|
86701 ANTIBODY HIV-1
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
1614007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$151.92 |
| 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 |
$63.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$75.96
|
| Rate for Payer: BCBS of TX Medicare |
$8.89
|
| Rate for Payer: BCBS of TX PPO |
$84.40
|
| Rate for Payer: Cash Price |
$143.48
|
| Rate for Payer: Cash Price |
$143.48
|
| Rate for Payer: Cigna Medicaid |
$151.92
|
| 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 |
$151.92
|
| 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 |
$151.92
|
| 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 |
$151.92
|
| 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
|
|
|
86701 ANTIBODY HIV-1
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
1614007
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$143.48
|
|
|
86704 HEPATITIS B CORE ANTIBODY
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
1603133
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$252.28
|
|
|
86704 HEPATITIS B CORE ANTIBODY
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
1603133
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$267.12 |
| 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 |
$111.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$133.56
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$148.40
|
| Rate for Payer: Cash Price |
$252.28
|
| Rate for Payer: Cash Price |
$252.28
|
| Rate for Payer: Cigna Medicaid |
$267.12
|
| 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 |
$267.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$241.15
|
| Rate for Payer: Multiplan Commercial |
$241.15
|
| Rate for Payer: Multiplan Workers Comp |
$241.15
|
| Rate for Payer: Parkland Medicaid |
$267.12
|
| 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 |
$267.12
|
| 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
|
|
|
86708 HEPATITIS A ANTIBODY TOTAL
|
Facility
|
OP
|
$110.34
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
1603125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$79.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.39
|
| Rate for Payer: Amerigroup Medicare |
$12.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.72
|
| Rate for Payer: BCBS of TX Medicare |
$12.39
|
| Rate for Payer: BCBS of TX PPO |
$44.14
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cigna Medicaid |
$79.44
|
| Rate for Payer: Cigna Medicare |
$12.39
|
| Rate for Payer: Employer Direct Commercial |
$12.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$79.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.39
|
| Rate for Payer: Molina Medicare |
$12.39
|
| Rate for Payer: Multiplan Auto |
$71.72
|
| Rate for Payer: Multiplan Commercial |
$71.72
|
| Rate for Payer: Multiplan Workers Comp |
$71.72
|
| Rate for Payer: Parkland Medicaid |
$79.44
|
| Rate for Payer: Scott and White EPO/PPO |
$15.49
|
| Rate for Payer: Scott and White Medicare |
$12.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$79.44
|
| Rate for Payer: Superior Health Plan EPO |
$12.39
|
| Rate for Payer: Superior Health Plan Medicare |
$12.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.39
|
| Rate for Payer: Universal American Medicare |
$12.39
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: Wellmed Medicare |
$12.39
|
|
|
86708 HEPATITIS A ANTIBODY TOTAL
|
Facility
|
IP
|
$110.34
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
1603125
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$75.03
|
|
|
86710 ANTIBODY INFLUENZA VIRUS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
1705953
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$126.72 |
| 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 |
$52.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.36
|
| Rate for Payer: BCBS of TX Medicare |
$13.55
|
| Rate for Payer: BCBS of TX PPO |
$70.40
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cigna Medicaid |
$126.72
|
| 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 |
$126.72
|
| 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 |
$126.72
|
| 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 |
$126.72
|
| 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
|
|
|
86710 ANTIBODY INFLUENZA VIRUS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
1705953
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$119.68
|
|
|
86757 Rickettsia Antibody
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
9154976
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52.20
|
| Rate for Payer: BCBS of TX Medicare |
$19.35
|
| Rate for Payer: BCBS of TX PPO |
$58.00
|
| Rate for Payer: Cash Price |
$98.60
|
| Rate for Payer: Cash Price |
$98.60
|
| Rate for Payer: Cigna Medicaid |
$104.40
|
| Rate for Payer: Cigna Medicare |
$19.35
|
| Rate for Payer: Employer Direct Commercial |
$19.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$104.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Molina Medicare |
$19.35
|
| Rate for Payer: Multiplan Auto |
$94.25
|
| Rate for Payer: Multiplan Commercial |
$94.25
|
| Rate for Payer: Multiplan Workers Comp |
$94.25
|
| Rate for Payer: Parkland Medicaid |
$104.40
|
| Rate for Payer: Scott and White EPO/PPO |
$24.19
|
| Rate for Payer: Scott and White Medicare |
$19.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$104.40
|
| Rate for Payer: Superior Health Plan EPO |
$19.35
|
| Rate for Payer: Superior Health Plan Medicare |
$19.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.35
|
| Rate for Payer: Universal American Medicare |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: Wellmed Medicare |
$19.35
|
|
|
86757 Rickettsia Antibody
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
9154976
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$98.60
|
|
|
86778 ANTIBODY TOXOPLASMA IGM
|
Facility
|
IP
|
$139.49
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
1703024
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$94.85
|
|
|
86778 ANTIBODY TOXOPLASMA IGM
|
Facility
|
OP
|
$139.49
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
1703024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$100.43 |
| 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 |
$41.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.22
|
| Rate for Payer: BCBS of TX Medicare |
$14.41
|
| Rate for Payer: BCBS of TX PPO |
$55.80
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cigna Medicaid |
$100.43
|
| 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 |
$100.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.41
|
| Rate for Payer: Molina Medicare |
$14.41
|
| Rate for Payer: Multiplan Auto |
$90.67
|
| Rate for Payer: Multiplan Commercial |
$90.67
|
| Rate for Payer: Multiplan Workers Comp |
$90.67
|
| Rate for Payer: Parkland Medicaid |
$100.43
|
| 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 |
$100.43
|
| 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
|
|
|
86788 WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
1720002
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$112.88
|
|
|
86788 WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
1720002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$119.52 |
| 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 |
$49.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.76
|
| Rate for Payer: BCBS of TX Medicare |
$16.85
|
| Rate for Payer: BCBS of TX PPO |
$66.40
|
| Rate for Payer: Cash Price |
$112.88
|
| Rate for Payer: Cash Price |
$112.88
|
| Rate for Payer: Cigna Medicaid |
$119.52
|
| 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 |
$119.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Molina Medicare |
$16.85
|
| Rate for Payer: Multiplan Auto |
$107.90
|
| Rate for Payer: Multiplan Commercial |
$107.90
|
| Rate for Payer: Multiplan Workers Comp |
$107.90
|
| Rate for Payer: Parkland Medicaid |
$119.52
|
| 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 |
$119.52
|
| 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
|
|
|
86789 WEST NILE VIRUS ANTIBODY
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
1720010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$100.08 |
| 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 |
$41.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.04
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$55.60
|
| Rate for Payer: Cash Price |
$94.52
|
| Rate for Payer: Cash Price |
$94.52
|
| Rate for Payer: Cigna Medicaid |
$100.08
|
| 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 |
$100.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$90.35
|
| Rate for Payer: Multiplan Commercial |
$90.35
|
| Rate for Payer: Multiplan Workers Comp |
$90.35
|
| Rate for Payer: Parkland Medicaid |
$100.08
|
| 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 |
$100.08
|
| 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
|
|
|
86789 WEST NILE VIRUS ANTIBODY
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
1720010
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$94.52
|
|
|
86901 BLOOD TYPING RH (D)
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
2400414
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$76.84
|
|
|
86901 BLOOD TYPING RH (D)
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
2400414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2.99
|
| Rate for Payer: Amerigroup Medicare |
$2.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40.68
|
| Rate for Payer: BCBS of TX Medicare |
$2.99
|
| Rate for Payer: BCBS of TX PPO |
$45.20
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$81.36
|
| Rate for Payer: Cigna Medicare |
$2.99
|
| Rate for Payer: Employer Direct Commercial |
$2.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$2.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$81.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2.99
|
| Rate for Payer: Molina Medicare |
$2.99
|
| Rate for Payer: Multiplan Auto |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$73.45
|
| Rate for Payer: Multiplan Workers Comp |
$73.45
|
| Rate for Payer: Parkland Medicaid |
$81.36
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$2.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$81.36
|
| Rate for Payer: Superior Health Plan EPO |
$2.99
|
| Rate for Payer: Superior Health Plan Medicare |
$2.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2.99
|
| Rate for Payer: Universal American Medicare |
$2.99
|
| Rate for Payer: Wellcare Medicare |
$2.99
|
| Rate for Payer: Wellmed Medicare |
$2.99
|
|
|
86SYN005
|
Facility
|
IP
|
$8,464.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
991023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.00 |
| Max. Negotiated Rate |
$4,232.00 |
| Rate for Payer: Cash Price |
$5,755.52
|
| Rate for Payer: Cigna Commercial |
$2,116.00
|
| Rate for Payer: Multiplan Auto |
$4,232.00
|
| Rate for Payer: Multiplan Commercial |
$4,232.00
|
| Rate for Payer: Multiplan Workers Comp |
$4,232.00
|
| Rate for Payer: Scott and White EPO/PPO |
$4,232.00
|
|
|
86SYN005
|
Facility
|
OP
|
$8,464.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
991023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.76 |
| Max. Negotiated Rate |
$6,094.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$761.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,539.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,047.04
|
| Rate for Payer: BCBS of TX PPO |
$3,385.60
|
| Rate for Payer: Cash Price |
$5,755.52
|
| Rate for Payer: Cigna Medicaid |
$6,094.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,094.08
|
| Rate for Payer: Multiplan Auto |
$4,232.00
|
| Rate for Payer: Multiplan Commercial |
$4,232.00
|
| Rate for Payer: Multiplan Workers Comp |
$4,232.00
|
| Rate for Payer: Parkland Medicaid |
$6,094.08
|
| Rate for Payer: Scott and White EPO/PPO |
$4,232.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,094.08
|
| Rate for Payer: Superior Health Plan EPO |
$1,151.10
|
|
|
87070 CULTURE NON URINE,BLOOD OR STOOL
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
1604719
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$210.12
|
|
|
87070 CULTURE NON URINE,BLOOD OR STOOL
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
1604719
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$222.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Amerigroup Medicare |
$8.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$92.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$111.24
|
| Rate for Payer: BCBS of TX Medicare |
$8.62
|
| Rate for Payer: BCBS of TX PPO |
$123.60
|
| Rate for Payer: Cash Price |
$210.12
|
| Rate for Payer: Cash Price |
$210.12
|
| Rate for Payer: Cigna Medicaid |
$222.48
|
| Rate for Payer: Cigna Medicare |
$8.62
|
| Rate for Payer: Employer Direct Commercial |
$8.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$222.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Molina Medicare |
$8.62
|
| Rate for Payer: Multiplan Auto |
$200.85
|
| Rate for Payer: Multiplan Commercial |
$200.85
|
| Rate for Payer: Multiplan Workers Comp |
$200.85
|
| Rate for Payer: Parkland Medicaid |
$222.48
|
| Rate for Payer: Scott and White EPO/PPO |
$10.78
|
| Rate for Payer: Scott and White Medicare |
$8.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$222.48
|
| Rate for Payer: Superior Health Plan EPO |
$8.62
|
| Rate for Payer: Superior Health Plan Medicare |
$8.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Universal American Medicare |
$8.62
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: Wellmed Medicare |
$8.62
|
|
|
87075 CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4107075
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$335.24
|
|
|
87075 CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
8684512
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Amerigroup Medicare |
$9.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$177.48
|
| Rate for Payer: BCBS of TX Medicare |
$9.47
|
| Rate for Payer: BCBS of TX PPO |
$197.20
|
| Rate for Payer: Cash Price |
$335.24
|
| Rate for Payer: Cash Price |
$335.24
|
| Rate for Payer: Cigna Medicaid |
$354.96
|
| Rate for Payer: Cigna Medicare |
$9.47
|
| Rate for Payer: Employer Direct Commercial |
$9.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$354.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Molina Medicare |
$9.47
|
| Rate for Payer: Multiplan Auto |
$320.45
|
| Rate for Payer: Multiplan Commercial |
$320.45
|
| Rate for Payer: Multiplan Workers Comp |
$320.45
|
| Rate for Payer: Parkland Medicaid |
$354.96
|
| Rate for Payer: Scott and White EPO/PPO |
$11.84
|
| Rate for Payer: Scott and White Medicare |
$9.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$354.96
|
| Rate for Payer: Superior Health Plan EPO |
$9.47
|
| Rate for Payer: Superior Health Plan Medicare |
$9.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Universal American Medicare |
$9.47
|
| Rate for Payer: Wellcare Medicare |
$9.47
|
| Rate for Payer: Wellmed Medicare |
$9.47
|
|
|
87075 CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
8684512
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$335.24
|
|
