|
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
|
|
|
88264 AP Bill Send Out Chromosome Analysis
|
Facility
|
IP
|
$1,074.50
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
8852670
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$730.66
|
|
|
88264 AP Bill Send Out Chromosome Analysis
|
Facility
|
OP
|
$1,074.50
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
8852670
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$773.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.61
|
| Rate for Payer: Amerigroup Medicare |
$144.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$322.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$386.82
|
| Rate for Payer: BCBS of TX Medicare |
$144.61
|
| Rate for Payer: BCBS of TX PPO |
$429.80
|
| Rate for Payer: Cash Price |
$730.66
|
| Rate for Payer: Cash Price |
$730.66
|
| Rate for Payer: Cigna Medicaid |
$773.64
|
| Rate for Payer: Cigna Medicare |
$144.61
|
| Rate for Payer: Employer Direct Commercial |
$144.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$773.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.61
|
| Rate for Payer: Molina Medicare |
$144.61
|
| Rate for Payer: Multiplan Auto |
$698.42
|
| Rate for Payer: Multiplan Commercial |
$698.42
|
| Rate for Payer: Multiplan Workers Comp |
$698.42
|
| Rate for Payer: Parkland Medicaid |
$773.64
|
| Rate for Payer: Scott and White EPO/PPO |
$180.76
|
| Rate for Payer: Scott and White Medicare |
$144.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$773.64
|
| Rate for Payer: Superior Health Plan EPO |
$144.61
|
| Rate for Payer: Superior Health Plan Medicare |
$144.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.61
|
| Rate for Payer: Universal American Medicare |
$144.61
|
| Rate for Payer: Wellcare Medicare |
$144.61
|
| Rate for Payer: Wellmed Medicare |
$144.61
|
|
|
88280 AP Bill Send Out Chromosome Analysis
|
Facility
|
IP
|
$356.88
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
8852667
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$242.68
|
|
|
88280 AP Bill Send Out Chromosome Analysis
|
Facility
|
OP
|
$356.88
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
8852667
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$256.95 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33.47
|
| Rate for Payer: Amerigroup Medicare |
$33.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$107.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$128.48
|
| Rate for Payer: BCBS of TX Medicare |
$33.47
|
| Rate for Payer: BCBS of TX PPO |
$142.75
|
| Rate for Payer: Cash Price |
$242.68
|
| Rate for Payer: Cash Price |
$242.68
|
| Rate for Payer: Cigna Medicaid |
$256.95
|
| Rate for Payer: Cigna Medicare |
$33.47
|
| Rate for Payer: Employer Direct Commercial |
$33.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$33.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$256.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33.47
|
| Rate for Payer: Molina Medicare |
$33.47
|
| Rate for Payer: Multiplan Auto |
$231.97
|
| Rate for Payer: Multiplan Commercial |
$231.97
|
| Rate for Payer: Multiplan Workers Comp |
$231.97
|
| Rate for Payer: Parkland Medicaid |
$256.95
|
| Rate for Payer: Scott and White EPO/PPO |
$41.84
|
| Rate for Payer: Scott and White Medicare |
$33.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$256.95
|
| Rate for Payer: Superior Health Plan EPO |
$33.47
|
| Rate for Payer: Superior Health Plan Medicare |
$33.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33.47
|
| Rate for Payer: Universal American Medicare |
$33.47
|
| Rate for Payer: Wellcare Medicare |
$33.47
|
| Rate for Payer: Wellmed Medicare |
$33.47
|
|
|
88291 AP Bill Send Out Cytogenetics
|
Facility
|
IP
|
$193.25
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
8852668
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$131.41
|
|
|
88291 AP Bill Send Out Cytogenetics
|
Facility
|
OP
|
$193.25
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
8852668
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$139.14 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.57
|
| Rate for Payer: BCBS of TX PPO |
$77.30
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Medicaid |
$139.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$139.14
|
| Rate for Payer: Multiplan Auto |
$125.61
|
| Rate for Payer: Multiplan Commercial |
$125.61
|
| Rate for Payer: Multiplan Workers Comp |
$125.61
|
| Rate for Payer: Parkland Medicaid |
$139.14
|
| Rate for Payer: Scott and White EPO/PPO |
$41.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$139.14
|
| Rate for Payer: Superior Health Plan EPO |
$26.28
|
|
|
88300 AP Bill Surgical Pathology Level I Complexity
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
1801901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29.06
|
| Rate for Payer: Amerigroup Medicare |
$29.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$66.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$79.56
|
| Rate for Payer: BCBS of TX Medicare |
$29.06
|
| Rate for Payer: BCBS of TX PPO |
$88.40
|
| Rate for Payer: Cash Price |
$150.28
|
| Rate for Payer: Cash Price |
$150.28
|
| Rate for Payer: Cash Price |
$150.28
|
| Rate for Payer: Cigna Commercial |
$61.41
|
| Rate for Payer: Cigna Medicaid |
$159.12
|
| 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 |
$159.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29.06
|
| Rate for Payer: Molina Medicare |
$29.06
|
| Rate for Payer: Multiplan Auto |
$143.65
|
| Rate for Payer: Multiplan Commercial |
$143.65
|
| Rate for Payer: Multiplan Workers Comp |
$143.65
|
| Rate for Payer: Parkland Medicaid |
$159.12
|
| Rate for Payer: Scott and White EPO/PPO |
$20.10
|
| Rate for Payer: Scott and White Medicare |
$29.06
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$159.12
|
| 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
|
|
|
88300 AP Bill Surgical Pathology Level I Complexity
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
1801901
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$150.28
|
|
|
88302 AP Bill Surgical Pathology Level II Complexity
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
1801919
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$157.08
|
|
|
88302 AP Bill Surgical Pathology Level II Complexity
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
1801919
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$166.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Amerigroup Medicare |
$37.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.16
|
| Rate for Payer: BCBS of TX Medicare |
$37.52
|
| Rate for Payer: BCBS of TX PPO |
$92.40
|
| Rate for Payer: Cash Price |
$157.08
|
| Rate for Payer: Cash Price |
$157.08
|
| Rate for Payer: Cash Price |
$157.08
|
| Rate for Payer: Cigna Commercial |
$79.31
|
| Rate for Payer: Cigna Medicaid |
$166.32
|
| 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 |
$166.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.52
|
| Rate for Payer: Molina Medicare |
$37.52
|
| Rate for Payer: Multiplan Auto |
$150.15
|
| Rate for Payer: Multiplan Commercial |
$150.15
|
| Rate for Payer: Multiplan Workers Comp |
$150.15
|
| Rate for Payer: Parkland Medicaid |
$166.32
|
| Rate for Payer: Scott and White EPO/PPO |
$41.14
|
| Rate for Payer: Scott and White Medicare |
$37.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$166.32
|
| 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
|
|
|
88304 AP Bill Surgical Pathology Level III Complexity
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
1801935
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$254.32
|
|
|
88304 AP Bill Surgical Pathology Level III Complexity
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
1801935
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$269.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Amerigroup Medicare |
$52.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$134.64
|
| Rate for Payer: BCBS of TX Medicare |
$52.35
|
| Rate for Payer: BCBS of TX PPO |
$149.60
|
| Rate for Payer: Cash Price |
$254.32
|
| Rate for Payer: Cash Price |
$254.32
|
| Rate for Payer: Cash Price |
$254.32
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cigna Medicaid |
$269.28
|
| 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 |
$269.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Molina Medicare |
$52.35
|
| Rate for Payer: Multiplan Auto |
$243.10
|
| Rate for Payer: Multiplan Commercial |
$243.10
|
| Rate for Payer: Multiplan Workers Comp |
$243.10
|
| Rate for Payer: Parkland Medicaid |
$269.28
|
| Rate for Payer: Scott and White EPO/PPO |
$53.10
|
| Rate for Payer: Scott and White Medicare |
$52.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$269.28
|
| 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
|
|
|
88305 AP Bill Surgical Pathology Level IV Complexity
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
1801943
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Amerigroup Medicare |
$52.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.40
|
| Rate for Payer: BCBS of TX Medicare |
$52.35
|
| Rate for Payer: BCBS of TX PPO |
$216.00
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cigna Medicaid |
$388.80
|
| 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 |
$388.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Molina Medicare |
$52.35
|
| Rate for Payer: Multiplan Auto |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Multiplan Workers Comp |
$351.00
|
| Rate for Payer: Parkland Medicaid |
$388.80
|
| Rate for Payer: Scott and White EPO/PPO |
$88.64
|
| Rate for Payer: Scott and White Medicare |
$52.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$388.80
|
| 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
|
|
|
88305 AP Bill Surgical Pathology Level IV Complexity
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
1801943
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$367.20
|
|
|
88307 AP Bill Surgical Pathology Level V Complexity
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
1801950
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$393.04
|
|
|
88307 AP Bill Surgical Pathology Level V Complexity
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
1801950
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$109.79 |
| Max. Negotiated Rate |
$761.14 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$360.08
|
| Rate for Payer: Amerigroup Medicare |
$360.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$173.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.08
|
| Rate for Payer: BCBS of TX Medicare |
$360.08
|
| Rate for Payer: BCBS of TX PPO |
$231.20
|
| Rate for Payer: Cash Price |
$393.04
|
| Rate for Payer: Cash Price |
$393.04
|
| Rate for Payer: Cash Price |
$393.04
|
| Rate for Payer: Cigna Commercial |
$761.14
|
| Rate for Payer: Cigna Medicaid |
$416.16
|
| Rate for Payer: Cigna Medicare |
$360.08
|
| Rate for Payer: Employer Direct Commercial |
$360.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$360.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$416.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$360.08
|
| Rate for Payer: Molina Medicare |
$360.08
|
| Rate for Payer: Multiplan Auto |
$375.70
|
| Rate for Payer: Multiplan Commercial |
$375.70
|
| Rate for Payer: Multiplan Workers Comp |
$375.70
|
| Rate for Payer: Parkland Medicaid |
$416.16
|
| Rate for Payer: Scott and White EPO/PPO |
$356.00
|
| Rate for Payer: Scott and White Medicare |
$360.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$416.16
|
| Rate for Payer: Superior Health Plan EPO |
$360.08
|
| Rate for Payer: Superior Health Plan Medicare |
$360.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$360.08
|
| Rate for Payer: Universal American Medicare |
$360.08
|
| Rate for Payer: Wellcare Medicare |
$360.08
|
| Rate for Payer: Wellmed Medicare |
$360.08
|
|
|
88309 AP Bill Surgical Pathology Level VI Complexity
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
1802016
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$166.79 |
| Max. Negotiated Rate |
$1,710.82 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$166.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$809.35
|
| Rate for Payer: Amerigroup Medicare |
$809.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$277.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$333.00
|
| Rate for Payer: BCBS of TX Medicare |
$809.35
|
| Rate for Payer: BCBS of TX PPO |
$370.00
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cigna Commercial |
$1,710.82
|
| Rate for Payer: Cigna Medicaid |
$666.00
|
| Rate for Payer: Cigna Medicare |
$809.35
|
| Rate for Payer: Employer Direct Commercial |
$809.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$809.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$666.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$809.35
|
| Rate for Payer: Molina Medicare |
$809.35
|
| Rate for Payer: Multiplan Auto |
$601.25
|
| Rate for Payer: Multiplan Commercial |
$601.25
|
| Rate for Payer: Multiplan Workers Comp |
$601.25
|
| Rate for Payer: Parkland Medicaid |
$666.00
|
| Rate for Payer: Scott and White EPO/PPO |
$534.98
|
| Rate for Payer: Scott and White Medicare |
$809.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$666.00
|
| Rate for Payer: Superior Health Plan EPO |
$809.35
|
| Rate for Payer: Superior Health Plan Medicare |
$809.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$809.35
|
| Rate for Payer: Universal American Medicare |
$809.35
|
| Rate for Payer: Wellcare Medicare |
$809.35
|
| Rate for Payer: Wellmed Medicare |
$809.35
|
|
|
88309 AP Bill Surgical Pathology Level VI Complexity
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
1802016
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$629.00
|
|
|
88311 AP Bill Decalcification
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
1801927
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$222.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.58
|
| 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 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: Molina CHIP/Medicaid |
$222.48
|
| 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 |
$25.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$222.48
|
| Rate for Payer: Superior Health Plan EPO |
$42.02
|
|
|
88311 AP Bill Decalcification
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
1801927
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$210.12
|
|
|
88312 AP Bill Special Stains Group I
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
1801711
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$267.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Amerigroup Medicare |
$52.35
|
| 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 |
$52.35
|
| 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: Cash Price |
$252.28
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cigna Medicaid |
$267.12
|
| 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 |
$267.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$52.35
|
| Rate for Payer: Molina Medicare |
$52.35
|
| 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 |
$139.30
|
| Rate for Payer: Scott and White Medicare |
$52.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$267.12
|
| 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
|
|
|
88312 AP Bill Special Stains Group I
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
1801711
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$252.28
|
|
|
88313 AP Bill Special Stains Group II
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
1801638
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$173.40
|
|
|
88313 AP Bill Special Stains Group II
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
1801638
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$76.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$91.80
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$102.00
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$183.60
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$183.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$165.75
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Multiplan Workers Comp |
$165.75
|
| Rate for Payer: Parkland Medicaid |
$183.60
|
| Rate for Payer: Scott and White EPO/PPO |
$102.56
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$183.60
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
