|
87075 CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4107075
|
|
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
|
|
|
87190 SUSCEPTIBILITY STDY MYCOBAC PROPORT
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
1603794
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$105.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Amerigroup Medicare |
$7.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$44.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52.92
|
| Rate for Payer: BCBS of TX Medicare |
$7.31
|
| Rate for Payer: BCBS of TX PPO |
$58.80
|
| Rate for Payer: Cash Price |
$99.96
|
| Rate for Payer: Cash Price |
$99.96
|
| Rate for Payer: Cigna Medicaid |
$105.84
|
| Rate for Payer: Cigna Medicare |
$7.31
|
| Rate for Payer: Employer Direct Commercial |
$7.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$105.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Molina Medicare |
$7.31
|
| Rate for Payer: Multiplan Auto |
$95.55
|
| Rate for Payer: Multiplan Commercial |
$95.55
|
| Rate for Payer: Multiplan Workers Comp |
$95.55
|
| Rate for Payer: Parkland Medicaid |
$105.84
|
| Rate for Payer: Scott and White EPO/PPO |
$9.14
|
| Rate for Payer: Scott and White Medicare |
$7.31
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$105.84
|
| Rate for Payer: Superior Health Plan EPO |
$7.31
|
| Rate for Payer: Superior Health Plan Medicare |
$7.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Universal American Medicare |
$7.31
|
| Rate for Payer: Wellcare Medicare |
$7.31
|
| Rate for Payer: Wellmed Medicare |
$7.31
|
|
|
87190 SUSCEPTIBILITY STDY MYCOBAC PROPORT
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
1603794
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$99.96
|
|
|
87206 SMEAR FLUORESCENT AND AFB W/INTERPR
|
Facility
|
OP
|
$68.11
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
1603885
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$49.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Amerigroup Medicare |
$5.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.52
|
| Rate for Payer: BCBS of TX Medicare |
$5.39
|
| Rate for Payer: BCBS of TX PPO |
$27.24
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cigna Medicaid |
$49.04
|
| Rate for Payer: Cigna Medicare |
$5.39
|
| Rate for Payer: Employer Direct Commercial |
$5.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$49.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Molina Medicare |
$5.39
|
| Rate for Payer: Multiplan Auto |
$44.27
|
| Rate for Payer: Multiplan Commercial |
$44.27
|
| Rate for Payer: Multiplan Workers Comp |
$44.27
|
| Rate for Payer: Parkland Medicaid |
$49.04
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$5.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$49.04
|
| Rate for Payer: Superior Health Plan EPO |
$5.39
|
| Rate for Payer: Superior Health Plan Medicare |
$5.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.39
|
| Rate for Payer: Universal American Medicare |
$5.39
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: Wellmed Medicare |
$5.39
|
|
|
87206 SMEAR FLUORESCENT AND AFB W/INTERPR
|
Facility
|
IP
|
$68.11
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
1603885
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$46.31
|
|
|
87209 SMEAR COMPLEX STAIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
1605989
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Amerigroup Medicare |
$17.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.76
|
| Rate for Payer: BCBS of TX Medicare |
$17.98
|
| Rate for Payer: BCBS of TX PPO |
$56.40
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cigna Medicaid |
$101.52
|
| Rate for Payer: Cigna Medicare |
$17.98
|
| Rate for Payer: Employer Direct Commercial |
$17.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$101.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Molina Medicare |
$17.98
|
| Rate for Payer: Multiplan Auto |
$91.65
|
| Rate for Payer: Multiplan Commercial |
$91.65
|
| Rate for Payer: Multiplan Workers Comp |
$91.65
|
| Rate for Payer: Parkland Medicaid |
$101.52
|
| Rate for Payer: Scott and White EPO/PPO |
$22.48
|
| Rate for Payer: Scott and White Medicare |
$17.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$101.52
|
| Rate for Payer: Superior Health Plan EPO |
$17.98
|
| Rate for Payer: Superior Health Plan Medicare |
$17.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Universal American Medicare |
$17.98
|
| Rate for Payer: Wellcare Medicare |
$17.98
|
| Rate for Payer: Wellmed Medicare |
$17.98
|
|
|
87209 SMEAR COMPLEX STAIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
1605989
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$95.88
|
|
|
87254 VIRUS INOCULATION, SHELL VIA
|
Facility
|
OP
|
$164.23
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
1708841
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19.56
|
| Rate for Payer: Amerigroup Medicare |
$19.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.12
|
| Rate for Payer: BCBS of TX Medicare |
$19.56
|
| Rate for Payer: BCBS of TX PPO |
$65.69
|
| Rate for Payer: Cash Price |
$111.68
|
| Rate for Payer: Cash Price |
$111.68
|
| Rate for Payer: Cigna Medicaid |
$118.25
|
| Rate for Payer: Cigna Medicare |
$19.56
|
| Rate for Payer: Employer Direct Commercial |
$19.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$19.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$118.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19.56
|
| Rate for Payer: Molina Medicare |
$19.56
|
| Rate for Payer: Multiplan Auto |
$106.75
|
| Rate for Payer: Multiplan Commercial |
$106.75
|
| Rate for Payer: Multiplan Workers Comp |
$106.75
|
| Rate for Payer: Parkland Medicaid |
$118.25
|
| Rate for Payer: Scott and White EPO/PPO |
$24.45
|
| Rate for Payer: Scott and White Medicare |
$19.56
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$118.25
|
| Rate for Payer: Superior Health Plan EPO |
$19.56
|
| Rate for Payer: Superior Health Plan Medicare |
$19.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19.56
|
| Rate for Payer: Universal American Medicare |
$19.56
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
| Rate for Payer: Wellmed Medicare |
$19.56
|
|
|
87254 VIRUS INOCULATION, SHELL VIA
|
Facility
|
IP
|
$164.23
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
1708841
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$111.68
|
|
|
87340 HEPATITIS B SURFACE ANTIGEN SCREEN
|
Facility
|
OP
|
$84.36
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
1602747
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$60.74 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Amerigroup Medicare |
$10.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.37
|
| Rate for Payer: BCBS of TX Medicare |
$10.33
|
| Rate for Payer: BCBS of TX PPO |
$33.74
|
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Cigna Medicaid |
$60.74
|
| Rate for Payer: Cigna Medicare |
$10.33
|
| Rate for Payer: Employer Direct Commercial |
$10.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$60.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Molina Medicare |
$10.33
|
| Rate for Payer: Multiplan Auto |
$54.83
|
| Rate for Payer: Multiplan Commercial |
$54.83
|
| Rate for Payer: Multiplan Workers Comp |
$54.83
|
| Rate for Payer: Parkland Medicaid |
$60.74
|
| Rate for Payer: Scott and White EPO/PPO |
$12.91
|
| Rate for Payer: Scott and White Medicare |
$10.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$60.74
|
| Rate for Payer: Superior Health Plan EPO |
$10.33
|
| Rate for Payer: Superior Health Plan Medicare |
$10.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.33
|
| Rate for Payer: Universal American Medicare |
$10.33
|
| Rate for Payer: Wellcare Medicare |
$10.33
|
| Rate for Payer: Wellmed Medicare |
$10.33
|
|
|
87340 HEPATITIS B SURFACE ANTIGEN SCREEN
|
Facility
|
IP
|
$84.36
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
1602747
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$57.36
|
|
|
87350 INFECT AGNT DETECT HB E AG
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
1700384
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$82.28
|
|
|
87350 INFECT AGNT DETECT HB E AG
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
1700384
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$87.12 |
| 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 |
$36.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.56
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$48.40
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cigna Medicaid |
$87.12
|
| 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 |
$87.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$87.12
|
| 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 |
$87.12
|
| 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
|
|
|
87491 CHYLMD TRACH DNA AMP PROBE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
1709682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$214.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.28
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$119.20
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cigna Medicaid |
$214.56
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$214.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$214.56
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$214.56
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
87491 CHYLMD TRACH DNA AMP PROBE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
1709682
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$202.64
|
|
|
87529 HERPES SIMPLEX, AMPLIFIED
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
1709013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$412.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$171.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$206.28
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$229.20
|
| Rate for Payer: Cash Price |
$389.64
|
| Rate for Payer: Cash Price |
$389.64
|
| Rate for Payer: Cigna Medicaid |
$412.56
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$412.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$372.45
|
| Rate for Payer: Multiplan Workers Comp |
$372.45
|
| Rate for Payer: Parkland Medicaid |
$412.56
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$412.56
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
87529 HERPES SIMPLEX, AMPLIFIED
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
1709013
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$389.64
|
|
|
87538 HIV-2 PROBE&REVRSE TRNSCRIPJ
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 87538
|
| Hospital Charge Code |
8734635
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$427.72
|
|
|
87538 HIV-2 PROBE&REVRSE TRNSCRIPJ
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 87538
|
| Hospital Charge Code |
8734635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$452.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$188.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.44
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$251.60
|
| Rate for Payer: Cash Price |
$427.72
|
| Rate for Payer: Cash Price |
$427.72
|
| Rate for Payer: Cigna Medicaid |
$452.88
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$452.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$408.85
|
| Rate for Payer: Multiplan Commercial |
$408.85
|
| Rate for Payer: Multiplan Workers Comp |
$408.85
|
| Rate for Payer: Parkland Medicaid |
$452.88
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$452.88
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
87591 N GONORRHOEAE DNA AMP PROBE
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
1709179
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$166.60
|
|
|
87591 N GONORRHOEAE DNA AMP PROBE
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
1709179
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$73.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$88.20
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$98.00
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cigna Medicaid |
$176.40
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$176.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$159.25
|
| Rate for Payer: Multiplan Workers Comp |
$159.25
|
| Rate for Payer: Parkland Medicaid |
$176.40
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$176.40
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
87633 RESPIRATORY VIRUS 12-25 TARGETS
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
8266867
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$1,073.04
|
|
|
87633 RESPIRATORY VIRUS 12-25 TARGETS
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
8266867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$1,136.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$416.78
|
| Rate for Payer: Amerigroup Medicare |
$416.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$473.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$568.08
|
| Rate for Payer: BCBS of TX Medicare |
$416.78
|
| Rate for Payer: BCBS of TX PPO |
$631.20
|
| Rate for Payer: Cash Price |
$1,073.04
|
| Rate for Payer: Cash Price |
$1,073.04
|
| Rate for Payer: Cigna Medicaid |
$1,136.16
|
| Rate for Payer: Cigna Medicare |
$416.78
|
| Rate for Payer: Employer Direct Commercial |
$416.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$416.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,136.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$416.78
|
| Rate for Payer: Molina Medicare |
$416.78
|
| Rate for Payer: Multiplan Auto |
$1,025.70
|
| Rate for Payer: Multiplan Commercial |
$1,025.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,025.70
|
| Rate for Payer: Parkland Medicaid |
$1,136.16
|
| Rate for Payer: Scott and White EPO/PPO |
$520.98
|
| Rate for Payer: Scott and White Medicare |
$416.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,136.16
|
| Rate for Payer: Superior Health Plan EPO |
$416.78
|
| Rate for Payer: Superior Health Plan Medicare |
$416.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$416.78
|
| Rate for Payer: Universal American Medicare |
$416.78
|
| Rate for Payer: Wellcare Medicare |
$416.78
|
| Rate for Payer: Wellmed Medicare |
$416.78
|
|
|
87661 TRICHOMONAS VEGININALIS AMP PROBE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
1840004
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$151.64
|
|
|
87661 TRICHOMONAS VEGININALIS AMP PROBE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
1840004
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$160.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$66.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$80.28
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$89.20
|
| Rate for Payer: Cash Price |
$151.64
|
| Rate for Payer: Cash Price |
$151.64
|
| Rate for Payer: Cigna Medicaid |
$160.56
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$160.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$144.95
|
| Rate for Payer: Multiplan Commercial |
$144.95
|
| Rate for Payer: Multiplan Workers Comp |
$144.95
|
| Rate for Payer: Parkland Medicaid |
$160.56
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$160.56
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
