|
87798 INFECTIOUS DETECT, AMP PROBE EACH
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
1709039
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$363.80
|
|
|
87798 INFECTIOUS DETECT, AMP PROBE EACH
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
1709039
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$385.20 |
| 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 |
$160.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$192.60
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$214.00
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cigna Medicaid |
$385.20
|
| 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 |
$385.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| Rate for Payer: Parkland Medicaid |
$385.20
|
| 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 |
$385.20
|
| 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
|
|
|
87801 DETECT AGNT MULT DNA AMPLI
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
1709732
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$296.48
|
|
|
87801 DETECT AGNT MULT DNA AMPLI
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
1709732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$70.20
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.96
|
| Rate for Payer: BCBS of TX Medicare |
$70.20
|
| Rate for Payer: BCBS of TX PPO |
$174.40
|
| Rate for Payer: Cash Price |
$296.48
|
| Rate for Payer: Cash Price |
$296.48
|
| Rate for Payer: Cigna Medicaid |
$313.92
|
| Rate for Payer: Cigna Medicare |
$70.20
|
| Rate for Payer: Employer Direct Commercial |
$70.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$70.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$313.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$70.20
|
| Rate for Payer: Molina Medicare |
$70.20
|
| Rate for Payer: Multiplan Auto |
$283.40
|
| Rate for Payer: Multiplan Commercial |
$283.40
|
| Rate for Payer: Multiplan Workers Comp |
$283.40
|
| Rate for Payer: Parkland Medicaid |
$313.92
|
| Rate for Payer: Scott and White EPO/PPO |
$87.75
|
| Rate for Payer: Scott and White Medicare |
$70.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$313.92
|
| Rate for Payer: Superior Health Plan EPO |
$70.20
|
| Rate for Payer: Superior Health Plan Medicare |
$70.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$70.20
|
| Rate for Payer: Universal American Medicare |
$70.20
|
| Rate for Payer: Wellcare Medicare |
$70.20
|
| Rate for Payer: Wellmed Medicare |
$70.20
|
|
|
88104 AP Bill Non-Gyn Cytology
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4308104
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$137.36
|
|
|
88104 AP Bill Non-Gyn Cytology
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4308104
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$145.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Amerigroup Medicare |
$37.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$72.72
|
| Rate for Payer: BCBS of TX Medicare |
$37.52
|
| Rate for Payer: BCBS of TX PPO |
$80.80
|
| Rate for Payer: Cash Price |
$137.36
|
| Rate for Payer: Cash Price |
$137.36
|
| Rate for Payer: Cash Price |
$137.36
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$145.44
|
| Rate for Payer: Cigna Medicare |
$37.52
|
| Rate for Payer: Employer Direct Commercial |
$37.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$145.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Molina Medicare |
$37.52
|
| Rate for Payer: Multiplan Auto |
$131.30
|
| Rate for Payer: Multiplan Commercial |
$131.30
|
| Rate for Payer: Multiplan Workers Comp |
$131.30
|
| Rate for Payer: Parkland Medicaid |
$145.44
|
| Rate for Payer: Scott and White EPO/PPO |
$93.50
|
| Rate for Payer: Scott and White Medicare |
$37.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$145.44
|
| Rate for Payer: Superior Health Plan EPO |
$37.52
|
| Rate for Payer: Superior Health Plan Medicare |
$37.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Universal American Medicare |
$37.52
|
| Rate for Payer: Wellcare Medicare |
$37.52
|
| Rate for Payer: Wellmed Medicare |
$37.52
|
|
|
88108 AP Bill Non-Gyn Cytology Concentration Technique
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
4308108
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$229.16
|
|
|
88108 AP Bill Non-Gyn Cytology Concentration Technique
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
4308108
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$242.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Amerigroup Medicare |
$37.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$101.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$121.32
|
| Rate for Payer: BCBS of TX Medicare |
$37.52
|
| Rate for Payer: BCBS of TX PPO |
$134.80
|
| Rate for Payer: Cash Price |
$229.16
|
| Rate for Payer: Cash Price |
$229.16
|
| Rate for Payer: Cash Price |
$229.16
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$242.64
|
| Rate for Payer: Cigna Medicare |
$37.52
|
| Rate for Payer: Employer Direct Commercial |
$37.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$242.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Molina Medicare |
$37.52
|
| Rate for Payer: Multiplan Auto |
$219.05
|
| Rate for Payer: Multiplan Commercial |
$219.05
|
| Rate for Payer: Multiplan Workers Comp |
$219.05
|
| Rate for Payer: Parkland Medicaid |
$242.64
|
| Rate for Payer: Scott and White EPO/PPO |
$84.88
|
| Rate for Payer: Scott and White Medicare |
$37.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$242.64
|
| Rate for Payer: Superior Health Plan EPO |
$37.52
|
| Rate for Payer: Superior Health Plan Medicare |
$37.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Universal American Medicare |
$37.52
|
| Rate for Payer: Wellcare Medicare |
$37.52
|
| Rate for Payer: Wellmed Medicare |
$37.52
|
|
|
8811313015- Dialysis Cath
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS A4305
|
| Hospital Charge Code |
994099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.00
|
| Rate for Payer: BCBS of TX PPO |
$60.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Medicaid |
$108.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$108.00
|
| Rate for Payer: Multiplan Auto |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Multiplan Workers Comp |
$97.50
|
| Rate for Payer: Parkland Medicaid |
$108.00
|
| Rate for Payer: Scott and White EPO/PPO |
$75.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$108.00
|
| Rate for Payer: Superior Health Plan EPO |
$20.40
|
|
|
8811313015- Dialysis Cath
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS A4305
|
| Hospital Charge Code |
994099
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$102.00
|
|
|
88161 AP Bill Cyto Smear prep, cyto path smear
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
4308140
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29.06
|
| Rate for Payer: Amerigroup Medicare |
$29.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.12
|
| Rate for Payer: BCBS of TX Medicare |
$29.06
|
| Rate for Payer: BCBS of TX PPO |
$66.80
|
| Rate for Payer: Cash Price |
$113.56
|
| Rate for Payer: Cash Price |
$113.56
|
| Rate for Payer: Cash Price |
$113.56
|
| Rate for Payer: Cigna Commercial |
$61.41
|
| Rate for Payer: Cigna Medicaid |
$120.24
|
| Rate for Payer: Cigna Medicare |
$29.06
|
| Rate for Payer: Employer Direct Commercial |
$29.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$29.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$120.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29.06
|
| Rate for Payer: Molina Medicare |
$29.06
|
| Rate for Payer: Multiplan Auto |
$108.55
|
| Rate for Payer: Multiplan Commercial |
$108.55
|
| Rate for Payer: Multiplan Workers Comp |
$108.55
|
| Rate for Payer: Parkland Medicaid |
$120.24
|
| Rate for Payer: Scott and White EPO/PPO |
$100.49
|
| Rate for Payer: Scott and White Medicare |
$29.06
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$120.24
|
| Rate for Payer: Superior Health Plan EPO |
$29.06
|
| Rate for Payer: Superior Health Plan Medicare |
$29.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29.06
|
| Rate for Payer: Universal American Medicare |
$29.06
|
| Rate for Payer: Wellcare Medicare |
$29.06
|
| Rate for Payer: Wellmed Medicare |
$29.06
|
|
|
88161 AP Bill Cyto Smear prep, cyto path smear
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
4308140
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$113.56
|
|
|
88172 AP Bill FNA Immediate Read
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
1600014
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$373.32
|
|
|
88172 AP Bill FNA Immediate Read
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
1600014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$395.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$164.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$197.64
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$219.60
|
| Rate for Payer: Cash Price |
$373.32
|
| Rate for Payer: Cash Price |
$373.32
|
| Rate for Payer: Cash Price |
$373.32
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$395.28
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$395.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$356.85
|
| Rate for Payer: Multiplan Commercial |
$356.85
|
| Rate for Payer: Multiplan Workers Comp |
$356.85
|
| Rate for Payer: Parkland Medicaid |
$395.28
|
| Rate for Payer: Scott and White EPO/PPO |
$68.84
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$395.28
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
88173 AP Bill FNA Interp and report
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
1600154
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$348.84
|
|
|
88173 AP Bill FNA Interp and report
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
1600154
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.35 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Amerigroup Medicare |
$52.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$153.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$184.68
|
| Rate for Payer: BCBS of TX Medicare |
$52.35
|
| Rate for Payer: BCBS of TX PPO |
$205.20
|
| Rate for Payer: Cash Price |
$348.84
|
| Rate for Payer: Cash Price |
$348.84
|
| Rate for Payer: Cash Price |
$348.84
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cigna Medicaid |
$369.36
|
| Rate for Payer: Cigna Medicare |
$52.35
|
| Rate for Payer: Employer Direct Commercial |
$52.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$52.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$369.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Molina Medicare |
$52.35
|
| Rate for Payer: Multiplan Auto |
$333.45
|
| Rate for Payer: Multiplan Commercial |
$333.45
|
| Rate for Payer: Multiplan Workers Comp |
$333.45
|
| Rate for Payer: Parkland Medicaid |
$369.36
|
| Rate for Payer: Scott and White EPO/PPO |
$206.88
|
| Rate for Payer: Scott and White Medicare |
$52.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$369.36
|
| Rate for Payer: Superior Health Plan EPO |
$52.35
|
| Rate for Payer: Superior Health Plan Medicare |
$52.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Universal American Medicare |
$52.35
|
| Rate for Payer: Wellcare Medicare |
$52.35
|
| Rate for Payer: Wellmed Medicare |
$52.35
|
|
|
88185 FLOWCYTOMETRY TC ADD ON
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
1709476
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.68
|
| Rate for Payer: BCBS of TX PPO |
$55.20
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna Medicaid |
$99.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$99.36
|
| Rate for Payer: Multiplan Auto |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$89.70
|
| Rate for Payer: Multiplan Workers Comp |
$89.70
|
| Rate for Payer: Parkland Medicaid |
$99.36
|
| Rate for Payer: Scott and White EPO/PPO |
$29.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$99.36
|
| Rate for Payer: Superior Health Plan EPO |
$18.77
|
|
|
88185 FLOWCYTOMETRY TC ADD ON
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
1709476
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$93.84
|
|
|
88188 AP Bill Send Out Flow Cytometry
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 88188
|
| Hospital Charge Code |
8490466
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$175.44
|
|
|
88188 AP Bill Send Out Flow Cytometry
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 88188
|
| Hospital Charge Code |
8490466
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$185.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$77.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$92.88
|
| Rate for Payer: BCBS of TX PPO |
$103.20
|
| Rate for Payer: Cash Price |
$175.44
|
| Rate for Payer: Cash Price |
$175.44
|
| Rate for Payer: Cigna Medicaid |
$185.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$185.76
|
| Rate for Payer: Multiplan Auto |
$167.70
|
| Rate for Payer: Multiplan Commercial |
$167.70
|
| Rate for Payer: Multiplan Workers Comp |
$167.70
|
| Rate for Payer: Parkland Medicaid |
$185.76
|
| Rate for Payer: Scott and White EPO/PPO |
$74.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$185.76
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
|
|
88189 AP Bill Send Out Flow Cyto
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 88189
|
| Hospital Charge Code |
8852669
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$276.76
|
|
|
88189 AP Bill Send Out Flow Cyto
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 88189
|
| Hospital Charge Code |
8852669
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$293.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$122.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$146.52
|
| Rate for Payer: BCBS of TX PPO |
$162.80
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cigna Medicaid |
$293.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$293.04
|
| Rate for Payer: Multiplan Auto |
$264.55
|
| Rate for Payer: Multiplan Commercial |
$264.55
|
| Rate for Payer: Multiplan Workers Comp |
$264.55
|
| Rate for Payer: Parkland Medicaid |
$293.04
|
| Rate for Payer: Scott and White EPO/PPO |
$100.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$293.04
|
| Rate for Payer: Superior Health Plan EPO |
$55.35
|
|
|
88237 TISSUE CULTURE NEOPLASTIC DISORDER
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
1707298
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$143.75
|
| Rate for Payer: Amerigroup Medicare |
$143.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.96
|
| Rate for Payer: BCBS of TX Medicare |
$143.75
|
| Rate for Payer: BCBS of TX PPO |
$174.40
|
| Rate for Payer: Cash Price |
$296.48
|
| Rate for Payer: Cash Price |
$296.48
|
| Rate for Payer: Cigna Medicaid |
$313.92
|
| Rate for Payer: Cigna Medicare |
$143.75
|
| Rate for Payer: Employer Direct Commercial |
$143.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$143.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$313.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$143.75
|
| Rate for Payer: Molina Medicare |
$143.75
|
| Rate for Payer: Multiplan Auto |
$283.40
|
| Rate for Payer: Multiplan Commercial |
$283.40
|
| Rate for Payer: Multiplan Workers Comp |
$283.40
|
| Rate for Payer: Parkland Medicaid |
$313.92
|
| Rate for Payer: Scott and White EPO/PPO |
$179.69
|
| Rate for Payer: Scott and White Medicare |
$143.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$313.92
|
| Rate for Payer: Superior Health Plan EPO |
$143.75
|
| Rate for Payer: Superior Health Plan Medicare |
$143.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$143.75
|
| Rate for Payer: Universal American Medicare |
$143.75
|
| Rate for Payer: Wellcare Medicare |
$143.75
|
| Rate for Payer: Wellmed Medicare |
$143.75
|
|
|
88237 TISSUE CULTURE NEOPLASTIC DISORDER
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
1707298
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$296.48
|
|
|
88239 AP Bill Send Out Cytogenetic Studies
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 88239
|
| Hospital Charge Code |
8490467
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$769.08
|
|
