|
hook passer cresent
|
Facility
|
OP
|
$796.18
|
|
| Hospital Charge Code |
8646517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$517.52 |
| Rate for Payer: Aetna Commercial |
$437.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$238.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$286.62
|
| Rate for Payer: BCBS of TX PPO |
$318.47
|
| Rate for Payer: Cash Price |
$700.64
|
| Rate for Payer: Multiplan Auto |
$517.52
|
| Rate for Payer: Multiplan Commercial |
$517.52
|
| Rate for Payer: Multiplan Workers Comp |
$517.52
|
| Rate for Payer: Scott and White EPO/PPO |
$398.09
|
| Rate for Payer: Superior Health Plan EPO |
$108.28
|
|
|
HOOK SUTURE -- DHF
|
Facility
|
OP
|
$229.08
|
|
| Hospital Charge Code |
81799025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$148.90 |
| Rate for Payer: Aetna Commercial |
$125.99
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$20.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$68.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$82.47
|
| Rate for Payer: BCBS of TX PPO |
$91.63
|
| Rate for Payer: Cash Price |
$201.59
|
| Rate for Payer: Multiplan Auto |
$148.90
|
| Rate for Payer: Multiplan Commercial |
$148.90
|
| Rate for Payer: Multiplan Workers Comp |
$148.90
|
| Rate for Payer: Scott and White EPO/PPO |
$114.54
|
| Rate for Payer: Superior Health Plan EPO |
$31.15
|
|
|
HOOK SUTURE -- DHF
|
Facility
|
IP
|
$229.08
|
|
| Hospital Charge Code |
81799025
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$201.59
|
|
|
.HPV E6/E7 QuantaSure 507905 SO
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 88199
|
| Hospital Charge Code |
8662516
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$569.36
|
|
|
.HPV E6/E7 QuantaSure 507905 SO
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 88199
|
| Hospital Charge Code |
8662516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$420.55 |
| Rate for Payer: Aetna Commercial |
$355.85
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Amerigroup Medicare |
$49.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.95
|
| Rate for Payer: BCBS of TX Medicare |
$49.56
|
| Rate for Payer: BCBS of TX PPO |
$109.33
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cigna Commercial |
$112.25
|
| Rate for Payer: Cigna Medicare |
$49.56
|
| Rate for Payer: Employer Direct Commercial |
$49.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Molina Medicare |
$49.56
|
| Rate for Payer: Multiplan Auto |
$420.55
|
| Rate for Payer: Multiplan Commercial |
$420.55
|
| Rate for Payer: Multiplan Workers Comp |
$420.55
|
| Rate for Payer: Scott and White EPO/PPO |
$0.89
|
| Rate for Payer: Scott and White Medicare |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$49.56
|
| Rate for Payer: Superior Health Plan Medicare |
$49.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Universal American Medicare |
$49.56
|
| Rate for Payer: Wellcare Medicare |
$49.56
|
| Rate for Payer: Wellmed Medicare |
$49.56
|
|
|
.HPV low vol rfx 507405 SO
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8662515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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 |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$152.10
|
| Rate for Payer: Multiplan Workers Comp |
$152.10
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| 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 |
$35.09
|
| 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
|
|
|
.HPV low vol rfx 507405 SO
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8662515
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$205.92
|
|
|
.H pylori Breath Test, Peds SO
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
1740995
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$250.90 |
| Rate for Payer: Aetna Commercial |
$70.74
|
| Rate for Payer: Aetna Medicare |
$101.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Amerigroup Medicare |
$67.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$111.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$133.37
|
| Rate for Payer: BCBS of TX Medicare |
$67.36
|
| Rate for Payer: BCBS of TX PPO |
$148.87
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cigna Medicaid |
$67.36
|
| Rate for Payer: Cigna Medicare |
$67.36
|
| Rate for Payer: Employer Direct Commercial |
$67.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$67.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Molina Medicare |
$67.36
|
| Rate for Payer: Multiplan Auto |
$250.90
|
| Rate for Payer: Multiplan Commercial |
$250.90
|
| Rate for Payer: Multiplan Workers Comp |
$250.90
|
| Rate for Payer: Parkland Medicaid |
$67.36
|
| Rate for Payer: Scott and White EPO/PPO |
$84.20
|
| Rate for Payer: Scott and White Medicare |
$67.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.36
|
| Rate for Payer: Superior Health Plan EPO |
$67.36
|
| Rate for Payer: Superior Health Plan Medicare |
$67.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Universal American Medicare |
$67.36
|
| Rate for Payer: Wellcare Medicare |
$67.36
|
| Rate for Payer: Wellmed Medicare |
$67.36
|
|
|
.H. pylori Breath Test SO
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
1740995
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$339.68
|
|
|
.H. pylori Breath Test SO
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
1740995
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$250.90 |
| Rate for Payer: Aetna Commercial |
$70.74
|
| Rate for Payer: Aetna Medicare |
$101.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Amerigroup Medicare |
$67.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$111.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$133.37
|
| Rate for Payer: BCBS of TX Medicare |
$67.36
|
| Rate for Payer: BCBS of TX PPO |
$148.87
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cigna Medicaid |
$67.36
|
| Rate for Payer: Cigna Medicare |
$67.36
|
| Rate for Payer: Employer Direct Commercial |
$67.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$67.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Molina Medicare |
$67.36
|
| Rate for Payer: Multiplan Auto |
$250.90
|
| Rate for Payer: Multiplan Commercial |
$250.90
|
| Rate for Payer: Multiplan Workers Comp |
$250.90
|
| Rate for Payer: Parkland Medicaid |
$67.36
|
| Rate for Payer: Scott and White EPO/PPO |
$84.20
|
| Rate for Payer: Scott and White Medicare |
$67.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.36
|
| Rate for Payer: Superior Health Plan EPO |
$67.36
|
| Rate for Payer: Superior Health Plan Medicare |
$67.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$67.36
|
| Rate for Payer: Universal American Medicare |
$67.36
|
| Rate for Payer: Wellcare Medicare |
$67.36
|
| Rate for Payer: Wellmed Medicare |
$67.36
|
|
|
H. pylori, IgG Abs SO
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
1604990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Amerigroup Medicare |
$16.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.36
|
| Rate for Payer: BCBS of TX Medicare |
$16.85
|
| Rate for Payer: BCBS of TX PPO |
$37.24
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cigna Medicaid |
$16.85
|
| Rate for Payer: Cigna Medicare |
$16.85
|
| Rate for Payer: Employer Direct Commercial |
$16.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Molina Medicare |
$16.85
|
| Rate for Payer: Multiplan Auto |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: Multiplan Workers Comp |
$140.40
|
| Rate for Payer: Parkland Medicaid |
$16.85
|
| Rate for Payer: Scott and White EPO/PPO |
$21.06
|
| Rate for Payer: Scott and White Medicare |
$16.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.85
|
| Rate for Payer: Superior Health Plan EPO |
$16.85
|
| Rate for Payer: Superior Health Plan Medicare |
$16.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Universal American Medicare |
$16.85
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: Wellmed Medicare |
$16.85
|
|
|
H pylori, IgM, IgG, IgA Ab SO
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
1604990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Amerigroup Medicare |
$16.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.36
|
| Rate for Payer: BCBS of TX Medicare |
$16.85
|
| Rate for Payer: BCBS of TX PPO |
$37.24
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cigna Medicaid |
$16.85
|
| Rate for Payer: Cigna Medicare |
$16.85
|
| Rate for Payer: Employer Direct Commercial |
$16.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Molina Medicare |
$16.85
|
| Rate for Payer: Multiplan Auto |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: Multiplan Workers Comp |
$140.40
|
| Rate for Payer: Parkland Medicaid |
$16.85
|
| Rate for Payer: Scott and White EPO/PPO |
$21.06
|
| Rate for Payer: Scott and White Medicare |
$16.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.85
|
| Rate for Payer: Superior Health Plan EPO |
$16.85
|
| Rate for Payer: Superior Health Plan Medicare |
$16.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Universal American Medicare |
$16.85
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: Wellmed Medicare |
$16.85
|
|
|
H. pylori Stool Ag, EIA SO
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
1614015
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$183.92
|
|
|
H. pylori Stool Ag, EIA SO
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
1614015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.38
|
| Rate for Payer: Amerigroup Medicare |
$14.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.47
|
| Rate for Payer: BCBS of TX Medicare |
$14.38
|
| Rate for Payer: BCBS of TX PPO |
$31.78
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cigna Medicaid |
$14.38
|
| Rate for Payer: Cigna Medicare |
$14.38
|
| Rate for Payer: Employer Direct Commercial |
$14.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.38
|
| Rate for Payer: Molina Medicare |
$14.38
|
| Rate for Payer: Multiplan Auto |
$135.85
|
| Rate for Payer: Multiplan Commercial |
$135.85
|
| Rate for Payer: Multiplan Workers Comp |
$135.85
|
| Rate for Payer: Parkland Medicaid |
$14.38
|
| Rate for Payer: Scott and White EPO/PPO |
$17.98
|
| Rate for Payer: Scott and White Medicare |
$14.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.38
|
| Rate for Payer: Superior Health Plan EPO |
$14.38
|
| Rate for Payer: Superior Health Plan Medicare |
$14.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.38
|
| Rate for Payer: Universal American Medicare |
$14.38
|
| Rate for Payer: Wellcare Medicare |
$14.38
|
| Rate for Payer: Wellmed Medicare |
$14.38
|
|
|
HSV 1/2 PCR, CSF SO
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8722542
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$504.24
|
|
|
HSV 1/2 PCR, CSF SO
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8722542
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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 |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$372.45
|
| Rate for Payer: Multiplan Workers Comp |
$372.45
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| 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 |
$35.09
|
| 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
|
|
|
HSV 1/2 PCR SO
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1709013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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 |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$372.45
|
| Rate for Payer: Multiplan Workers Comp |
$372.45
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| 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 |
$35.09
|
| 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
|
|
|
HSV 1/2 PCR SO
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1709013
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$504.24
|
|
|
HSV 1 and 2 IgM Abs, Indirect SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
1708882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38.31
|
| Rate for Payer: BCBS of TX Medicare |
$19.35
|
| Rate for Payer: BCBS of TX PPO |
$42.76
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$19.35
|
| Rate for Payer: Cigna Medicare |
$19.35
|
| Rate for Payer: Employer Direct Commercial |
$19.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$19.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Molina Medicare |
$19.35
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$19.35
|
| Rate for Payer: Scott and White EPO/PPO |
$24.19
|
| Rate for Payer: Scott and White Medicare |
$19.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19.35
|
| Rate for Payer: Superior Health Plan EPO |
$19.35
|
| Rate for Payer: Superior Health Plan Medicare |
$19.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Universal American Medicare |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: Wellmed Medicare |
$19.35
|
|
|
HSV 1 and 2-Spec Ab, IgG w/Rfx SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
1708882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38.31
|
| Rate for Payer: BCBS of TX Medicare |
$19.35
|
| Rate for Payer: BCBS of TX PPO |
$42.76
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$19.35
|
| Rate for Payer: Cigna Medicare |
$19.35
|
| Rate for Payer: Employer Direct Commercial |
$19.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$19.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Molina Medicare |
$19.35
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$19.35
|
| Rate for Payer: Scott and White EPO/PPO |
$24.19
|
| Rate for Payer: Scott and White Medicare |
$19.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19.35
|
| Rate for Payer: Superior Health Plan EPO |
$19.35
|
| Rate for Payer: Superior Health Plan Medicare |
$19.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Universal American Medicare |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: Wellmed Medicare |
$19.35
|
|
|
.HSV-2 IgG Supplemental 163006 SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
1708882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38.31
|
| Rate for Payer: BCBS of TX Medicare |
$19.35
|
| Rate for Payer: BCBS of TX PPO |
$42.76
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$19.35
|
| Rate for Payer: Cigna Medicare |
$19.35
|
| Rate for Payer: Employer Direct Commercial |
$19.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$19.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Molina Medicare |
$19.35
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$19.35
|
| Rate for Payer: Scott and White EPO/PPO |
$24.19
|
| Rate for Payer: Scott and White Medicare |
$19.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19.35
|
| Rate for Payer: Superior Health Plan EPO |
$19.35
|
| Rate for Payer: Superior Health Plan Medicare |
$19.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Universal American Medicare |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: Wellmed Medicare |
$19.35
|
|
|
HSV-2 Type Spec Ab, IgG w/Rflx SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
1708882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38.31
|
| Rate for Payer: BCBS of TX Medicare |
$19.35
|
| Rate for Payer: BCBS of TX PPO |
$42.76
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$19.35
|
| Rate for Payer: Cigna Medicare |
$19.35
|
| Rate for Payer: Employer Direct Commercial |
$19.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$19.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Molina Medicare |
$19.35
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$19.35
|
| Rate for Payer: Scott and White EPO/PPO |
$24.19
|
| Rate for Payer: Scott and White Medicare |
$19.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19.35
|
| Rate for Payer: Superior Health Plan EPO |
$19.35
|
| Rate for Payer: Superior Health Plan Medicare |
$19.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Universal American Medicare |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: Wellmed Medicare |
$19.35
|
|
|
HSV-2 Type Spec Ab, IgG w/Rflx SO
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
1708882
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$105.60
|
|
|
HSV Culture and Typing SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1740928
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna Medicare |
$50.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Amerigroup Medicare |
$33.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$67.04
|
| Rate for Payer: BCBS of TX Medicare |
$33.86
|
| Rate for Payer: BCBS of TX PPO |
$74.83
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$33.86
|
| Rate for Payer: Cigna Medicare |
$33.86
|
| Rate for Payer: Employer Direct Commercial |
$33.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$33.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$33.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Molina Medicare |
$33.86
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$33.86
|
| Rate for Payer: Scott and White EPO/PPO |
$42.32
|
| Rate for Payer: Scott and White Medicare |
$33.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33.86
|
| Rate for Payer: Superior Health Plan EPO |
$33.86
|
| Rate for Payer: Superior Health Plan Medicare |
$33.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Universal American Medicare |
$33.86
|
| Rate for Payer: Wellcare Medicare |
$33.86
|
| Rate for Payer: Wellmed Medicare |
$33.86
|
|
|
HSV Culture Without Typing SO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
1740928
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna Medicare |
$50.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Amerigroup Medicare |
$33.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$67.04
|
| Rate for Payer: BCBS of TX Medicare |
$33.86
|
| Rate for Payer: BCBS of TX PPO |
$74.83
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Medicaid |
$33.86
|
| Rate for Payer: Cigna Medicare |
$33.86
|
| Rate for Payer: Employer Direct Commercial |
$33.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$33.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$33.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Molina Medicare |
$33.86
|
| Rate for Payer: Multiplan Auto |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Workers Comp |
$78.00
|
| Rate for Payer: Parkland Medicaid |
$33.86
|
| Rate for Payer: Scott and White EPO/PPO |
$42.32
|
| Rate for Payer: Scott and White Medicare |
$33.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33.86
|
| Rate for Payer: Superior Health Plan EPO |
$33.86
|
| Rate for Payer: Superior Health Plan Medicare |
$33.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33.86
|
| Rate for Payer: Universal American Medicare |
$33.86
|
| Rate for Payer: Wellcare Medicare |
$33.86
|
| Rate for Payer: Wellmed Medicare |
$33.86
|
|
