|
ANTIBODY HISTOPLASMA
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
1704030
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$82.72
|
|
|
ANTIBODY HISTOPLASMA
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
1704030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$20.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.79
|
| Rate for Payer: Amerigroup Medicare |
$13.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.30
|
| Rate for Payer: BCBS of TX Medicare |
$13.79
|
| Rate for Payer: BCBS of TX PPO |
$30.48
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Medicaid |
$13.79
|
| Rate for Payer: Cigna Medicare |
$13.79
|
| Rate for Payer: Employer Direct Commercial |
$13.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.79
|
| Rate for Payer: Molina Medicare |
$13.79
|
| Rate for Payer: Multiplan Auto |
$61.10
|
| Rate for Payer: Multiplan Commercial |
$61.10
|
| Rate for Payer: Multiplan Workers Comp |
$61.10
|
| Rate for Payer: Parkland Medicaid |
$13.79
|
| Rate for Payer: Scott and White EPO/PPO |
$17.24
|
| Rate for Payer: Scott and White Medicare |
$13.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.79
|
| Rate for Payer: Superior Health Plan EPO |
$13.79
|
| Rate for Payer: Superior Health Plan Medicare |
$13.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.79
|
| Rate for Payer: Universal American Medicare |
$13.79
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
| Rate for Payer: Wellmed Medicare |
$13.79
|
|
|
ANTIBODY HIV-1
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
1614007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.89
|
| Rate for Payer: Amerigroup Medicare |
$8.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.60
|
| Rate for Payer: BCBS of TX Medicare |
$8.89
|
| Rate for Payer: BCBS of TX PPO |
$19.65
|
| Rate for Payer: Cash Price |
$185.68
|
| Rate for Payer: Cash Price |
$185.68
|
| Rate for Payer: Cigna Medicaid |
$8.89
|
| Rate for Payer: Cigna Medicare |
$8.89
|
| Rate for Payer: Employer Direct Commercial |
$8.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.89
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.89
|
| Rate for Payer: Molina Medicare |
$8.89
|
| Rate for Payer: Multiplan Auto |
$137.15
|
| Rate for Payer: Multiplan Commercial |
$137.15
|
| Rate for Payer: Multiplan Workers Comp |
$137.15
|
| Rate for Payer: Parkland Medicaid |
$8.89
|
| Rate for Payer: Scott and White EPO/PPO |
$11.11
|
| Rate for Payer: Scott and White Medicare |
$8.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.89
|
| Rate for Payer: Superior Health Plan EPO |
$8.89
|
| Rate for Payer: Superior Health Plan Medicare |
$8.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.89
|
| Rate for Payer: Universal American Medicare |
$8.89
|
| Rate for Payer: Wellcare Medicare |
$8.89
|
| Rate for Payer: Wellmed Medicare |
$8.89
|
|
|
ANTIBODY HIV-1
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
1614007
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$185.68
|
|
|
ANTIBODY; HTLV-I
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86687
|
| Hospital Charge Code |
1700037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.09
|
| Rate for Payer: Amerigroup Medicare |
$9.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.00
|
| Rate for Payer: BCBS of TX Medicare |
$9.09
|
| Rate for Payer: BCBS of TX PPO |
$20.09
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$9.09
|
| Rate for Payer: Cigna Medicare |
$9.09
|
| Rate for Payer: Employer Direct Commercial |
$9.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.09
|
| Rate for Payer: Molina Medicare |
$9.09
|
| 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 |
$9.09
|
| Rate for Payer: Scott and White EPO/PPO |
$11.36
|
| Rate for Payer: Scott and White Medicare |
$9.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.09
|
| Rate for Payer: Superior Health Plan EPO |
$9.09
|
| Rate for Payer: Superior Health Plan Medicare |
$9.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.09
|
| Rate for Payer: Universal American Medicare |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$9.09
|
| Rate for Payer: Wellmed Medicare |
$9.09
|
|
|
ANTIBODY; HTLV-I
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86687
|
| Hospital Charge Code |
1700037
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$102.96
|
|
|
Antibody Identification
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2403061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$302.90
|
| Rate for Payer: Multiplan Commercial |
$302.90
|
| Rate for Payer: Multiplan Workers Comp |
$302.90
|
| Rate for Payer: Scott and White EPO/PPO |
$5.88
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
ANTIBODY INFLUENZA VIRUS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
1705953
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Amerigroup Medicare |
$13.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.83
|
| Rate for Payer: BCBS of TX Medicare |
$13.55
|
| Rate for Payer: BCBS of TX PPO |
$29.95
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cigna Medicaid |
$13.55
|
| Rate for Payer: Cigna Medicare |
$13.55
|
| Rate for Payer: Employer Direct Commercial |
$13.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Molina Medicare |
$13.55
|
| Rate for Payer: Multiplan Auto |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Multiplan Workers Comp |
$114.40
|
| Rate for Payer: Parkland Medicaid |
$13.55
|
| Rate for Payer: Scott and White EPO/PPO |
$16.94
|
| Rate for Payer: Scott and White Medicare |
$13.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.55
|
| Rate for Payer: Superior Health Plan EPO |
$13.55
|
| Rate for Payer: Superior Health Plan Medicare |
$13.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Universal American Medicare |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: Wellmed Medicare |
$13.55
|
|
|
ANTIBODY MUMPS
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
1705557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$13.70
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.84
|
| Rate for Payer: BCBS of TX Medicare |
$13.05
|
| Rate for Payer: BCBS of TX PPO |
$28.84
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$13.05
|
| Rate for Payer: Cigna Medicare |
$13.05
|
| Rate for Payer: Employer Direct Commercial |
$13.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Molina Medicare |
$13.05
|
| 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 |
$13.05
|
| Rate for Payer: Scott and White EPO/PPO |
$16.31
|
| Rate for Payer: Scott and White Medicare |
$13.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.05
|
| Rate for Payer: Superior Health Plan EPO |
$13.05
|
| Rate for Payer: Superior Health Plan Medicare |
$13.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Universal American Medicare |
$13.05
|
| Rate for Payer: Wellcare Medicare |
$13.05
|
| Rate for Payer: Wellmed Medicare |
$13.05
|
|
|
ANTIBODY MYCOPLASMA
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
1701200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Multiplan Workers Comp |
$221.00
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
ANTIBODY PARVOVIRUS
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
1703842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$33.22 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Amerigroup Medicare |
$15.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.76
|
| Rate for Payer: BCBS of TX Medicare |
$15.03
|
| Rate for Payer: BCBS of TX PPO |
$33.22
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cigna Medicaid |
$15.03
|
| Rate for Payer: Cigna Medicare |
$15.03
|
| Rate for Payer: Employer Direct Commercial |
$15.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Molina Medicare |
$15.03
|
| Rate for Payer: Multiplan Auto |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Workers Comp |
$18.20
|
| Rate for Payer: Parkland Medicaid |
$15.03
|
| Rate for Payer: Scott and White EPO/PPO |
$18.79
|
| Rate for Payer: Scott and White Medicare |
$15.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.03
|
| Rate for Payer: Superior Health Plan EPO |
$15.03
|
| Rate for Payer: Superior Health Plan Medicare |
$15.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Universal American Medicare |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: Wellmed Medicare |
$15.03
|
|
|
ANTIBODY RUBELLA
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
1605377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.49
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$31.80
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cigna Medicaid |
$14.39
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Parkland Medicaid |
$14.39
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.39
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
ANTIBODY RUBEOLA
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$96.20 |
| 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 |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| 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 |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| 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
|
|
|
Antibody Screen Echo
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| 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 |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| 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 |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| 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
|
|
|
Antibody Screen Gel
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| 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 |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| 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 |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| 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
|
|
|
Antibody Screen Tube
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| 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 |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| 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 |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| 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
|
|
|
ANTIBODY TOXOPLASMA IGM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
1703024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Medicare |
$21.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.41
|
| Rate for Payer: Amerigroup Medicare |
$14.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.53
|
| Rate for Payer: BCBS of TX Medicare |
$14.41
|
| Rate for Payer: BCBS of TX PPO |
$31.85
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Medicaid |
$14.41
|
| Rate for Payer: Cigna Medicare |
$14.41
|
| Rate for Payer: Employer Direct Commercial |
$14.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.41
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.41
|
| Rate for Payer: Molina Medicare |
$14.41
|
| Rate for Payer: Multiplan Auto |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Workers Comp |
$58.50
|
| Rate for Payer: Parkland Medicaid |
$14.41
|
| Rate for Payer: Scott and White EPO/PPO |
$18.01
|
| Rate for Payer: Scott and White Medicare |
$14.41
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.41
|
| Rate for Payer: Superior Health Plan EPO |
$14.41
|
| Rate for Payer: Superior Health Plan Medicare |
$14.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.41
|
| Rate for Payer: Universal American Medicare |
$14.41
|
| Rate for Payer: Wellcare Medicare |
$14.41
|
| Rate for Payer: Wellmed Medicare |
$14.41
|
|
|
ANTIBODY VARICELLA-ZOSTER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
1700897
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$128.05 |
| 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 |
$173.36
|
| Rate for Payer: Cash Price |
$173.36
|
| 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 |
$128.05
|
| Rate for Payer: Multiplan Commercial |
$128.05
|
| Rate for Payer: Multiplan Workers Comp |
$128.05
|
| 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
|
|
|
Anticardiolip Ab, IgA/G/M, Qn SO
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
1702406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: Aetna Commercial |
$26.72
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.39
|
| Rate for Payer: BCBS of TX Medicare |
$25.45
|
| Rate for Payer: BCBS of TX PPO |
$56.24
|
| Rate for Payer: Cash Price |
$73.92
|
| Rate for Payer: Cash Price |
$73.92
|
| Rate for Payer: Cigna Medicaid |
$25.45
|
| Rate for Payer: Cigna Medicare |
$25.45
|
| Rate for Payer: Employer Direct Commercial |
$25.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Molina Medicare |
$25.45
|
| Rate for Payer: Multiplan Auto |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$54.60
|
| Rate for Payer: Multiplan Workers Comp |
$54.60
|
| Rate for Payer: Parkland Medicaid |
$25.45
|
| Rate for Payer: Scott and White EPO/PPO |
$31.81
|
| Rate for Payer: Scott and White Medicare |
$25.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.45
|
| Rate for Payer: Superior Health Plan EPO |
$25.45
|
| Rate for Payer: Superior Health Plan Medicare |
$25.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Universal American Medicare |
$25.45
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: Wellmed Medicare |
$25.45
|
|
|
Anticardiolip Ab, IgA/G/M, Qn SO
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
1702406
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$73.92
|
|
|
Anti-Centromere B Antibodies SO
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1701143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.93
|
| Rate for Payer: Amerigroup Medicare |
$17.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.50
|
| Rate for Payer: BCBS of TX Medicare |
$17.93
|
| Rate for Payer: BCBS of TX PPO |
$39.63
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cigna Medicaid |
$17.93
|
| Rate for Payer: Cigna Medicare |
$17.93
|
| Rate for Payer: Employer Direct Commercial |
$17.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare |
$17.93
|
| Rate for Payer: Multiplan Auto |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$149.50
|
| Rate for Payer: Multiplan Workers Comp |
$149.50
|
| Rate for Payer: Parkland Medicaid |
$17.93
|
| Rate for Payer: Scott and White EPO/PPO |
$22.41
|
| Rate for Payer: Scott and White Medicare |
$17.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.93
|
| Rate for Payer: Superior Health Plan EPO |
$17.93
|
| Rate for Payer: Superior Health Plan Medicare |
$17.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.93
|
| Rate for Payer: Universal American Medicare |
$17.93
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: Wellmed Medicare |
$17.93
|
|
|
Anti-DNA(SS)IgG, Ab, Qn SO
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
1703891
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$74.80
|
|
|
Anti-DNA(SS)IgG, Ab, Qn SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
1703891
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Medicare |
$18.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.98
|
| Rate for Payer: BCBS of TX Medicare |
$12.11
|
| Rate for Payer: BCBS of TX PPO |
$26.76
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cigna Medicaid |
$12.11
|
| Rate for Payer: Cigna Medicare |
$12.11
|
| Rate for Payer: Employer Direct Commercial |
$12.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Molina Medicare |
$12.11
|
| Rate for Payer: Multiplan Auto |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| Rate for Payer: Parkland Medicaid |
$12.11
|
| Rate for Payer: Scott and White EPO/PPO |
$15.14
|
| Rate for Payer: Scott and White Medicare |
$12.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.11
|
| Rate for Payer: Superior Health Plan EPO |
$12.11
|
| Rate for Payer: Superior Health Plan Medicare |
$12.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Universal American Medicare |
$12.11
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: Wellmed Medicare |
$12.11
|
|
|
Anti-dsDNA Antibodies SO
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
1605344
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$374.88
|
|
|
Anti-dsDNA Antibodies SO
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
1605344
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$276.90 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$20.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Amerigroup Medicare |
$13.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.21
|
| Rate for Payer: BCBS of TX Medicare |
$13.74
|
| Rate for Payer: BCBS of TX PPO |
$30.37
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cigna Medicaid |
$13.74
|
| Rate for Payer: Cigna Medicare |
$13.74
|
| Rate for Payer: Employer Direct Commercial |
$13.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Molina Medicare |
$13.74
|
| Rate for Payer: Multiplan Auto |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$276.90
|
| Rate for Payer: Multiplan Workers Comp |
$276.90
|
| Rate for Payer: Parkland Medicaid |
$13.74
|
| Rate for Payer: Scott and White EPO/PPO |
$17.18
|
| Rate for Payer: Scott and White Medicare |
$13.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.74
|
| Rate for Payer: Superior Health Plan EPO |
$13.74
|
| Rate for Payer: Superior Health Plan Medicare |
$13.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Universal American Medicare |
$13.74
|
| Rate for Payer: Wellcare Medicare |
$13.74
|
| Rate for Payer: Wellmed Medicare |
$13.74
|
|
