|
Chest / breast drape, 30.5 x 30.5
|
Facility
|
IP
|
$36.89
|
|
| Hospital Charge Code |
992787
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$25.09
|
|
|
Chest / breast drape, 30.5 x 30.5
|
Facility
|
OP
|
$36.89
|
|
| Hospital Charge Code |
992787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.28
|
| Rate for Payer: BCBS of TX PPO |
$14.76
|
| Rate for Payer: Cash Price |
$25.09
|
| Rate for Payer: Cigna Medicaid |
$26.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$26.56
|
| Rate for Payer: Multiplan Auto |
$23.98
|
| Rate for Payer: Multiplan Commercial |
$23.98
|
| Rate for Payer: Multiplan Workers Comp |
$23.98
|
| Rate for Payer: Parkland Medicaid |
$26.56
|
| Rate for Payer: Scott and White EPO/PPO |
$18.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$26.56
|
| Rate for Payer: Superior Health Plan EPO |
$5.02
|
|
|
chest drainage kit
|
Facility
|
IP
|
$240.71
|
|
| Hospital Charge Code |
993260
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$163.68
|
|
|
chest drainage kit
|
Facility
|
OP
|
$240.71
|
|
| Hospital Charge Code |
993260
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.66 |
| Max. Negotiated Rate |
$173.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86.66
|
| Rate for Payer: BCBS of TX PPO |
$96.28
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cigna Medicaid |
$173.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$173.31
|
| Rate for Payer: Multiplan Auto |
$156.46
|
| Rate for Payer: Multiplan Commercial |
$156.46
|
| Rate for Payer: Multiplan Workers Comp |
$156.46
|
| Rate for Payer: Parkland Medicaid |
$173.31
|
| Rate for Payer: Scott and White EPO/PPO |
$120.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.31
|
| Rate for Payer: Superior Health Plan EPO |
$32.74
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$13,744.60
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$6,082.78 |
| Max. Negotiated Rate |
$13,744.60 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,036.97
|
| Rate for Payer: Amerigroup Medicare |
$10,036.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,082.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,298.63
|
| Rate for Payer: BCBS of TX Medicare |
$10,036.97
|
| Rate for Payer: BCBS of TX PPO |
$8,109.90
|
| Rate for Payer: Cigna Commercial |
$9,273.60
|
| Rate for Payer: Cigna Medicare |
$10,036.97
|
| Rate for Payer: Employer Direct Commercial |
$10,036.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,036.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,036.97
|
| Rate for Payer: Molina Medicare |
$10,036.97
|
| Rate for Payer: Multiplan Auto |
$13,744.60
|
| Rate for Payer: Multiplan Commercial |
$13,744.60
|
| Rate for Payer: Multiplan Workers Comp |
$13,744.60
|
| Rate for Payer: Scott and White EPO/PPO |
$6,329.75
|
| Rate for Payer: Scott and White Medicare |
$10,036.97
|
| Rate for Payer: Superior Health Plan EPO |
$10,036.97
|
| Rate for Payer: Superior Health Plan Medicare |
$10,036.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,036.97
|
| Rate for Payer: Universal American Medicare |
$10,036.97
|
| Rate for Payer: Wellcare Medicare |
$10,036.97
|
| Rate for Payer: Wellmed Medicare |
$10,036.97
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$6,094.24
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$5,745.87 |
| Max. Negotiated Rate |
$6,094.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,745.87
|
| Rate for Payer: Cigna Medicaid |
$5,745.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,745.87
|
| Rate for Payer: Parkland Medicaid |
$5,745.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,094.24
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$2,992.62
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$2,821.54 |
| Max. Negotiated Rate |
$2,992.62 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,821.54
|
| Rate for Payer: Cigna Medicaid |
$2,821.54
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,821.54
|
| Rate for Payer: Parkland Medicaid |
$2,821.54
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,992.62
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$2,721.04
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$2,565.49 |
| Max. Negotiated Rate |
$2,721.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,565.49
|
| Rate for Payer: Cigna Medicaid |
$2,565.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,565.49
|
| Rate for Payer: Parkland Medicaid |
$2,565.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,721.04
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$2,246.91
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$2,118.47 |
| Max. Negotiated Rate |
$2,246.91 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,118.47
|
| Rate for Payer: Cigna Medicaid |
$2,118.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,118.47
|
| Rate for Payer: Parkland Medicaid |
$2,118.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,246.91
|
|
|
CHI ANGPLSTY ILIAC ARTERY UNI LATRL
|
Facility
|
OP
|
$11,190.44
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
2170640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,007.14 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,007.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$7,609.50
|
| Rate for Payer: Cash Price |
$7,609.50
|
| Rate for Payer: Cash Price |
$7,609.50
|
| Rate for Payer: Cigna Medicaid |
$8,057.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,057.12
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$8,057.12
|
| Rate for Payer: Scott and White EPO/PPO |
$9,670.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,057.12
|
| Rate for Payer: Superior Health Plan EPO |
$1,521.90
|
|
|
CHI ANGPLSTY ILIAC ARTERY UNI LATRL
|
Facility
|
IP
|
$11,190.44
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
2170640
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$7,609.50
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$114,775.97
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$108,214.81 |
| Max. Negotiated Rate |
$114,775.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$108,214.81
|
| Rate for Payer: Cigna Medicaid |
$108,214.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$108,214.81
|
| Rate for Payer: Parkland Medicaid |
$108,214.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$114,775.97
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$45,324.92
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$42,733.92 |
| Max. Negotiated Rate |
$45,324.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42,733.92
|
| Rate for Payer: Cigna Medicaid |
$42,733.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$42,733.92
|
| Rate for Payer: Parkland Medicaid |
$42,733.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$45,324.92
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$686,758.80
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$316,270.50 |
| Max. Negotiated Rate |
$686,758.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$321,247.95
|
| Rate for Payer: Amerigroup Medicare |
$321,247.95
|
| Rate for Payer: BCBS of TX Medicare |
$321,247.95
|
| Rate for Payer: Cigna Commercial |
$556,194.46
|
| Rate for Payer: Cigna Medicare |
$321,247.95
|
| Rate for Payer: Employer Direct Commercial |
$321,247.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$321,247.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$321,247.95
|
| Rate for Payer: Molina Medicare |
$321,247.95
|
| Rate for Payer: Multiplan Auto |
$686,758.80
|
| Rate for Payer: Multiplan Commercial |
$686,758.80
|
| Rate for Payer: Multiplan Workers Comp |
$686,758.80
|
| Rate for Payer: Scott and White EPO/PPO |
$316,270.50
|
| Rate for Payer: Scott and White Medicare |
$321,247.95
|
| Rate for Payer: Superior Health Plan EPO |
$321,247.95
|
| Rate for Payer: Superior Health Plan Medicare |
$321,247.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$321,247.95
|
| Rate for Payer: Universal American Medicare |
$321,247.95
|
| Rate for Payer: Wellcare Medicare |
$321,247.95
|
| Rate for Payer: Wellmed Medicare |
$321,247.95
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$65,221.64
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$61,493.24 |
| Max. Negotiated Rate |
$65,221.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61,493.24
|
| Rate for Payer: Cigna Medicaid |
$61,493.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$61,493.24
|
| Rate for Payer: Parkland Medicaid |
$61,493.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$65,221.64
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$25,775.96
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$24,302.48 |
| Max. Negotiated Rate |
$25,775.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24,302.48
|
| Rate for Payer: Cigna Medicaid |
$24,302.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$24,302.48
|
| Rate for Payer: Parkland Medicaid |
$24,302.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25,775.96
|
|
|
Chlamydia PCR
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
4107492
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$202.64
|
|
|
Chlamydia PCR
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
4107492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$214.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.28
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$119.20
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cigna Medicaid |
$214.56
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$214.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$214.56
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$214.56
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia pneumoniae IgG Ab SO
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
1703305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Amerigroup Medicare |
$11.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.64
|
| Rate for Payer: BCBS of TX Medicare |
$11.82
|
| Rate for Payer: BCBS of TX PPO |
$49.60
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cigna Medicaid |
$89.28
|
| Rate for Payer: Cigna Medicare |
$11.82
|
| Rate for Payer: Employer Direct Commercial |
$11.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$89.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Molina Medicare |
$11.82
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$89.28
|
| Rate for Payer: Scott and White EPO/PPO |
$14.78
|
| Rate for Payer: Scott and White Medicare |
$11.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$89.28
|
| Rate for Payer: Superior Health Plan EPO |
$11.82
|
| Rate for Payer: Superior Health Plan Medicare |
$11.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Universal American Medicare |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$11.82
|
| Rate for Payer: Wellmed Medicare |
$11.82
|
|
|
Chlamydia pneumoniae IgG Ab SO
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
1703305
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$84.32
|
|
|
Chlamydia pneumoniae IgM SO
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
1703313
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$80.92
|
|
|
Chlamydia pneumoniae IgM SO
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
1703313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Amerigroup Medicare |
$12.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$42.84
|
| Rate for Payer: BCBS of TX Medicare |
$12.68
|
| Rate for Payer: BCBS of TX PPO |
$47.60
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cigna Medicaid |
$85.68
|
| Rate for Payer: Cigna Medicare |
$12.68
|
| Rate for Payer: Employer Direct Commercial |
$12.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Molina Medicare |
$12.68
|
| Rate for Payer: Multiplan Auto |
$77.35
|
| Rate for Payer: Multiplan Commercial |
$77.35
|
| Rate for Payer: Multiplan Workers Comp |
$77.35
|
| Rate for Payer: Parkland Medicaid |
$85.68
|
| Rate for Payer: Scott and White EPO/PPO |
$15.85
|
| Rate for Payer: Scott and White Medicare |
$12.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.68
|
| Rate for Payer: Superior Health Plan EPO |
$12.68
|
| Rate for Payer: Superior Health Plan Medicare |
$12.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Universal American Medicare |
$12.68
|
| Rate for Payer: Wellcare Medicare |
$12.68
|
| Rate for Payer: Wellmed Medicare |
$12.68
|
|
|
Chlamydia pneumoniae, PCR SO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
8722543
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$176.80
|
|
|
Chlamydia pneumoniae, PCR SO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
8722543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$78.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$93.60
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$104.00
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cigna Medicaid |
$187.20
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$187.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$169.00
|
| Rate for Payer: Multiplan Workers Comp |
$169.00
|
| Rate for Payer: Parkland Medicaid |
$187.20
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$187.20
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia pneumoniae, PCR SO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
1740900
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$176.80
|
|
