|
IMMUNOFIXATION ELECTRO OTHER FLUIDS
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
1605849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$297.05 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Amerigroup Medicare |
$29.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58.11
|
| Rate for Payer: BCBS of TX Medicare |
$29.35
|
| Rate for Payer: BCBS of TX PPO |
$64.86
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cigna Medicaid |
$29.35
|
| Rate for Payer: Cigna Medicare |
$29.35
|
| Rate for Payer: Employer Direct Commercial |
$29.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$29.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$29.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Molina Medicare |
$29.35
|
| Rate for Payer: Multiplan Auto |
$297.05
|
| Rate for Payer: Multiplan Commercial |
$297.05
|
| Rate for Payer: Multiplan Workers Comp |
$297.05
|
| Rate for Payer: Parkland Medicaid |
$29.35
|
| Rate for Payer: Scott and White EPO/PPO |
$36.69
|
| Rate for Payer: Scott and White Medicare |
$29.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$29.35
|
| Rate for Payer: Superior Health Plan EPO |
$29.35
|
| Rate for Payer: Superior Health Plan Medicare |
$29.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Universal American Medicare |
$29.35
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: Wellmed Medicare |
$29.35
|
|
|
Immunofixation, Serum SO
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
1602044
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$366.96
|
|
|
Immunofixation, Serum SO
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
1602044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$271.05 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Amerigroup Medicare |
$22.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.23
|
| Rate for Payer: BCBS of TX Medicare |
$22.34
|
| Rate for Payer: BCBS of TX PPO |
$49.37
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cigna Medicaid |
$22.34
|
| Rate for Payer: Cigna Medicare |
$22.34
|
| Rate for Payer: Employer Direct Commercial |
$22.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$22.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Molina Medicare |
$22.34
|
| Rate for Payer: Multiplan Auto |
$271.05
|
| Rate for Payer: Multiplan Commercial |
$271.05
|
| Rate for Payer: Multiplan Workers Comp |
$271.05
|
| Rate for Payer: Parkland Medicaid |
$22.34
|
| Rate for Payer: Scott and White EPO/PPO |
$27.92
|
| Rate for Payer: Scott and White Medicare |
$22.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.34
|
| Rate for Payer: Superior Health Plan EPO |
$22.34
|
| Rate for Payer: Superior Health Plan Medicare |
$22.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Universal American Medicare |
$22.34
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: Wellmed Medicare |
$22.34
|
|
|
Immunofixation, Urine SO
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
1605849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$297.05 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Amerigroup Medicare |
$29.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58.11
|
| Rate for Payer: BCBS of TX Medicare |
$29.35
|
| Rate for Payer: BCBS of TX PPO |
$64.86
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cigna Medicaid |
$29.35
|
| Rate for Payer: Cigna Medicare |
$29.35
|
| Rate for Payer: Employer Direct Commercial |
$29.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$29.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$29.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Molina Medicare |
$29.35
|
| Rate for Payer: Multiplan Auto |
$297.05
|
| Rate for Payer: Multiplan Commercial |
$297.05
|
| Rate for Payer: Multiplan Workers Comp |
$297.05
|
| Rate for Payer: Parkland Medicaid |
$29.35
|
| Rate for Payer: Scott and White EPO/PPO |
$36.69
|
| Rate for Payer: Scott and White Medicare |
$29.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$29.35
|
| Rate for Payer: Superior Health Plan EPO |
$29.35
|
| Rate for Payer: Superior Health Plan Medicare |
$29.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Universal American Medicare |
$29.35
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: Wellmed Medicare |
$29.35
|
|
|
Immunofixation, Urine SO
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
1605849
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$402.16
|
|
|
Immunoglobulin A, Qn, Serum SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
Immunoglobulin E, Total SO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
1701408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$159.90 |
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Amerigroup Medicare |
$16.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.59
|
| Rate for Payer: BCBS of TX Medicare |
$16.46
|
| Rate for Payer: BCBS of TX PPO |
$36.38
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cigna Medicaid |
$16.46
|
| Rate for Payer: Cigna Medicare |
$16.46
|
| Rate for Payer: Employer Direct Commercial |
$16.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Molina Medicare |
$16.46
|
| Rate for Payer: Multiplan Auto |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$159.90
|
| Rate for Payer: Multiplan Workers Comp |
$159.90
|
| Rate for Payer: Parkland Medicaid |
$16.46
|
| Rate for Payer: Scott and White EPO/PPO |
$20.58
|
| Rate for Payer: Scott and White Medicare |
$16.46
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.46
|
| Rate for Payer: Superior Health Plan EPO |
$16.46
|
| Rate for Payer: Superior Health Plan Medicare |
$16.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Universal American Medicare |
$16.46
|
| Rate for Payer: Wellcare Medicare |
$16.46
|
| Rate for Payer: Wellmed Medicare |
$16.46
|
|
|
Immunoglobulin G, Qn, Serum SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
Immunoglobulin G, Quant, CSF SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
Immunoglobulin G,Syn Rate,CSF SO
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1601491
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$158.40
|
|
|
Immunoglobulin G,Syn Rate,CSF SO
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1601491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.80
|
| Rate for Payer: BCBS of TX Medicare |
$4.95
|
| Rate for Payer: BCBS of TX PPO |
$10.94
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Medicaid |
$4.95
|
| Rate for Payer: Cigna Medicare |
$4.95
|
| Rate for Payer: Employer Direct Commercial |
$4.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Molina Medicare |
$4.95
|
| Rate for Payer: Multiplan Auto |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Workers Comp |
$117.00
|
| Rate for Payer: Parkland Medicaid |
$4.95
|
| Rate for Payer: Scott and White EPO/PPO |
$6.19
|
| Rate for Payer: Scott and White Medicare |
$4.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.95
|
| Rate for Payer: Superior Health Plan EPO |
$4.95
|
| Rate for Payer: Superior Health Plan Medicare |
$4.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Universal American Medicare |
$4.95
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: Wellmed Medicare |
$4.95
|
|
|
Immunoglobulin M, Qn, Serum SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
Immunoglobulins A/E/G/M, Serum SO
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
1701408
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$216.48
|
|
|
Immunoglobulins A/E/G/M, Serum SO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
1701408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$159.90 |
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Amerigroup Medicare |
$16.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.59
|
| Rate for Payer: BCBS of TX Medicare |
$16.46
|
| Rate for Payer: BCBS of TX PPO |
$36.38
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cigna Medicaid |
$16.46
|
| Rate for Payer: Cigna Medicare |
$16.46
|
| Rate for Payer: Employer Direct Commercial |
$16.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Molina Medicare |
$16.46
|
| Rate for Payer: Multiplan Auto |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$159.90
|
| Rate for Payer: Multiplan Workers Comp |
$159.90
|
| Rate for Payer: Parkland Medicaid |
$16.46
|
| Rate for Payer: Scott and White EPO/PPO |
$20.58
|
| Rate for Payer: Scott and White Medicare |
$16.46
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.46
|
| Rate for Payer: Superior Health Plan EPO |
$16.46
|
| Rate for Payer: Superior Health Plan Medicare |
$16.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.46
|
| Rate for Payer: Universal American Medicare |
$16.46
|
| Rate for Payer: Wellcare Medicare |
$16.46
|
| Rate for Payer: Wellmed Medicare |
$16.46
|
|
|
Immunoglobulins A/G/M, Qn, Ser SO
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$175.12
|
|
|
Immunoglobulins A/G/M, Qn, Ser SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
IMMUNOGLOBULIN SUB CL G1,2,3OR 4 EA
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
1703925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.02
|
| Rate for Payer: Amerigroup Medicare |
$8.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.88
|
| Rate for Payer: BCBS of TX Medicare |
$8.02
|
| Rate for Payer: BCBS of TX PPO |
$17.72
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Medicaid |
$8.02
|
| Rate for Payer: Cigna Medicare |
$8.02
|
| Rate for Payer: Employer Direct Commercial |
$8.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.02
|
| Rate for Payer: Molina Medicare |
$8.02
|
| Rate for Payer: Multiplan Auto |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$32.50
|
| Rate for Payer: Multiplan Workers Comp |
$32.50
|
| Rate for Payer: Parkland Medicaid |
$8.02
|
| Rate for Payer: Scott and White EPO/PPO |
$10.02
|
| Rate for Payer: Scott and White Medicare |
$8.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.02
|
| Rate for Payer: Superior Health Plan EPO |
$8.02
|
| Rate for Payer: Superior Health Plan Medicare |
$8.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.02
|
| Rate for Payer: Universal American Medicare |
$8.02
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: Wellmed Medicare |
$8.02
|
|
|
IMMUNOGLOBULIN SUB CL G1,2,3OR 4 EA
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
1703925
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$44.00
|
|
|
IMOBL SHLDR -- DHF
|
Facility
|
OP
|
$130.67
|
|
| Hospital Charge Code |
81143505
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$84.94 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$47.04
|
| Rate for Payer: BCBS of TX PPO |
$52.27
|
| Rate for Payer: Cash Price |
$114.99
|
| Rate for Payer: Multiplan Auto |
$84.94
|
| Rate for Payer: Multiplan Commercial |
$84.94
|
| Rate for Payer: Multiplan Workers Comp |
$84.94
|
| Rate for Payer: Scott and White EPO/PPO |
$65.34
|
| Rate for Payer: Superior Health Plan EPO |
$17.77
|
|
|
IMOBL SHLDR -- DHF
|
Facility
|
IP
|
$130.67
|
|
| Hospital Charge Code |
81143505
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$114.99
|
|
|
IMP ACHILLES MIDSUBSTANCE SPEEDBRIDGE
|
Facility
|
IP
|
$8,391.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.89 |
| Max. Negotiated Rate |
$4,195.78 |
| Rate for Payer: Aetna Commercial |
$2,517.47
|
| Rate for Payer: Cash Price |
$7,384.58
|
| Rate for Payer: Cigna Commercial |
$2,097.89
|
| Rate for Payer: Multiplan Auto |
$4,195.78
|
| Rate for Payer: Multiplan Commercial |
$4,195.78
|
| Rate for Payer: Multiplan Workers Comp |
$4,195.78
|
| Rate for Payer: Scott and White EPO/PPO |
$4,195.78
|
|
|
IMP ACHILLES MIDSUBSTANCE SPEEDBRIDGE
|
Facility
|
OP
|
$8,391.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$755.24 |
| Max. Negotiated Rate |
$4,195.78 |
| Rate for Payer: Aetna Commercial |
$2,517.47
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$755.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,517.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,020.97
|
| Rate for Payer: BCBS of TX PPO |
$3,356.63
|
| Rate for Payer: Cash Price |
$7,384.58
|
| Rate for Payer: Multiplan Auto |
$4,195.78
|
| Rate for Payer: Multiplan Commercial |
$4,195.78
|
| Rate for Payer: Multiplan Workers Comp |
$4,195.78
|
| Rate for Payer: Scott and White EPO/PPO |
$4,195.78
|
| Rate for Payer: Superior Health Plan EPO |
$1,141.25
|
|
|
IMP BN SUBST FOAM 5CC -- DHF
|
Facility
|
OP
|
$10,537.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40112013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.42 |
| Max. Negotiated Rate |
$5,268.98 |
| Rate for Payer: Aetna Commercial |
$3,161.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$948.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,161.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,793.66
|
| Rate for Payer: BCBS of TX PPO |
$4,215.18
|
| Rate for Payer: Cash Price |
$9,273.40
|
| Rate for Payer: Multiplan Auto |
$5,268.98
|
| Rate for Payer: Multiplan Commercial |
$5,268.98
|
| Rate for Payer: Multiplan Workers Comp |
$5,268.98
|
| Rate for Payer: Scott and White EPO/PPO |
$5,268.98
|
| Rate for Payer: Superior Health Plan EPO |
$1,433.16
|
|
|
IMP BN SUBST FOAM 5CC -- DHF
|
Facility
|
IP
|
$10,537.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40112013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,634.49 |
| Max. Negotiated Rate |
$5,268.98 |
| Rate for Payer: Aetna Commercial |
$3,161.38
|
| Rate for Payer: Cash Price |
$9,273.40
|
| Rate for Payer: Cigna Commercial |
$2,634.49
|
| Rate for Payer: Multiplan Auto |
$5,268.98
|
| Rate for Payer: Multiplan Commercial |
$5,268.98
|
| Rate for Payer: Multiplan Workers Comp |
$5,268.98
|
| Rate for Payer: Scott and White EPO/PPO |
$5,268.98
|
|
|
IMP JOINT TOE -- DHF
|
Facility
|
IP
|
$5,187.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
82401498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,296.85 |
| Max. Negotiated Rate |
$2,593.70 |
| Rate for Payer: Aetna Commercial |
$1,556.22
|
| Rate for Payer: Cash Price |
$4,564.92
|
| Rate for Payer: Cigna Commercial |
$1,296.85
|
| Rate for Payer: Multiplan Auto |
$2,593.70
|
| Rate for Payer: Multiplan Commercial |
$2,593.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,593.70
|
| Rate for Payer: Scott and White EPO/PPO |
$2,593.70
|
|
