|
Antiglomerular BM Ab SO
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$139.75
|
| Rate for Payer: Multiplan Workers Comp |
$139.75
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
Antihistone 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-HMGCR Autoantibodies SO
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1706332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$144.30 |
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$25.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.19
|
| Rate for Payer: BCBS of TX Medicare |
$17.27
|
| Rate for Payer: BCBS of TX PPO |
$38.17
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cigna Medicaid |
$17.27
|
| Rate for Payer: Cigna Medicare |
$17.27
|
| Rate for Payer: Employer Direct Commercial |
$17.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Molina Medicare |
$17.27
|
| Rate for Payer: Multiplan Auto |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$144.30
|
| Rate for Payer: Multiplan Workers Comp |
$144.30
|
| Rate for Payer: Parkland Medicaid |
$17.27
|
| Rate for Payer: Scott and White EPO/PPO |
$21.59
|
| Rate for Payer: Scott and White Medicare |
$17.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.27
|
| Rate for Payer: Superior Health Plan EPO |
$17.27
|
| Rate for Payer: Superior Health Plan Medicare |
$17.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Universal American Medicare |
$17.27
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: Wellmed Medicare |
$17.27
|
|
|
Anti-Jo-1 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-Mullerian Hormone (AMH) SO
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
1704261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Medicare |
$21.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Amerigroup Medicare |
$14.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.96
|
| Rate for Payer: BCBS of TX Medicare |
$14.12
|
| Rate for Payer: BCBS of TX PPO |
$31.21
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cigna Medicaid |
$14.12
|
| Rate for Payer: Cigna Medicare |
$14.12
|
| Rate for Payer: Employer Direct Commercial |
$14.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Molina Medicare |
$14.12
|
| Rate for Payer: Multiplan Auto |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$118.30
|
| Rate for Payer: Multiplan Workers Comp |
$118.30
|
| Rate for Payer: Parkland Medicaid |
$14.12
|
| Rate for Payer: Scott and White EPO/PPO |
$17.65
|
| Rate for Payer: Scott and White Medicare |
$14.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.12
|
| Rate for Payer: Superior Health Plan EPO |
$14.12
|
| Rate for Payer: Superior Health Plan Medicare |
$14.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Universal American Medicare |
$14.12
|
| Rate for Payer: Wellcare Medicare |
$14.12
|
| Rate for Payer: Wellmed Medicare |
$14.12
|
|
|
Antineutrophil Cytoplasmic Ab SO
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86037
|
| Hospital Charge Code |
1700285
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$364.32
|
|
|
Antineutrophil Cytoplasmic Ab SO
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86037
|
| Hospital Charge Code |
1700285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1605393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Amerigroup Medicare |
$12.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.94
|
| Rate for Payer: BCBS of TX Medicare |
$12.09
|
| Rate for Payer: BCBS of TX PPO |
$26.72
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cigna Medicaid |
$12.09
|
| Rate for Payer: Cigna Medicare |
$12.09
|
| Rate for Payer: Employer Direct Commercial |
$12.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Molina Medicare |
$12.09
|
| Rate for Payer: Multiplan Auto |
$219.70
|
| Rate for Payer: Multiplan Commercial |
$219.70
|
| Rate for Payer: Multiplan Workers Comp |
$219.70
|
| Rate for Payer: Parkland Medicaid |
$12.09
|
| Rate for Payer: Scott and White EPO/PPO |
$15.11
|
| Rate for Payer: Scott and White Medicare |
$12.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.09
|
| Rate for Payer: Superior Health Plan EPO |
$12.09
|
| Rate for Payer: Superior Health Plan Medicare |
$12.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Universal American Medicare |
$12.09
|
| Rate for Payer: Wellcare Medicare |
$12.09
|
| Rate for Payer: Wellmed Medicare |
$12.09
|
|
|
Antinuclear Antibodies Direct SO
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1605393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Amerigroup Medicare |
$12.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.94
|
| Rate for Payer: BCBS of TX Medicare |
$12.09
|
| Rate for Payer: BCBS of TX PPO |
$26.72
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cigna Medicaid |
$12.09
|
| Rate for Payer: Cigna Medicare |
$12.09
|
| Rate for Payer: Employer Direct Commercial |
$12.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Molina Medicare |
$12.09
|
| Rate for Payer: Multiplan Auto |
$219.70
|
| Rate for Payer: Multiplan Commercial |
$219.70
|
| Rate for Payer: Multiplan Workers Comp |
$219.70
|
| Rate for Payer: Parkland Medicaid |
$12.09
|
| Rate for Payer: Scott and White EPO/PPO |
$15.11
|
| Rate for Payer: Scott and White Medicare |
$12.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.09
|
| Rate for Payer: Superior Health Plan EPO |
$12.09
|
| Rate for Payer: Superior Health Plan Medicare |
$12.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Universal American Medicare |
$12.09
|
| Rate for Payer: Wellcare Medicare |
$12.09
|
| Rate for Payer: Wellmed Medicare |
$12.09
|
|
|
Antinuclear Antibodies Direct SO
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1605393
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$297.44
|
|
|
Antinuclear Antibodies, IFA SO
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1605393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Amerigroup Medicare |
$12.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.94
|
| Rate for Payer: BCBS of TX Medicare |
$12.09
|
| Rate for Payer: BCBS of TX PPO |
$26.72
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cigna Medicaid |
$12.09
|
| Rate for Payer: Cigna Medicare |
$12.09
|
| Rate for Payer: Employer Direct Commercial |
$12.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Molina Medicare |
$12.09
|
| Rate for Payer: Multiplan Auto |
$219.70
|
| Rate for Payer: Multiplan Commercial |
$219.70
|
| Rate for Payer: Multiplan Workers Comp |
$219.70
|
| Rate for Payer: Parkland Medicaid |
$12.09
|
| Rate for Payer: Scott and White EPO/PPO |
$15.11
|
| Rate for Payer: Scott and White Medicare |
$12.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.09
|
| Rate for Payer: Superior Health Plan EPO |
$12.09
|
| Rate for Payer: Superior Health Plan Medicare |
$12.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Universal American Medicare |
$12.09
|
| Rate for Payer: Wellcare Medicare |
$12.09
|
| Rate for Payer: Wellmed Medicare |
$12.09
|
|
|
Antipancreatic Islet Cells SO
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
1707454
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$52.09 |
| Rate for Payer: Aetna Commercial |
$24.74
|
| Rate for Payer: Aetna Medicare |
$35.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Amerigroup Medicare |
$23.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.67
|
| Rate for Payer: BCBS of TX Medicare |
$23.57
|
| Rate for Payer: BCBS of TX PPO |
$52.09
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cigna Medicaid |
$23.57
|
| Rate for Payer: Cigna Medicare |
$23.57
|
| Rate for Payer: Employer Direct Commercial |
$23.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$23.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$23.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Molina Medicare |
$23.57
|
| Rate for Payer: Multiplan Auto |
$40.95
|
| Rate for Payer: Multiplan Commercial |
$40.95
|
| Rate for Payer: Multiplan Workers Comp |
$40.95
|
| Rate for Payer: Parkland Medicaid |
$23.57
|
| Rate for Payer: Scott and White EPO/PPO |
$29.46
|
| Rate for Payer: Scott and White Medicare |
$23.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23.57
|
| Rate for Payer: Superior Health Plan EPO |
$23.57
|
| Rate for Payer: Superior Health Plan Medicare |
$23.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Universal American Medicare |
$23.57
|
| Rate for Payer: Wellcare Medicare |
$23.57
|
| Rate for Payer: Wellmed Medicare |
$23.57
|
|
|
Antiparietal Cell Antibody SO
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$139.75
|
| Rate for Payer: Multiplan Workers Comp |
$139.75
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
Antiphospholipid Syndrome SO APTT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1600535
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Amerigroup Medicare |
$6.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.90
|
| Rate for Payer: BCBS of TX Medicare |
$6.01
|
| Rate for Payer: BCBS of TX PPO |
$13.28
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna Medicaid |
$6.01
|
| Rate for Payer: Cigna Medicare |
$6.01
|
| Rate for Payer: Employer Direct Commercial |
$6.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Molina Medicare |
$6.01
|
| Rate for Payer: Multiplan Auto |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$143.00
|
| Rate for Payer: Multiplan Workers Comp |
$143.00
|
| Rate for Payer: Parkland Medicaid |
$6.01
|
| Rate for Payer: Scott and White EPO/PPO |
$7.51
|
| Rate for Payer: Scott and White Medicare |
$6.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.01
|
| Rate for Payer: Superior Health Plan EPO |
$6.01
|
| Rate for Payer: Superior Health Plan Medicare |
$6.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Universal American Medicare |
$6.01
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: Wellmed Medicare |
$6.01
|
|
|
Anti-PLA2R SO
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cash Price |
$189.20
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$139.75
|
| Rate for Payer: Multiplan Workers Comp |
$139.75
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
Antiscleroderma-70 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
|
|
|
Antistreptolysin O Ab SO
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
1700962
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$7.66
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Amerigroup Medicare |
$7.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.45
|
| Rate for Payer: BCBS of TX Medicare |
$7.30
|
| Rate for Payer: BCBS of TX PPO |
$16.13
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Medicaid |
$7.30
|
| Rate for Payer: Cigna Medicare |
$7.30
|
| Rate for Payer: Employer Direct Commercial |
$7.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Molina Medicare |
$7.30
|
| Rate for Payer: Multiplan Auto |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Multiplan Workers Comp |
$130.00
|
| Rate for Payer: Parkland Medicaid |
$7.30
|
| Rate for Payer: Scott and White EPO/PPO |
$9.12
|
| Rate for Payer: Scott and White Medicare |
$7.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.30
|
| Rate for Payer: Superior Health Plan EPO |
$7.30
|
| Rate for Payer: Superior Health Plan Medicare |
$7.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Universal American Medicare |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$7.30
|
| Rate for Payer: Wellmed Medicare |
$7.30
|
|
|
Antistreptolysin O Ab SO
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
1700962
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$176.00
|
|
|
Antithrombin Activity SO
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
1706415
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$271.04
|
|
|
Antithrombin Activity SO
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
1706415
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$12.44
|
| Rate for Payer: Aetna Medicare |
$17.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Amerigroup Medicare |
$11.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.46
|
| Rate for Payer: BCBS of TX Medicare |
$11.85
|
| Rate for Payer: BCBS of TX PPO |
$26.19
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cigna Medicaid |
$11.85
|
| Rate for Payer: Cigna Medicare |
$11.85
|
| Rate for Payer: Employer Direct Commercial |
$11.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Molina Medicare |
$11.85
|
| Rate for Payer: Multiplan Auto |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$200.20
|
| Rate for Payer: Multiplan Workers Comp |
$200.20
|
| Rate for Payer: Parkland Medicaid |
$11.85
|
| Rate for Payer: Scott and White EPO/PPO |
$14.81
|
| Rate for Payer: Scott and White Medicare |
$11.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.85
|
| Rate for Payer: Superior Health Plan EPO |
$11.85
|
| Rate for Payer: Superior Health Plan Medicare |
$11.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Universal American Medicare |
$11.85
|
| Rate for Payer: Wellcare Medicare |
$11.85
|
| Rate for Payer: Wellmed Medicare |
$11.85
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$130,239.30
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$51,770.32 |
| Max. Negotiated Rate |
$130,239.30 |
| Rate for Payer: Aetna Commercial |
$77,115.38
|
| Rate for Payer: Aetna Medicare |
$77,655.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$51,770.32
|
| Rate for Payer: Amerigroup Medicare |
$51,770.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$54,220.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69,175.48
|
| Rate for Payer: BCBS of TX Medicare |
$51,770.32
|
| Rate for Payer: BCBS of TX PPO |
$76,864.62
|
| Rate for Payer: Cigna Commercial |
$88,288.54
|
| Rate for Payer: Cigna Medicare |
$51,770.32
|
| Rate for Payer: Employer Direct Commercial |
$51,770.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$51,770.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$51,770.32
|
| Rate for Payer: Molina Medicare |
$51,770.32
|
| Rate for Payer: Multiplan Auto |
$130,239.30
|
| Rate for Payer: Multiplan Commercial |
$130,239.30
|
| Rate for Payer: Multiplan Workers Comp |
$130,239.30
|
| Rate for Payer: Scott and White EPO/PPO |
$59,978.62
|
| Rate for Payer: Scott and White Medicare |
$51,770.32
|
| Rate for Payer: Superior Health Plan EPO |
$51,770.32
|
| Rate for Payer: Superior Health Plan Medicare |
$51,770.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$51,770.32
|
| Rate for Payer: Universal American Medicare |
$51,770.32
|
| Rate for Payer: Wellcare Medicare |
$51,770.32
|
| Rate for Payer: Wellmed Medicare |
$51,770.32
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$79,013.40
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$32,530.81 |
| Max. Negotiated Rate |
$79,013.40 |
| Rate for Payer: Aetna Commercial |
$46,784.25
|
| Rate for Payer: Aetna Medicare |
$48,796.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$32,530.81
|
| Rate for Payer: Amerigroup Medicare |
$32,530.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34,635.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$42,833.14
|
| Rate for Payer: BCBS of TX Medicare |
$32,530.81
|
| Rate for Payer: BCBS of TX PPO |
$47,594.22
|
| Rate for Payer: Cigna Commercial |
$53,562.77
|
| Rate for Payer: Cigna Medicare |
$32,530.81
|
| Rate for Payer: Employer Direct Commercial |
$32,530.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$32,530.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$32,530.81
|
| Rate for Payer: Molina Medicare |
$32,530.81
|
| Rate for Payer: Multiplan Auto |
$79,013.40
|
| Rate for Payer: Multiplan Commercial |
$79,013.40
|
| Rate for Payer: Multiplan Workers Comp |
$79,013.40
|
| Rate for Payer: Scott and White EPO/PPO |
$36,387.75
|
| Rate for Payer: Scott and White Medicare |
$32,530.81
|
| Rate for Payer: Superior Health Plan EPO |
$32,530.81
|
| Rate for Payer: Superior Health Plan Medicare |
$32,530.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$32,530.81
|
| Rate for Payer: Universal American Medicare |
$32,530.81
|
| Rate for Payer: Wellcare Medicare |
$32,530.81
|
| Rate for Payer: Wellmed Medicare |
$32,530.81
|
|
|
AORTOGRAPHY
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
2320548
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$219.33 |
| Max. Negotiated Rate |
$7,287.00 |
| Rate for Payer: Aetna Commercial |
$7,287.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$219.33
|
| Rate for Payer: Cash Price |
$2,144.56
|
| Rate for Payer: Cash Price |
$2,144.56
|
| Rate for Payer: Multiplan Auto |
$1,584.05
|
| Rate for Payer: Multiplan Commercial |
$1,584.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,584.05
|
| Rate for Payer: Scott and White EPO/PPO |
$1,218.50
|
| Rate for Payer: Superior Health Plan EPO |
$331.43
|
|
|
AORTOGRAPHY
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
2320548
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$2,144.56
|
|
|
Aortography, abdominal, by serialography, radiological supervision and interpretation
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
36075625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$69.93
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| 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: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$126.30
|
| 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 |
$126.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| 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 |
$126.30
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$126.30
|
| 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
|
|
