|
Hepatitis A Antibody IgM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
1600865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna Commercial |
$11.83
|
| Rate for Payer: Aetna Medicare |
$16.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.26
|
| Rate for Payer: Amerigroup Medicare |
$11.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.29
|
| Rate for Payer: BCBS of TX Medicare |
$11.26
|
| Rate for Payer: BCBS of TX PPO |
$24.88
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Medicaid |
$11.26
|
| Rate for Payer: Cigna Medicare |
$11.26
|
| Rate for Payer: Employer Direct Commercial |
$11.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.26
|
| Rate for Payer: Molina Medicare |
$11.26
|
| Rate for Payer: Multiplan Auto |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Multiplan Workers Comp |
$136.50
|
| Rate for Payer: Parkland Medicaid |
$11.26
|
| Rate for Payer: Scott and White EPO/PPO |
$14.08
|
| Rate for Payer: Scott and White Medicare |
$11.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.26
|
| Rate for Payer: Superior Health Plan EPO |
$11.26
|
| Rate for Payer: Superior Health Plan Medicare |
$11.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.26
|
| Rate for Payer: Universal American Medicare |
$11.26
|
| Rate for Payer: Wellcare Medicare |
$11.26
|
| Rate for Payer: Wellmed Medicare |
$11.26
|
|
|
Hepatitis Acute Panel
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1603307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$570.70 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare |
$71.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Amerigroup Medicare |
$47.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$78.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$94.31
|
| Rate for Payer: BCBS of TX Medicare |
$47.63
|
| Rate for Payer: BCBS of TX PPO |
$105.26
|
| Rate for Payer: Cash Price |
$772.64
|
| Rate for Payer: Cash Price |
$772.64
|
| Rate for Payer: Cigna Medicaid |
$47.63
|
| Rate for Payer: Cigna Medicare |
$47.63
|
| Rate for Payer: Employer Direct Commercial |
$47.63
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.63
|
| Rate for Payer: Molina CHIP/Medicaid |
$47.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Molina Medicare |
$47.63
|
| Rate for Payer: Multiplan Auto |
$570.70
|
| Rate for Payer: Multiplan Commercial |
$570.70
|
| Rate for Payer: Multiplan Workers Comp |
$570.70
|
| Rate for Payer: Parkland Medicaid |
$47.63
|
| Rate for Payer: Scott and White EPO/PPO |
$59.54
|
| Rate for Payer: Scott and White Medicare |
$47.63
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$47.63
|
| Rate for Payer: Superior Health Plan EPO |
$47.63
|
| Rate for Payer: Superior Health Plan Medicare |
$47.63
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Universal American Medicare |
$47.63
|
| Rate for Payer: Wellcare Medicare |
$47.63
|
| Rate for Payer: Wellmed Medicare |
$47.63
|
|
|
HEPATITIS B CORE ANTIBODY
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
1603133
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$241.15 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$241.15
|
| Rate for Payer: Multiplan Commercial |
$241.15
|
| Rate for Payer: Multiplan Workers Comp |
$241.15
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
Hepatitis B Core Antibody IgM
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1600873
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$286.88
|
|
|
Hepatitis B Core Antibody IgM
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1600873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$211.90 |
| Rate for Payer: Aetna Commercial |
$12.36
|
| Rate for Payer: Aetna Medicare |
$17.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Amerigroup Medicare |
$11.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.30
|
| Rate for Payer: BCBS of TX Medicare |
$11.77
|
| Rate for Payer: BCBS of TX PPO |
$26.01
|
| Rate for Payer: Cash Price |
$286.88
|
| Rate for Payer: Cash Price |
$286.88
|
| Rate for Payer: Cigna Medicaid |
$11.77
|
| Rate for Payer: Cigna Medicare |
$11.77
|
| Rate for Payer: Employer Direct Commercial |
$11.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Molina Medicare |
$11.77
|
| Rate for Payer: Multiplan Auto |
$211.90
|
| Rate for Payer: Multiplan Commercial |
$211.90
|
| Rate for Payer: Multiplan Workers Comp |
$211.90
|
| Rate for Payer: Parkland Medicaid |
$11.77
|
| Rate for Payer: Scott and White EPO/PPO |
$14.71
|
| Rate for Payer: Scott and White Medicare |
$11.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.77
|
| Rate for Payer: Superior Health Plan EPO |
$11.77
|
| Rate for Payer: Superior Health Plan Medicare |
$11.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Universal American Medicare |
$11.77
|
| Rate for Payer: Wellcare Medicare |
$11.77
|
| Rate for Payer: Wellmed Medicare |
$11.77
|
|
|
Hepatitis B Surf Ab Quant SO
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1703156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$15.73
|
| Rate for Payer: Aetna Medicare |
$22.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.99
|
| Rate for Payer: Amerigroup Medicare |
$14.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.68
|
| Rate for Payer: BCBS of TX Medicare |
$14.99
|
| Rate for Payer: BCBS of TX PPO |
$33.13
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$14.99
|
| Rate for Payer: Cigna Medicare |
$14.99
|
| Rate for Payer: Employer Direct Commercial |
$14.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.99
|
| Rate for Payer: Molina Medicare |
$14.99
|
| Rate for Payer: Multiplan Auto |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$76.05
|
| Rate for Payer: Multiplan Workers Comp |
$76.05
|
| Rate for Payer: Parkland Medicaid |
$14.99
|
| Rate for Payer: Scott and White EPO/PPO |
$18.74
|
| Rate for Payer: Scott and White Medicare |
$14.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.99
|
| Rate for Payer: Superior Health Plan EPO |
$14.99
|
| Rate for Payer: Superior Health Plan Medicare |
$14.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.99
|
| Rate for Payer: Universal American Medicare |
$14.99
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: Wellmed Medicare |
$14.99
|
|
|
Hepatitis B Surf Ab Quant SO
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1703156
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$102.96
|
|
|
HEPATITIS B SURFACE AB
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1603117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$191.10 |
| Rate for Payer: Aetna Commercial |
$11.27
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Amerigroup Medicare |
$10.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21.27
|
| Rate for Payer: BCBS of TX Medicare |
$10.74
|
| Rate for Payer: BCBS of TX PPO |
$23.74
|
| Rate for Payer: Cash Price |
$258.72
|
| Rate for Payer: Cash Price |
$258.72
|
| Rate for Payer: Cigna Medicaid |
$10.74
|
| Rate for Payer: Cigna Medicare |
$10.74
|
| Rate for Payer: Employer Direct Commercial |
$10.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Molina Medicare |
$10.74
|
| Rate for Payer: Multiplan Auto |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$191.10
|
| Rate for Payer: Multiplan Workers Comp |
$191.10
|
| Rate for Payer: Parkland Medicaid |
$10.74
|
| Rate for Payer: Scott and White EPO/PPO |
$13.42
|
| Rate for Payer: Scott and White Medicare |
$10.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.74
|
| Rate for Payer: Superior Health Plan EPO |
$10.74
|
| Rate for Payer: Superior Health Plan Medicare |
$10.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Universal American Medicare |
$10.74
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: Wellmed Medicare |
$10.74
|
|
|
Hepatitis B Surface Antibody
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1603117
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$258.72
|
|
|
Hepatitis B Surface Antibody
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1603117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$191.10 |
| Rate for Payer: Aetna Commercial |
$11.27
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Amerigroup Medicare |
$10.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21.27
|
| Rate for Payer: BCBS of TX Medicare |
$10.74
|
| Rate for Payer: BCBS of TX PPO |
$23.74
|
| Rate for Payer: Cash Price |
$258.72
|
| Rate for Payer: Cash Price |
$258.72
|
| Rate for Payer: Cigna Medicaid |
$10.74
|
| Rate for Payer: Cigna Medicare |
$10.74
|
| Rate for Payer: Employer Direct Commercial |
$10.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Molina Medicare |
$10.74
|
| Rate for Payer: Multiplan Auto |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$191.10
|
| Rate for Payer: Multiplan Workers Comp |
$191.10
|
| Rate for Payer: Parkland Medicaid |
$10.74
|
| Rate for Payer: Scott and White EPO/PPO |
$13.42
|
| Rate for Payer: Scott and White Medicare |
$10.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.74
|
| Rate for Payer: Superior Health Plan EPO |
$10.74
|
| Rate for Payer: Superior Health Plan Medicare |
$10.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Universal American Medicare |
$10.74
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: Wellmed Medicare |
$10.74
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
1602747
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Amerigroup Medicare |
$10.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.45
|
| Rate for Payer: BCBS of TX Medicare |
$10.33
|
| Rate for Payer: BCBS of TX PPO |
$22.83
|
| Rate for Payer: Cash Price |
$212.96
|
| Rate for Payer: Cash Price |
$212.96
|
| Rate for Payer: Cigna Medicaid |
$10.33
|
| Rate for Payer: Cigna Medicare |
$10.33
|
| Rate for Payer: Employer Direct Commercial |
$10.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Molina Medicare |
$10.33
|
| Rate for Payer: Multiplan Auto |
$157.30
|
| Rate for Payer: Multiplan Commercial |
$157.30
|
| Rate for Payer: Multiplan Workers Comp |
$157.30
|
| Rate for Payer: Parkland Medicaid |
$10.33
|
| Rate for Payer: Scott and White EPO/PPO |
$12.91
|
| Rate for Payer: Scott and White Medicare |
$10.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.33
|
| Rate for Payer: Superior Health Plan EPO |
$10.33
|
| Rate for Payer: Superior Health Plan Medicare |
$10.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Universal American Medicare |
$10.33
|
| Rate for Payer: Wellcare Medicare |
$10.33
|
| Rate for Payer: Wellmed Medicare |
$10.33
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
1602747
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$212.96
|
|
|
Hepatitis C Antibody
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1602895
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$330.88
|
|
|
Hepatitis C Antibody
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1602895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Amerigroup Medicare |
$14.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.25
|
| Rate for Payer: BCBS of TX Medicare |
$14.27
|
| Rate for Payer: BCBS of TX PPO |
$31.54
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Medicaid |
$14.27
|
| Rate for Payer: Cigna Medicare |
$14.27
|
| Rate for Payer: Employer Direct Commercial |
$14.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Molina Medicare |
$14.27
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Parkland Medicaid |
$14.27
|
| Rate for Payer: Scott and White EPO/PPO |
$17.84
|
| Rate for Payer: Scott and White Medicare |
$14.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.27
|
| Rate for Payer: Superior Health Plan EPO |
$14.27
|
| Rate for Payer: Superior Health Plan Medicare |
$14.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Universal American Medicare |
$14.27
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: Wellmed Medicare |
$14.27
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1602895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Amerigroup Medicare |
$14.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.25
|
| Rate for Payer: BCBS of TX Medicare |
$14.27
|
| Rate for Payer: BCBS of TX PPO |
$31.54
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Medicaid |
$14.27
|
| Rate for Payer: Cigna Medicare |
$14.27
|
| Rate for Payer: Employer Direct Commercial |
$14.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Molina Medicare |
$14.27
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Parkland Medicaid |
$14.27
|
| Rate for Payer: Scott and White EPO/PPO |
$17.84
|
| Rate for Payer: Scott and White Medicare |
$14.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.27
|
| Rate for Payer: Superior Health Plan EPO |
$14.27
|
| Rate for Payer: Superior Health Plan Medicare |
$14.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Universal American Medicare |
$14.27
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: Wellmed Medicare |
$14.27
|
|
|
Hepatitis E Virus (HEV) IgM SO
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1703651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$105.95
|
| Rate for Payer: Multiplan Commercial |
$105.95
|
| Rate for Payer: Multiplan Workers Comp |
$105.95
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
Hepatitis E Virus (HEV) IgM SO
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1703651
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$143.44
|
|
|
Hepatitis Panel (4) SO
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1603307
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$772.64
|
|
|
Hepatitis Panel (4) SO
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1603307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$570.70 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare |
$71.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Amerigroup Medicare |
$47.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$78.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$94.31
|
| Rate for Payer: BCBS of TX Medicare |
$47.63
|
| Rate for Payer: BCBS of TX PPO |
$105.26
|
| Rate for Payer: Cash Price |
$772.64
|
| Rate for Payer: Cash Price |
$772.64
|
| Rate for Payer: Cigna Medicaid |
$47.63
|
| Rate for Payer: Cigna Medicare |
$47.63
|
| Rate for Payer: Employer Direct Commercial |
$47.63
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.63
|
| Rate for Payer: Molina CHIP/Medicaid |
$47.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Molina Medicare |
$47.63
|
| Rate for Payer: Multiplan Auto |
$570.70
|
| Rate for Payer: Multiplan Commercial |
$570.70
|
| Rate for Payer: Multiplan Workers Comp |
$570.70
|
| Rate for Payer: Parkland Medicaid |
$47.63
|
| Rate for Payer: Scott and White EPO/PPO |
$59.54
|
| Rate for Payer: Scott and White Medicare |
$47.63
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$47.63
|
| Rate for Payer: Superior Health Plan EPO |
$47.63
|
| Rate for Payer: Superior Health Plan Medicare |
$47.63
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.63
|
| Rate for Payer: Universal American Medicare |
$47.63
|
| Rate for Payer: Wellcare Medicare |
$47.63
|
| Rate for Payer: Wellmed Medicare |
$47.63
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$32,482.40
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$14,472.94 |
| Max. Negotiated Rate |
$32,482.40 |
| Rate for Payer: Aetna Commercial |
$19,233.00
|
| Rate for Payer: Aetna Medicare |
$22,581.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,054.59
|
| Rate for Payer: Amerigroup Medicare |
$15,054.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,472.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,358.53
|
| Rate for Payer: BCBS of TX Medicare |
$15,054.59
|
| Rate for Payer: BCBS of TX PPO |
$20,399.16
|
| Rate for Payer: Cigna Commercial |
$22,019.65
|
| Rate for Payer: Cigna Medicare |
$15,054.59
|
| Rate for Payer: Employer Direct Commercial |
$15,054.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,054.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,054.59
|
| Rate for Payer: Molina Medicare |
$15,054.59
|
| Rate for Payer: Multiplan Auto |
$32,482.40
|
| Rate for Payer: Multiplan Commercial |
$32,482.40
|
| Rate for Payer: Multiplan Workers Comp |
$32,482.40
|
| Rate for Payer: Scott and White EPO/PPO |
$14,959.00
|
| Rate for Payer: Scott and White Medicare |
$15,054.59
|
| Rate for Payer: Superior Health Plan EPO |
$15,054.59
|
| Rate for Payer: Superior Health Plan Medicare |
$15,054.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,054.59
|
| Rate for Payer: Universal American Medicare |
$15,054.59
|
| Rate for Payer: Wellcare Medicare |
$15,054.59
|
| Rate for Payer: Wellmed Medicare |
$15,054.59
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,815.20
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$25,695.87 |
| Max. Negotiated Rate |
$60,815.20 |
| Rate for Payer: Aetna Commercial |
$36,009.00
|
| Rate for Payer: Aetna Medicare |
$38,543.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25,695.87
|
| Rate for Payer: Amerigroup Medicare |
$25,695.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29,866.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36,298.11
|
| Rate for Payer: BCBS of TX Medicare |
$25,695.87
|
| Rate for Payer: BCBS of TX PPO |
$40,332.80
|
| Rate for Payer: Cigna Commercial |
$41,226.30
|
| Rate for Payer: Cigna Medicare |
$25,695.87
|
| Rate for Payer: Employer Direct Commercial |
$25,695.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$25,695.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25,695.87
|
| Rate for Payer: Molina Medicare |
$25,695.87
|
| Rate for Payer: Multiplan Auto |
$60,815.20
|
| Rate for Payer: Multiplan Commercial |
$60,815.20
|
| Rate for Payer: Multiplan Workers Comp |
$60,815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$28,007.00
|
| Rate for Payer: Scott and White Medicare |
$25,695.87
|
| Rate for Payer: Superior Health Plan EPO |
$25,695.87
|
| Rate for Payer: Superior Health Plan Medicare |
$25,695.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25,695.87
|
| Rate for Payer: Universal American Medicare |
$25,695.87
|
| Rate for Payer: Wellcare Medicare |
$25,695.87
|
| Rate for Payer: Wellmed Medicare |
$25,695.87
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,809.00
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$12,236.08 |
| Max. Negotiated Rate |
$26,809.00 |
| Rate for Payer: Aetna Commercial |
$15,873.75
|
| Rate for Payer: Aetna Medicare |
$19,385.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,923.77
|
| Rate for Payer: Amerigroup Medicare |
$12,923.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,236.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,556.92
|
| Rate for Payer: BCBS of TX Medicare |
$12,923.77
|
| Rate for Payer: BCBS of TX PPO |
$17,286.14
|
| Rate for Payer: Cigna Commercial |
$18,173.68
|
| Rate for Payer: Cigna Medicare |
$12,923.77
|
| Rate for Payer: Employer Direct Commercial |
$12,923.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,923.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,923.77
|
| Rate for Payer: Molina Medicare |
$12,923.77
|
| Rate for Payer: Multiplan Auto |
$26,809.00
|
| Rate for Payer: Multiplan Commercial |
$26,809.00
|
| Rate for Payer: Multiplan Workers Comp |
$26,809.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,346.25
|
| Rate for Payer: Scott and White Medicare |
$12,923.77
|
| Rate for Payer: Superior Health Plan EPO |
$12,923.77
|
| Rate for Payer: Superior Health Plan Medicare |
$12,923.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,923.77
|
| Rate for Payer: Universal American Medicare |
$12,923.77
|
| Rate for Payer: Wellcare Medicare |
$12,923.77
|
| Rate for Payer: Wellmed Medicare |
$12,923.77
|
|
|
Hep B Core Ab, IgM SO
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1600873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$211.90 |
| Rate for Payer: Aetna Commercial |
$12.36
|
| Rate for Payer: Aetna Medicare |
$17.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Amerigroup Medicare |
$11.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.30
|
| Rate for Payer: BCBS of TX Medicare |
$11.77
|
| Rate for Payer: BCBS of TX PPO |
$26.01
|
| Rate for Payer: Cash Price |
$286.88
|
| Rate for Payer: Cash Price |
$286.88
|
| Rate for Payer: Cigna Medicaid |
$11.77
|
| Rate for Payer: Cigna Medicare |
$11.77
|
| Rate for Payer: Employer Direct Commercial |
$11.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Molina Medicare |
$11.77
|
| Rate for Payer: Multiplan Auto |
$211.90
|
| Rate for Payer: Multiplan Commercial |
$211.90
|
| Rate for Payer: Multiplan Workers Comp |
$211.90
|
| Rate for Payer: Parkland Medicaid |
$11.77
|
| Rate for Payer: Scott and White EPO/PPO |
$14.71
|
| Rate for Payer: Scott and White Medicare |
$11.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.77
|
| Rate for Payer: Superior Health Plan EPO |
$11.77
|
| Rate for Payer: Superior Health Plan Medicare |
$11.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.77
|
| Rate for Payer: Universal American Medicare |
$11.77
|
| Rate for Payer: Wellcare Medicare |
$11.77
|
| Rate for Payer: Wellmed Medicare |
$11.77
|
|
|
Hep B Core Ab, Tot SO
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
1603133
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$241.15 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$241.15
|
| Rate for Payer: Multiplan Commercial |
$241.15
|
| Rate for Payer: Multiplan Workers Comp |
$241.15
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
Hep B Core Ab, Tot SO
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
1603133
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$326.48
|
|
