|
ANGIOPLASTY ILIAC ARTERY UNI LAT
|
Facility
|
OP
|
$11,511.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
2320532
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,337.18 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,840.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Amerigroup Medicare |
$5,227.24
|
| 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 Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$10,129.68
|
| Rate for Payer: Cash Price |
$10,129.68
|
| Rate for Payer: Cigna Commercial |
$11,841.22
|
| Rate for Payer: Cigna Medicaid |
$2,337.18
|
| Rate for Payer: Cigna Medicare |
$5,227.24
|
| Rate for Payer: Employer Direct Commercial |
$5,227.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,227.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Molina Medicare |
$5,227.24
|
| 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 |
$2,337.18
|
| Rate for Payer: Scott and White EPO/PPO |
$9,670.39
|
| Rate for Payer: Scott and White Medicare |
$5,227.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Superior Health Plan EPO |
$5,227.24
|
| Rate for Payer: Superior Health Plan Medicare |
$5,227.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Universal American Medicare |
$5,227.24
|
| Rate for Payer: Wellcare Medicare |
$5,227.24
|
| Rate for Payer: Wellmed Medicare |
$5,227.24
|
|
|
ANGIOPLASTY+STENT TIBIAL/PERONEAL
|
Facility
|
OP
|
$37,815.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
2320542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,497.34 |
| Max. Negotiated Rate |
$40,168.72 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$24,055.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,497.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Amerigroup Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$33,277.20
|
| Rate for Payer: Cash Price |
$33,277.20
|
| Rate for Payer: Cigna Commercial |
$36,327.71
|
| Rate for Payer: Cigna Medicaid |
$8,497.34
|
| Rate for Payer: Cigna Medicare |
$16,036.68
|
| Rate for Payer: Employer Direct Commercial |
$16,036.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,036.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,497.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Molina Medicare |
$16,036.68
|
| 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 |
$8,497.34
|
| Rate for Payer: Scott and White EPO/PPO |
$29,667.86
|
| Rate for Payer: Scott and White Medicare |
$16,036.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,497.34
|
| Rate for Payer: Superior Health Plan EPO |
$16,036.68
|
| Rate for Payer: Superior Health Plan Medicare |
$16,036.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Universal American Medicare |
$16,036.68
|
| Rate for Payer: Wellcare Medicare |
$16,036.68
|
| Rate for Payer: Wellmed Medicare |
$16,036.68
|
|
|
ANGIOPLASTY+STENT TIBIAL/PERONEAL
|
Facility
|
IP
|
$37,815.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
2320542
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$33,277.20
|
|
|
ANGIOPLASTY TIBIAL/PERONEAL
|
Facility
|
OP
|
$23,790.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
2320540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,750.92 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,750.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$20,935.20
|
| Rate for Payer: Cash Price |
$20,935.20
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicaid |
$4,750.92
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,750.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| 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 |
$4,750.92
|
| Rate for Payer: Scott and White EPO/PPO |
$18,612.98
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,750.92
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
ANGIOPLASTY TIBIAL/PERONEAL
|
Facility
|
IP
|
$23,790.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
2320540
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,935.20
|
|
|
ANGIO PULM NON-SEL CATH
|
Facility
|
OP
|
$4,645.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
4615747
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$92.87
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$153.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$184.10
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$205.49
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$134.99
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$134.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,019.25
|
| Rate for Payer: Multiplan Commercial |
$3,019.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,019.25
|
| Rate for Payer: Parkland Medicaid |
$134.99
|
| Rate for Payer: Scott and White EPO/PPO |
$166.22
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$134.99
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIO PULM NON-SEL CATH
|
Facility
|
IP
|
$4,645.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
4615747
|
|
Hospital Revenue Code
|
323
|
| Rate for Payer: Cash Price |
$4,087.60
|
|
|
ANGIO PULM SEL BI
|
Facility
|
OP
|
$4,645.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
4615744
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$82.84
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$148.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$148.35
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$148.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,019.25
|
| Rate for Payer: Multiplan Commercial |
$3,019.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,019.25
|
| Rate for Payer: Parkland Medicaid |
$148.35
|
| Rate for Payer: Scott and White EPO/PPO |
$181.70
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$148.35
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIO PULM SEL BI
|
Facility
|
IP
|
$4,645.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
4615744
|
|
Hospital Revenue Code
|
323
|
| Rate for Payer: Cash Price |
$4,087.60
|
|
|
ANGIO SELECT EA ADDTL VESSEL
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
2320364
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$963.60
|
|
|
ANGIO SELECT EA ADDTL VESSEL
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
2320364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$711.75 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$109.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$131.29
|
| Rate for Payer: BCBS of TX PPO |
$146.55
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Multiplan Auto |
$711.75
|
| Rate for Payer: Multiplan Commercial |
$711.75
|
| Rate for Payer: Multiplan Workers Comp |
$711.75
|
| Rate for Payer: Scott and White EPO/PPO |
$118.80
|
| Rate for Payer: Superior Health Plan EPO |
$148.92
|
|
|
Angiotensin-Converting Enzyme SO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
1701648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$159.90 |
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Medicare |
$21.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.60
|
| Rate for Payer: Amerigroup Medicare |
$14.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.91
|
| Rate for Payer: BCBS of TX Medicare |
$14.60
|
| Rate for Payer: BCBS of TX PPO |
$32.27
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cash Price |
$216.48
|
| Rate for Payer: Cigna Medicaid |
$14.60
|
| Rate for Payer: Cigna Medicare |
$14.60
|
| Rate for Payer: Employer Direct Commercial |
$14.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.60
|
| Rate for Payer: Molina Medicare |
$14.60
|
| 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 |
$14.60
|
| Rate for Payer: Scott and White EPO/PPO |
$18.25
|
| Rate for Payer: Scott and White Medicare |
$14.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.60
|
| Rate for Payer: Superior Health Plan EPO |
$14.60
|
| Rate for Payer: Superior Health Plan Medicare |
$14.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.60
|
| Rate for Payer: Universal American Medicare |
$14.60
|
| Rate for Payer: Wellcare Medicare |
$14.60
|
| Rate for Payer: Wellmed Medicare |
$14.60
|
|
|
Angiotensin-Converting Enzyme SO
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
1701648
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$216.48
|
|
|
ANS BREATH/CIR -- DHF
|
Facility
|
IP
|
$487.79
|
|
| Hospital Charge Code |
81711350
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$429.26
|
|
|
ANS BREATH/CIR -- DHF
|
Facility
|
OP
|
$487.79
|
|
| Hospital Charge Code |
81711350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$317.06 |
| Rate for Payer: Aetna Commercial |
$268.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$146.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$175.60
|
| Rate for Payer: BCBS of TX PPO |
$195.12
|
| Rate for Payer: Cash Price |
$429.26
|
| Rate for Payer: Multiplan Auto |
$317.06
|
| Rate for Payer: Multiplan Commercial |
$317.06
|
| Rate for Payer: Multiplan Workers Comp |
$317.06
|
| Rate for Payer: Scott and White EPO/PPO |
$243.90
|
| Rate for Payer: Superior Health Plan EPO |
$66.34
|
|
|
ANTEGRADE NEPHROSTOGRAM
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
4614425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.10 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$133.10
|
| Rate for Payer: Aetna Medicare |
$527.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$137.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$381.04
|
| Rate for Payer: Cash Price |
$381.04
|
| Rate for Payer: Cash Price |
$381.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$137.66
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$137.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$281.45
|
| Rate for Payer: Multiplan Commercial |
$281.45
|
| Rate for Payer: Multiplan Workers Comp |
$281.45
|
| Rate for Payer: Parkland Medicaid |
$137.66
|
| Rate for Payer: Scott and White EPO/PPO |
$167.68
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$137.66
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
ANTEGRADE NEPHROSTOGRAM
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
4614425
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$381.04
|
|
|
ANTIBODY ASPERGILLUS
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1706894
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$15.80
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Amerigroup Medicare |
$15.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.80
|
| Rate for Payer: BCBS of TX Medicare |
$15.05
|
| Rate for Payer: BCBS of TX PPO |
$33.26
|
| Rate for Payer: Cash Price |
$178.64
|
| Rate for Payer: Cash Price |
$178.64
|
| Rate for Payer: Cigna Medicaid |
$15.05
|
| Rate for Payer: Cigna Medicare |
$15.05
|
| Rate for Payer: Employer Direct Commercial |
$15.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Molina Medicare |
$15.05
|
| Rate for Payer: Multiplan Auto |
$131.95
|
| Rate for Payer: Multiplan Commercial |
$131.95
|
| Rate for Payer: Multiplan Workers Comp |
$131.95
|
| Rate for Payer: Parkland Medicaid |
$15.05
|
| Rate for Payer: Scott and White EPO/PPO |
$18.81
|
| Rate for Payer: Scott and White Medicare |
$15.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.05
|
| Rate for Payer: Superior Health Plan EPO |
$15.05
|
| Rate for Payer: Superior Health Plan Medicare |
$15.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Universal American Medicare |
$15.05
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: Wellmed Medicare |
$15.05
|
|
|
ANTIBODY BORRELIA BURGDORFERI LYME
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
1704709
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$17.89
|
| Rate for Payer: Aetna Medicare |
$25.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.03
|
| Rate for Payer: Amerigroup Medicare |
$17.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.72
|
| Rate for Payer: BCBS of TX Medicare |
$17.03
|
| Rate for Payer: BCBS of TX PPO |
$37.64
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Cigna Medicaid |
$17.03
|
| Rate for Payer: Cigna Medicare |
$17.03
|
| Rate for Payer: Employer Direct Commercial |
$17.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.03
|
| Rate for Payer: Molina Medicare |
$17.03
|
| Rate for Payer: Multiplan Auto |
$169.65
|
| Rate for Payer: Multiplan Commercial |
$169.65
|
| Rate for Payer: Multiplan Workers Comp |
$169.65
|
| Rate for Payer: Parkland Medicaid |
$17.03
|
| Rate for Payer: Scott and White EPO/PPO |
$21.29
|
| Rate for Payer: Scott and White Medicare |
$17.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.03
|
| Rate for Payer: Superior Health Plan EPO |
$17.03
|
| Rate for Payer: Superior Health Plan Medicare |
$17.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.03
|
| Rate for Payer: Universal American Medicare |
$17.03
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: Wellmed Medicare |
$17.03
|
|
|
ANTIBODY CYTOMEGALOVIRUS IGM
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
1702596
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$25.27
|
| 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 |
$364.32
|
| Rate for Payer: Cash Price |
$364.32
|
| 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 |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| 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
|
|
|
ANTIBODY ENTEROVIRUS
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
1702323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Aetna Medicare |
$19.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Amerigroup Medicare |
$13.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.80
|
| Rate for Payer: BCBS of TX Medicare |
$13.03
|
| Rate for Payer: BCBS of TX PPO |
$28.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Medicaid |
$13.03
|
| Rate for Payer: Cigna Medicare |
$13.03
|
| Rate for Payer: Employer Direct Commercial |
$13.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Molina Medicare |
$13.03
|
| Rate for Payer: Multiplan Auto |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$81.25
|
| Rate for Payer: Multiplan Workers Comp |
$81.25
|
| Rate for Payer: Parkland Medicaid |
$13.03
|
| Rate for Payer: Scott and White EPO/PPO |
$16.29
|
| Rate for Payer: Scott and White Medicare |
$13.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.03
|
| Rate for Payer: Superior Health Plan EPO |
$13.03
|
| Rate for Payer: Superior Health Plan Medicare |
$13.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Universal American Medicare |
$13.03
|
| Rate for Payer: Wellcare Medicare |
$13.03
|
| Rate for Payer: Wellmed Medicare |
$13.03
|
|
|
ANTIBODY EPSTEIIN BARR VIRUS VCA
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1702232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Medicare |
$27.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.14
|
| Rate for Payer: Amerigroup Medicare |
$18.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.92
|
| Rate for Payer: BCBS of TX Medicare |
$18.14
|
| Rate for Payer: BCBS of TX PPO |
$40.09
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$18.14
|
| Rate for Payer: Cigna Medicare |
$18.14
|
| Rate for Payer: Employer Direct Commercial |
$18.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.14
|
| Rate for Payer: Molina Medicare |
$18.14
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Parkland Medicaid |
$18.14
|
| Rate for Payer: Scott and White EPO/PPO |
$22.68
|
| Rate for Payer: Scott and White Medicare |
$18.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.14
|
| Rate for Payer: Superior Health Plan EPO |
$18.14
|
| Rate for Payer: Superior Health Plan Medicare |
$18.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.14
|
| Rate for Payer: Universal American Medicare |
$18.14
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
| Rate for Payer: Wellmed Medicare |
$18.14
|
|
|
ANTIBODY HELICOBACTER PYLORI
|
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 |
$25.27
|
| 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
|
|
|
ANTIBODY HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
1701226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Medicare |
$19.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.19
|
| Rate for Payer: Amerigroup Medicare |
$13.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.12
|
| Rate for Payer: BCBS of TX Medicare |
$13.19
|
| Rate for Payer: BCBS of TX PPO |
$29.15
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cigna Medicaid |
$13.19
|
| Rate for Payer: Cigna Medicare |
$13.19
|
| Rate for Payer: Employer Direct Commercial |
$13.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.19
|
| Rate for Payer: Molina Medicare |
$13.19
|
| Rate for Payer: Multiplan Auto |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: Multiplan Workers Comp |
$63.70
|
| Rate for Payer: Parkland Medicaid |
$13.19
|
| Rate for Payer: Scott and White EPO/PPO |
$16.49
|
| Rate for Payer: Scott and White Medicare |
$13.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.19
|
| Rate for Payer: Superior Health Plan EPO |
$13.19
|
| Rate for Payer: Superior Health Plan Medicare |
$13.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.19
|
| Rate for Payer: Universal American Medicare |
$13.19
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: Wellmed Medicare |
$13.19
|
|
|
ANTIBODY HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
1701226
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$86.24
|
|
