Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Htlv-i antibody
Wellsville, NY
See all hospitals reporting CPT 86687 →Price type
Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp’s median price of $9 is 17% below the median hospital's median price ($11), higher than 6% of the 1,789 hospitals reporting CPT 86687. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 19 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | UnitedHealthcare united healthcare 515803 fee schedule · outpatient | $4.92 | $4.92 | $4.92 – $4.92 |
| 2 | Cigna mvp commercial ppo fully insured 290006, cigna healthcare (pob 182223) 514405 fee schedule · outpatient | $8.54 | $8.54 | $8.54 – $8.54 |
| 3 | Blue Cross Blue Shield amerigroup (bswny alternate) 172001 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 4 | Highmark highmark bcbs essential 1-2 200-250 5143 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 5 | Highmark highmark bcbs medicare 130101 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 6 | Humana humana medicare 131201 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 7 | UnitedHealthcare united healthcare essential 1-2 200-250 5158 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 8 | UnitedHealthcare united healthcare medicaid 171601, united healthcare essential 3-4 171602, united healthcare child health plus 515813 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 9 | UnitedHealthcare united healthcare medicare 130901 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 10 | WellCare wellcare medicare 131001 fee schedule · outpatient | $9.09 | $9.09 | $9.09 – $9.09 |
| 11 | Aetna aetna medicare 130001 fee schedule · outpatient | $9.64 | $9.64 | $9.64 – $9.64 |
| 12 | Molina molina medicaid 172301, molina child health plus 518901 fee schedule · outpatient | $10.00 | $10.00 | $10.00 – $10.00 |
| 13 | Excellus excellus 220101, excellus simply blue 220106, excellus blue choice 220107 fee schedule · outpatient | $10.21 | $10.21 | $10.21 – $10.21 |
| 14 | Excellus excellus metal tiers 220102 fee schedule · outpatient | $10.21 | $10.21 | $10.21 – $10.21 |
| 15 | Highmark highmark bcbs medicaid 170201 child health plus 170204 fee schedule · outpatient | $10.67 | $10.67 | $10.67 – $10.67 |
| 16 | Highmark highmark bcbs 514301 hmo / pos fee schedule · outpatient | $14.59 | $14.59 | $14.59 – $14.59 |
| 17 | Aetna aetna 270002 fee schedule · outpatient | $15.00 | $15.00 | $15.00 – $15.00 |
| 18 | Highmark highmark bcbs 514301 indemnity / ppo fee schedule · outpatient | $18.35 | $18.35 | $18.35 – $18.35 |
| 19 | Molina molina essential 3-4 172302, molina essential 1-2 200-250 5189 fee schedule · outpatient | $20.45 | $20.45 | $20.45 – $20.45 |
Last updated: Jan 1, 2026
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