Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$97.00

Service Code	HCPCS 87420
Hospital Charge Code	8742000
Hospital Revenue Code	306
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$97.00

Service Code	HCPCS 87420
Hospital Charge Code	8742000
Hospital Revenue Code	306
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$149.00

Service Code	HCPCS 87338
Hospital Charge Code	8733800
Hospital Revenue Code	306
Min. Negotiated Rate	$122.18
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$111.75
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$122.18

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$77.00

Service Code	HCPCS 87350
Hospital Charge Code	8735000
Hospital Revenue Code	306
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: BCBS Commercial	$43.38
Rate for Payer: Cash Price	$57.75
Rate for Payer: Cash Price	$57.75
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$89.00

Service Code	HCPCS 87400
Hospital Charge Code	8740000
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$149.00

Service Code	HCPCS 87338
Hospital Charge Code	8733800
Hospital Revenue Code	306
Min. Negotiated Rate	$31.18
Max. Negotiated Rate	$144.53
Rate for Payer: BCBS Commercial	$31.18
Rate for Payer: Cash Price	$111.75
Rate for Payer: Cash Price	$111.75
Rate for Payer: Celtic Commercial/Exchange	$68.84
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$125.16

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$89.00

Service Code	HCPCS 87425
Hospital Charge Code	8742500
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$150.00

Service Code	HCPCS 87324
Hospital Charge Code	8732400
Hospital Revenue Code	306
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$97.00

Service Code	HCPCS 87430
Hospital Charge Code	8743000
Hospital Revenue Code	306
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$77.00

Service Code	HCPCS 87350
Hospital Charge Code	8735000
Hospital Revenue Code	306
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.75
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$86.00

Service Code	HCPCS 87340
Hospital Charge Code	8734000
Hospital Revenue Code	306
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$83.42
Rate for Payer: BCBS Commercial	$24.62
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: Celtic Commercial/Exchange	$39.73
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$72.24

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$89.00

Service Code	HCPCS 87328
Hospital Charge Code	8732800
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$60.35
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$86.00

Service Code	HCPCS 87340
Hospital Charge Code	8734000
Hospital Revenue Code	306
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.50
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$70.52

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$89.00

Service Code	HCPCS 87328
Hospital Charge Code	8732800
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$89.00

Service Code	HCPCS 87400
Hospital Charge Code	8740000
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INF AGNT ANTGN DETEC BY ENZYME

Facility

IP

$89.00

Service Code	HCPCS 87425
Hospital Charge Code	8742500
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTGN DETEC BY ENZYME

Facility

OP

$150.00

Service Code	HCPCS 87324
Hospital Charge Code	8732400
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

INF AGNT ANTGN DETEC,DIR OPT Y

Facility

OP

$89.00

Service Code	HCPCS 87803
Hospital Charge Code	8780300
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INF AGNT ANTGN DETEC,DIR OPT Y

Facility

IP

$89.00

Service Code	HCPCS 87803
Hospital Charge Code	8780300
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTGN DETEC W/DIR OPT

Facility

IP

$89.00

Service Code	HCPCS 87802
Hospital Charge Code	8780200
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTGN DETEC W/DIR OPT

Facility

OP

$89.00

Service Code	HCPCS 87802
Hospital Charge Code	8780200
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$60.95
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INFAGNT ANTGN,HISTOPLAS CAPSUL

Facility

OP

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738500
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$220.19
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

INFAGNT ANTGN,HISTOPLAS CAPSUL

Facility

IP

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738500
Hospital Revenue Code	306
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

INF AGNT ANTGN,RESP SYNC VIRUS

Facility

IP

$128.00

Service Code	HCPCS 87807
Hospital Charge Code	8780700
Hospital Revenue Code	306
Min. Negotiated Rate	$104.96
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$104.96

INF AGNT ANTGN,RESP SYNC VIRUS

Facility

OP

$128.00

Service Code	HCPCS 87807
Hospital Charge Code	8780700
Hospital Revenue Code	306
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$124.16
Rate for Payer: BCBS Commercial	$26.54
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Celtic Commercial/Exchange	$59.14
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$107.52

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