: Anthem Medicaid |
$50.62
|
| Rate for Payer: Anthem Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.20
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$70.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$50.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$70.20
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$50.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.20
|
| Rate for Payer: Managed Health Services Medicaid |
$52.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$70.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.30
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50.62
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$70.20
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: United Healthcare Medicaid |
$50.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$70.20
|
| Rate for Payer: WMAP Medicaid |
$50.62
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Lyme Disease DNA, Qual, Tick
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3423522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Lyme Disease Serology/C6 Peptide
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$125.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.20
|
| Rate for Payer: Health EOS Commercial |
$120.12
|
| Rate for Payer: HFN Commercial |
$125.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.08
|
| Rate for Payer: Quartz Commercial |
$75.24
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Lyme Disease Serology/C6 Peptide
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Lyme Disease Serology/C6 Peptide
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6170288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.68
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Lyme IgM/IgG, Whole Cell ELISA
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
6170289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.71
|
| Rate for Payer: Anthem Medicaid |
$16.01
|
| Rate for Payer: Anthem Medicare Advantage |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.49
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$16.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.49
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.49
|
| Rate for Payer: Managed Health Services Medicaid |
$16.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$23.24
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.01
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$15.49
|
| Rate for Payer: The Alliance Commercial |
$61.96
|
| Rate for Payer: United Healthcare Medicaid |
$16.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$15.49
|
| Rate for Payer: WMAP Medicaid |
$16.01
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Lymphocyte Absolute CD19 Count
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
2942947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.19 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$519.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.20
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: HFN Commercial |
$519.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$519.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.68
|
| Rate for Payer: Quartz Commercial |
$311.79
|
| Rate for Payer: The Alliance Commercial |
$273.50
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
Lymphocyte Absolute CD19 Count
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
2942947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.10
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$410.25
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
Lymphocyte Absolute CD19 Count
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
2942947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
Lymphocyte Abssolute Natural Killer (CD16 & CD56) Count
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
2942946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
Lymphocyte Abssolute Natural Killer (CD16 & CD56) Count
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
2942946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.90
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$332.25
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
