|
Bill Only BB Cell Separation
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 86972
|
| Hospital Charge Code |
2403970
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$120.36
|
|
|
Bill Only BB Cell Separation
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 86972
|
| Hospital Charge Code |
2403970
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$361.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.72
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$70.80
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$127.44
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$127.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$115.05
|
| Rate for Payer: Multiplan Commercial |
$115.05
|
| Rate for Payer: Multiplan Workers Comp |
$115.05
|
| Rate for Payer: Parkland Medicaid |
$127.44
|
| Rate for Payer: Scott and White EPO/PPO |
$88.50
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$127.44
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
Bill Only BB CMV
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
1702604
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$281.52
|
|
|
Bill Only BB CMV
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
1702604
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$124.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$149.04
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$165.60
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cigna Medicaid |
$298.08
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$298.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| Rate for Payer: Parkland Medicaid |
$298.08
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$298.08
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Bill Only BB CMV
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
7256915
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$281.52
|
|
|
Bill Only BB CMV
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
7256915
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$124.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$149.04
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$165.60
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cigna Medicaid |
$298.08
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$298.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| Rate for Payer: Parkland Medicaid |
$298.08
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$298.08
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Bill Only BB Cold Agglutinin Screen
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86156
|
| Hospital Charge Code |
7106050
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$119.68
|
|
|
Bill Only BB Cold Agglutinin Screen
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86156
|
| Hospital Charge Code |
7106050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Amerigroup Medicare |
$8.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.36
|
| Rate for Payer: BCBS of TX Medicare |
$8.07
|
| Rate for Payer: BCBS of TX PPO |
$70.40
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cigna Medicaid |
$126.72
|
| Rate for Payer: Cigna Medicare |
$8.07
|
| Rate for Payer: Employer Direct Commercial |
$8.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$126.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Molina Medicare |
$8.07
|
| Rate for Payer: Multiplan Auto |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Multiplan Workers Comp |
$114.40
|
| Rate for Payer: Parkland Medicaid |
$126.72
|
| Rate for Payer: Scott and White EPO/PPO |
$10.09
|
| Rate for Payer: Scott and White Medicare |
$8.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$126.72
|
| Rate for Payer: Superior Health Plan EPO |
$8.07
|
| Rate for Payer: Superior Health Plan Medicare |
$8.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Universal American Medicare |
$8.07
|
| Rate for Payer: Wellcare Medicare |
$8.07
|
| Rate for Payer: Wellmed Medicare |
$8.07
|
|
|
Bill Only BB Direct Antiglobulin Test
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$125.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Amerigroup Medicare |
$5.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.12
|
| Rate for Payer: BCBS of TX Medicare |
$5.39
|
| Rate for Payer: BCBS of TX PPO |
$56.80
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$102.24
|
| Rate for Payer: Cigna Medicare |
$5.39
|
| Rate for Payer: Employer Direct Commercial |
$5.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$102.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Molina Medicare |
$5.39
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$102.24
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$5.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$102.24
|
| Rate for Payer: Superior Health Plan EPO |
$5.39
|
| Rate for Payer: Superior Health Plan Medicare |
$5.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Universal American Medicare |
$5.39
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: Wellmed Medicare |
$5.39
|
|
|
Bill Only BB Direct Antiglobulin Test
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$96.56
|
|
|
Bill Only BB Irradiate Product Fee
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86945
|
| Hospital Charge Code |
4506125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Amerigroup Medicare |
$37.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.76
|
| Rate for Payer: BCBS of TX Medicare |
$37.52
|
| Rate for Payer: BCBS of TX PPO |
$66.40
|
| Rate for Payer: Cash Price |
$112.88
|
| Rate for Payer: Cash Price |
$112.88
|
| Rate for Payer: Cash Price |
$112.88
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$119.52
|
| Rate for Payer: Cigna Medicare |
$37.52
|
| Rate for Payer: Employer Direct Commercial |
$37.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$119.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Molina Medicare |
$37.52
|
| Rate for Payer: Multiplan Auto |
$107.90
|
| Rate for Payer: Multiplan Commercial |
$107.90
|
| Rate for Payer: Multiplan Workers Comp |
$107.90
|
| Rate for Payer: Parkland Medicaid |
$119.52
|
| Rate for Payer: Scott and White EPO/PPO |
$55.02
|
| Rate for Payer: Scott and White Medicare |
$37.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$119.52
|
| Rate for Payer: Superior Health Plan EPO |
$37.52
|
| Rate for Payer: Superior Health Plan Medicare |
$37.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Universal American Medicare |
$37.52
|
| Rate for Payer: Wellcare Medicare |
$37.52
|
| Rate for Payer: Wellmed Medicare |
$37.52
|
|
|
Bill Only BB Irradiate Product Fee
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86945
|
| Hospital Charge Code |
4506125
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$112.88
|
|
|
Bill Only BB Molecular RBC Genotype
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
8590514
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$567.12
|
|
|
Bill Only BB Molecular RBC Genotype
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
8590514
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Amerigroup Medicare |
$720.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$250.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$300.24
|
| Rate for Payer: BCBS of TX Medicare |
$720.00
|
| Rate for Payer: BCBS of TX PPO |
$333.60
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cigna Medicaid |
$600.48
|
| Rate for Payer: Cigna Medicare |
$720.00
|
| Rate for Payer: Employer Direct Commercial |
$720.00
|
| Rate for Payer: Humana Medicare/TRICARE |
$720.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$600.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Molina Medicare |
$720.00
|
| Rate for Payer: Multiplan Auto |
$542.10
|
| Rate for Payer: Multiplan Commercial |
$542.10
|
| Rate for Payer: Multiplan Workers Comp |
$542.10
|
| Rate for Payer: Parkland Medicaid |
$600.48
|
| Rate for Payer: Scott and White EPO/PPO |
$900.00
|
| Rate for Payer: Scott and White Medicare |
$720.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$600.48
|
| Rate for Payer: Superior Health Plan EPO |
$720.00
|
| Rate for Payer: Superior Health Plan Medicare |
$720.00
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Universal American Medicare |
$720.00
|
| Rate for Payer: Wellcare Medicare |
$720.00
|
| Rate for Payer: Wellmed Medicare |
$720.00
|
|
|
Bill Only BB Patient RBC Phenotype
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
2403020
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$91.80
|
|
|
Bill Only BB Patient RBC Phenotype
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
2403020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.75
|
| Rate for Payer: Amerigroup Medicare |
$7.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$40.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$48.60
|
| Rate for Payer: BCBS of TX Medicare |
$7.75
|
| Rate for Payer: BCBS of TX PPO |
$54.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$97.20
|
| Rate for Payer: Cigna Medicare |
$7.75
|
| Rate for Payer: Employer Direct Commercial |
$7.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$97.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.75
|
| Rate for Payer: Molina Medicare |
$7.75
|
| Rate for Payer: Multiplan Auto |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Workers Comp |
$87.75
|
| Rate for Payer: Parkland Medicaid |
$97.20
|
| Rate for Payer: Scott and White EPO/PPO |
$9.69
|
| Rate for Payer: Scott and White Medicare |
$7.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$97.20
|
| Rate for Payer: Superior Health Plan EPO |
$7.75
|
| Rate for Payer: Superior Health Plan Medicare |
$7.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.75
|
| Rate for Payer: Universal American Medicare |
$7.75
|
| Rate for Payer: Wellcare Medicare |
$7.75
|
| Rate for Payer: Wellmed Medicare |
$7.75
|
|
|
Bill Only BB Pool Fee Only
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
2403376
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$361.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$61.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$73.80
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$82.00
|
| Rate for Payer: Cash Price |
$139.40
|
| Rate for Payer: Cash Price |
$139.40
|
| Rate for Payer: Cash Price |
$139.40
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$147.60
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$147.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Workers Comp |
$133.25
|
| Rate for Payer: Parkland Medicaid |
$147.60
|
| Rate for Payer: Scott and White EPO/PPO |
$102.50
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$147.60
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
Bill Only BB Pool Fee Only
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
2403376
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$139.40
|
|
|
Bill Only BB RBC Treat w/Enzymes
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86971
|
| Hospital Charge Code |
2403632
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$361.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37.80
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$42.00
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$75.60
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$75.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Multiplan Workers Comp |
$68.25
|
| Rate for Payer: Parkland Medicaid |
$75.60
|
| Rate for Payer: Scott and White EPO/PPO |
$52.50
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$75.60
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
Bill Only BB RBC Treat w/Enzymes
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86971
|
| Hospital Charge Code |
2403632
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$71.40
|
|
|
Bill Only BB Thaw FFP
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
2400547
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$59.16
|
|
|
Bill Only BB Thaw FFP
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
2400547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$361.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.32
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$34.80
|
| Rate for Payer: Cash Price |
$59.16
|
| Rate for Payer: Cash Price |
$59.16
|
| Rate for Payer: Cash Price |
$59.16
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$62.64
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$56.55
|
| Rate for Payer: Multiplan Commercial |
$56.55
|
| Rate for Payer: Multiplan Workers Comp |
$56.55
|
| Rate for Payer: Parkland Medicaid |
$62.64
|
| Rate for Payer: Scott and White EPO/PPO |
$234.31
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.64
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
Bill Only Cell Count without Differential
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
1620061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Medicare |
$4.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.04
|
| Rate for Payer: BCBS of TX Medicare |
$4.72
|
| Rate for Payer: BCBS of TX PPO |
$45.60
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cigna Medicaid |
$82.08
|
| Rate for Payer: Cigna Medicare |
$4.72
|
| Rate for Payer: Employer Direct Commercial |
$4.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$82.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Molina Medicare |
$4.72
|
| Rate for Payer: Multiplan Auto |
$74.10
|
| Rate for Payer: Multiplan Commercial |
$74.10
|
| Rate for Payer: Multiplan Workers Comp |
$74.10
|
| Rate for Payer: Parkland Medicaid |
$82.08
|
| Rate for Payer: Scott and White EPO/PPO |
$5.90
|
| Rate for Payer: Scott and White Medicare |
$4.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$82.08
|
| Rate for Payer: Superior Health Plan EPO |
$4.72
|
| Rate for Payer: Superior Health Plan Medicare |
$4.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Universal American Medicare |
$4.72
|
| Rate for Payer: Wellcare Medicare |
$4.72
|
| Rate for Payer: Wellmed Medicare |
$4.72
|
|
|
Bill Only Cell Count without Differential
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
1620061
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$77.52
|
|
|
Bill Only GTT 1st 3 Specimens
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
1602853
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$257.72
|
|
