|
781 - v34 MSDRG
|
Facility
|
IP
|
$7,035.66
|
|
|
Service Code
|
MSDRG 781
|
| Hospital Charge Code |
781
|
| Min. Negotiated Rate |
$7,035.66 |
| Max. Negotiated Rate |
$7,035.66 |
| Rate for Payer: BCBS of TX Blue Advantage |
$7,035.66
|
|
|
782 - v34 MSDRG
|
Facility
|
IP
|
$4,051.46
|
|
|
Service Code
|
MSDRG 782
|
| Hospital Charge Code |
782
|
| Min. Negotiated Rate |
$4,051.46 |
| Max. Negotiated Rate |
$4,051.46 |
| Rate for Payer: BCBS of TX Blue Advantage |
$4,051.46
|
|
|
82140 AMMONIA
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
1601616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Medicare |
$21.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Amerigroup Medicare |
$14.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.85
|
| Rate for Payer: BCBS of TX Medicare |
$14.57
|
| Rate for Payer: BCBS of TX PPO |
$32.20
|
| Rate for Payer: Cash Price |
$278.08
|
| Rate for Payer: Cash Price |
$278.08
|
| Rate for Payer: Cigna Medicaid |
$14.57
|
| Rate for Payer: Cigna Medicare |
$14.57
|
| Rate for Payer: Employer Direct Commercial |
$14.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Molina Medicare |
$14.57
|
| Rate for Payer: Multiplan Auto |
$205.40
|
| Rate for Payer: Multiplan Commercial |
$205.40
|
| Rate for Payer: Multiplan Workers Comp |
$205.40
|
| Rate for Payer: Parkland Medicaid |
$14.57
|
| Rate for Payer: Scott and White EPO/PPO |
$18.21
|
| Rate for Payer: Scott and White Medicare |
$14.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.57
|
| Rate for Payer: Superior Health Plan EPO |
$14.57
|
| Rate for Payer: Superior Health Plan Medicare |
$14.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Universal American Medicare |
$14.57
|
| Rate for Payer: Wellcare Medicare |
$14.57
|
| Rate for Payer: Wellmed Medicare |
$14.57
|
|
|
82436 CHLORIDE URINE
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Amerigroup Medicare |
$5.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX Medicare |
$5.75
|
| Rate for Payer: BCBS of TX PPO |
$12.71
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cigna Medicaid |
$5.75
|
| Rate for Payer: Cigna Medicare |
$5.75
|
| Rate for Payer: Employer Direct Commercial |
$5.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare |
$5.75
|
| Rate for Payer: Multiplan Auto |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Multiplan Workers Comp |
$93.60
|
| Rate for Payer: Parkland Medicaid |
$5.75
|
| Rate for Payer: Scott and White EPO/PPO |
$7.19
|
| Rate for Payer: Scott and White Medicare |
$5.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.75
|
| Rate for Payer: Superior Health Plan EPO |
$5.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Universal American Medicare |
$5.75
|
| Rate for Payer: Wellcare Medicare |
$5.75
|
| Rate for Payer: Wellmed Medicare |
$5.75
|
|
|
82570 CREATININE OTHER SOURCE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1601152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
83735 MAGNESIUM
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
1602143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.70
|
| Rate for Payer: Amerigroup Medicare |
$6.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.27
|
| Rate for Payer: BCBS of TX Medicare |
$6.70
|
| Rate for Payer: BCBS of TX PPO |
$14.81
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Medicaid |
$6.70
|
| Rate for Payer: Cigna Medicare |
$6.70
|
| Rate for Payer: Employer Direct Commercial |
$6.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.70
|
| Rate for Payer: Molina Medicare |
$6.70
|
| Rate for Payer: Multiplan Auto |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$152.10
|
| Rate for Payer: Multiplan Workers Comp |
$152.10
|
| Rate for Payer: Parkland Medicaid |
$6.70
|
| Rate for Payer: Scott and White EPO/PPO |
$8.38
|
| Rate for Payer: Scott and White Medicare |
$6.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.70
|
| Rate for Payer: Superior Health Plan EPO |
$6.70
|
| Rate for Payer: Superior Health Plan Medicare |
$6.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.70
|
| Rate for Payer: Universal American Medicare |
$6.70
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: Wellmed Medicare |
$6.70
|
|
|
83935 OSMOLALITY URINE
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1602564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Aetna Medicare |
$10.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.82
|
| Rate for Payer: Amerigroup Medicare |
$6.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.50
|
| Rate for Payer: BCBS of TX Medicare |
$6.82
|
| Rate for Payer: BCBS of TX PPO |
$15.07
|
| Rate for Payer: Cash Price |
$239.36
|
| Rate for Payer: Cash Price |
$239.36
|
| Rate for Payer: Cigna Medicaid |
$6.82
|
| Rate for Payer: Cigna Medicare |
$6.82
|
| Rate for Payer: Employer Direct Commercial |
$6.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.82
|
| Rate for Payer: Molina Medicare |
$6.82
|
| Rate for Payer: Multiplan Auto |
$176.80
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Multiplan Workers Comp |
$176.80
|
| Rate for Payer: Parkland Medicaid |
$6.82
|
| Rate for Payer: Scott and White EPO/PPO |
$8.52
|
| Rate for Payer: Scott and White Medicare |
$6.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.82
|
| Rate for Payer: Superior Health Plan EPO |
$6.82
|
| Rate for Payer: Superior Health Plan Medicare |
$6.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.82
|
| Rate for Payer: Universal American Medicare |
$6.82
|
| Rate for Payer: Wellcare Medicare |
$6.82
|
| Rate for Payer: Wellmed Medicare |
$6.82
|
|
|
84105 PHOSPHORUS URINE
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
1700160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$48.10
|
| Rate for Payer: Multiplan Commercial |
$48.10
|
| Rate for Payer: Multiplan Workers Comp |
$48.10
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
84105 PHOSPHORUS URINE
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
1700160
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$65.12
|
|
|
84133 POTASSIUM URINE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
1601145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna Commercial |
$4.97
|
| Rate for Payer: Aetna Medicare |
$7.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.73
|
| Rate for Payer: Amerigroup Medicare |
$4.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.37
|
| Rate for Payer: BCBS of TX Medicare |
$4.73
|
| Rate for Payer: BCBS of TX PPO |
$10.45
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cigna Medicaid |
$4.73
|
| Rate for Payer: Cigna Medicare |
$4.73
|
| Rate for Payer: Employer Direct Commercial |
$4.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.73
|
| Rate for Payer: Molina Medicare |
$4.73
|
| Rate for Payer: Multiplan Auto |
$141.05
|
| Rate for Payer: Multiplan Commercial |
$141.05
|
| Rate for Payer: Multiplan Workers Comp |
$141.05
|
| Rate for Payer: Parkland Medicaid |
$4.73
|
| Rate for Payer: Scott and White EPO/PPO |
$5.91
|
| Rate for Payer: Scott and White Medicare |
$4.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.73
|
| Rate for Payer: Superior Health Plan EPO |
$4.73
|
| Rate for Payer: Superior Health Plan Medicare |
$4.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.73
|
| Rate for Payer: Universal American Medicare |
$4.73
|
| Rate for Payer: Wellcare Medicare |
$4.73
|
| Rate for Payer: Wellmed Medicare |
$4.73
|
|
|
84300 SODIUM URINE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
1601111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$5.32
|
| Rate for Payer: Aetna Medicare |
$7.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Amerigroup Medicare |
$5.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.02
|
| Rate for Payer: BCBS of TX Medicare |
$5.06
|
| Rate for Payer: BCBS of TX PPO |
$11.18
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Medicaid |
$5.06
|
| Rate for Payer: Cigna Medicare |
$5.06
|
| Rate for Payer: Employer Direct Commercial |
$5.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Molina Medicare |
$5.06
|
| Rate for Payer: Multiplan Auto |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$105.30
|
| Rate for Payer: Multiplan Workers Comp |
$105.30
|
| Rate for Payer: Parkland Medicaid |
$5.06
|
| Rate for Payer: Scott and White EPO/PPO |
$6.32
|
| Rate for Payer: Scott and White Medicare |
$5.06
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.06
|
| Rate for Payer: Superior Health Plan EPO |
$5.06
|
| Rate for Payer: Superior Health Plan Medicare |
$5.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Universal American Medicare |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$5.06
|
| Rate for Payer: Wellmed Medicare |
$5.06
|
|
|
84392 SULFATE URINE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
1740927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.49
|
| Rate for Payer: Amerigroup Medicare |
$5.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.87
|
| Rate for Payer: BCBS of TX Medicare |
$5.49
|
| Rate for Payer: BCBS of TX PPO |
$12.13
|
| Rate for Payer: Cash Price |
$45.76
|
| Rate for Payer: Cash Price |
$45.76
|
| Rate for Payer: Cigna Medicaid |
$5.49
|
| Rate for Payer: Cigna Medicare |
$5.49
|
| Rate for Payer: Employer Direct Commercial |
$5.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.49
|
| Rate for Payer: Molina Medicare |
$5.49
|
| Rate for Payer: Multiplan Auto |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Multiplan Workers Comp |
$33.80
|
| Rate for Payer: Parkland Medicaid |
$5.49
|
| Rate for Payer: Scott and White EPO/PPO |
$6.86
|
| Rate for Payer: Scott and White Medicare |
$5.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.49
|
| Rate for Payer: Superior Health Plan EPO |
$5.49
|
| Rate for Payer: Superior Health Plan Medicare |
$5.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.49
|
| Rate for Payer: Universal American Medicare |
$5.49
|
| Rate for Payer: Wellcare Medicare |
$5.49
|
| Rate for Payer: Wellmed Medicare |
$5.49
|
|
|
84392 SULFATE URINE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
1740927
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$45.76
|
|
|
85097 AP Bill Bone Marrow Smear Interp
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
4305097
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$276.32
|
|
|
85097 AP Bill Bone Marrow Smear Interp
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
4305097
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$1,781.44 |
| Rate for Payer: Aetna Commercial |
$51.22
|
| Rate for Payer: Aetna Medicare |
$1,179.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$786.40
|
| Rate for Payer: Amerigroup Medicare |
$786.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,036.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,243.84
|
| Rate for Payer: BCBS of TX Medicare |
$786.40
|
| Rate for Payer: BCBS of TX PPO |
$1,388.32
|
| Rate for Payer: Cash Price |
$276.32
|
| Rate for Payer: Cash Price |
$276.32
|
| Rate for Payer: Cash Price |
$276.32
|
| Rate for Payer: Cigna Commercial |
$1,781.44
|
| Rate for Payer: Cigna Medicare |
$786.40
|
| Rate for Payer: Employer Direct Commercial |
$786.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$786.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$786.40
|
| Rate for Payer: Molina Medicare |
$786.40
|
| Rate for Payer: Multiplan Auto |
$204.10
|
| Rate for Payer: Multiplan Commercial |
$204.10
|
| Rate for Payer: Multiplan Workers Comp |
$204.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14.06
|
| Rate for Payer: Scott and White Medicare |
$786.40
|
| Rate for Payer: Superior Health Plan EPO |
$786.40
|
| Rate for Payer: Superior Health Plan Medicare |
$786.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$786.40
|
| Rate for Payer: Universal American Medicare |
$786.40
|
| Rate for Payer: Wellcare Medicare |
$786.40
|
| Rate for Payer: Wellmed Medicare |
$786.40
|
|
|
86037 ANCA TITER EACH ANTIBODY
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86037
|
| Hospital Charge Code |
1700285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
87075 CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
8684512
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: Aetna Medicare |
$14.20
|
| 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 |
$15.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.75
|
| Rate for Payer: BCBS of TX Medicare |
$9.47
|
| Rate for Payer: BCBS of TX PPO |
$20.93
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cigna Medicaid |
$9.47
|
| 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 |
$9.47
|
| 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 |
$9.47
|
| 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 |
$9.47
|
| 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
|
CPT 87075
|
| Hospital Charge Code |
8684512
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$433.84
|
|
|
87486 CHLAMYDIA PNEUMONIA DNA DETECTION
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
1740900
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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 |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$169.00
|
| Rate for Payer: Multiplan Workers Comp |
$169.00
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| 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 |
$35.09
|
| 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
|
|
|
87486 CHLAMYDIA PNEUMONIA DNA DETECTION
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
1740900
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$228.80
|
|
|
87538 HIV-2 PROBE&REVRSE TRNSCRIPJ
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
8734635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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 |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$553.52
|
| Rate for Payer: Cash Price |
$553.52
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| 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 |
$35.09
|
| 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 |
$35.09
|
| 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 |
$35.09
|
| 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
|
|
|
87538 HIV-2 PROBE&REVRSE TRNSCRIPJ
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
8734635
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$553.52
|
|
|
87633 RESPIRATORY VIRUS 12-25 TARGETS
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8266867
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$1,388.64
|
|
|
87633 RESPIRATORY VIRUS 12-25 TARGETS
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8266867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$1,025.70 |
| Rate for Payer: Aetna Commercial |
$437.62
|
| Rate for Payer: Aetna Medicare |
$625.17
|
| 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 |
$687.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$825.22
|
| Rate for Payer: BCBS of TX Medicare |
$416.78
|
| Rate for Payer: BCBS of TX PPO |
$921.08
|
| Rate for Payer: Cash Price |
$1,388.64
|
| Rate for Payer: Cash Price |
$1,388.64
|
| Rate for Payer: Cigna Medicaid |
$416.78
|
| 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 |
$416.78
|
| 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 |
$416.78
|
| 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 |
$416.78
|
| 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
|
|
|
88104 AP Bill Non-Gyn Cytology
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
4308104
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna Commercial |
$43.82
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Amerigroup Medicare |
$36.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$36.68
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$177.76
|
| Rate for Payer: Cash Price |
$177.76
|
| Rate for Payer: Cash Price |
$177.76
|
| Rate for Payer: Cigna Commercial |
$83.09
|
| Rate for Payer: Cigna Medicare |
$36.68
|
| Rate for Payer: Employer Direct Commercial |
$36.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$36.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare |
$36.68
|
| 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: Scott and White EPO/PPO |
$0.66
|
| Rate for Payer: Scott and White Medicare |
$36.68
|
| Rate for Payer: Superior Health Plan EPO |
$36.68
|
| Rate for Payer: Superior Health Plan Medicare |
$36.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Universal American Medicare |
$36.68
|
| Rate for Payer: Wellcare Medicare |
$36.68
|
| Rate for Payer: Wellmed Medicare |
$36.68
|
|
