|
Protein CSF
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
1605831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$125.45 |
| Rate for Payer: Aetna Commercial |
$4.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.00
|
| Rate for Payer: Amerigroup Medicare |
$4.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.92
|
| Rate for Payer: BCBS of TX Medicare |
$4.00
|
| Rate for Payer: BCBS of TX PPO |
$8.84
|
| Rate for Payer: Cash Price |
$169.84
|
| Rate for Payer: Cash Price |
$169.84
|
| Rate for Payer: Cigna Medicaid |
$4.00
|
| Rate for Payer: Cigna Medicare |
$4.00
|
| Rate for Payer: Employer Direct Commercial |
$4.00
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.00
|
| Rate for Payer: Molina Medicare |
$4.00
|
| Rate for Payer: Multiplan Auto |
$125.45
|
| Rate for Payer: Multiplan Commercial |
$125.45
|
| Rate for Payer: Multiplan Workers Comp |
$125.45
|
| Rate for Payer: Parkland Medicaid |
$4.00
|
| Rate for Payer: Scott and White EPO/PPO |
$5.00
|
| Rate for Payer: Scott and White Medicare |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$4.00
|
| Rate for Payer: Superior Health Plan Medicare |
$4.00
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.00
|
| Rate for Payer: Universal American Medicare |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: Wellmed Medicare |
$4.00
|
|
|
Protein CSF
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
1605831
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$169.84
|
|
|
Protein Electro, 24-Hour Urine SO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
PROTEIN ELECTROPHOREC FRAC & QUAL
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
1611805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Medicare |
$26.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.83
|
| Rate for Payer: Amerigroup Medicare |
$17.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.30
|
| Rate for Payer: BCBS of TX Medicare |
$17.83
|
| Rate for Payer: BCBS of TX PPO |
$39.40
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cigna Medicaid |
$17.83
|
| Rate for Payer: Cigna Medicare |
$17.83
|
| Rate for Payer: Employer Direct Commercial |
$17.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.83
|
| Rate for Payer: Molina Medicare |
$17.83
|
| Rate for Payer: Multiplan Auto |
$315.25
|
| Rate for Payer: Multiplan Commercial |
$315.25
|
| Rate for Payer: Multiplan Workers Comp |
$315.25
|
| Rate for Payer: Parkland Medicaid |
$17.83
|
| Rate for Payer: Scott and White EPO/PPO |
$22.29
|
| Rate for Payer: Scott and White Medicare |
$17.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.83
|
| Rate for Payer: Superior Health Plan EPO |
$17.83
|
| Rate for Payer: Superior Health Plan Medicare |
$17.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.83
|
| Rate for Payer: Universal American Medicare |
$17.83
|
| Rate for Payer: Wellcare Medicare |
$17.83
|
| Rate for Payer: Wellmed Medicare |
$17.83
|
|
|
PROTEIN ELECTROPHOREC FRAC & QUAL
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
1611805
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$426.80
|
|
|
PROTEIN ELECTROPHORETIC FRACTNATION
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
1601814
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$388.08
|
|
|
PROTEIN ELECTROPHORETIC FRACTNATION
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
1601814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$286.65 |
| Rate for Payer: Aetna Commercial |
$11.27
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Amerigroup Medicare |
$10.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21.27
|
| Rate for Payer: BCBS of TX Medicare |
$10.74
|
| Rate for Payer: BCBS of TX PPO |
$23.74
|
| Rate for Payer: Cash Price |
$388.08
|
| Rate for Payer: Cash Price |
$388.08
|
| Rate for Payer: Cigna Medicaid |
$10.74
|
| Rate for Payer: Cigna Medicare |
$10.74
|
| Rate for Payer: Employer Direct Commercial |
$10.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Molina Medicare |
$10.74
|
| Rate for Payer: Multiplan Auto |
$286.65
|
| Rate for Payer: Multiplan Commercial |
$286.65
|
| Rate for Payer: Multiplan Workers Comp |
$286.65
|
| Rate for Payer: Parkland Medicaid |
$10.74
|
| Rate for Payer: Scott and White EPO/PPO |
$13.42
|
| Rate for Payer: Scott and White Medicare |
$10.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.74
|
| Rate for Payer: Superior Health Plan EPO |
$10.74
|
| Rate for Payer: Superior Health Plan Medicare |
$10.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.74
|
| Rate for Payer: Universal American Medicare |
$10.74
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: Wellmed Medicare |
$10.74
|
|
|
Protein Electro, Random Urine SO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
Protein Electro.,S SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
1602226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
Protein S, Free SO
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1708437
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$22.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Amerigroup Medicare |
$15.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.33
|
| Rate for Payer: BCBS of TX Medicare |
$15.32
|
| Rate for Payer: BCBS of TX PPO |
$33.86
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cigna Medicaid |
$15.32
|
| Rate for Payer: Cigna Medicare |
$15.32
|
| Rate for Payer: Employer Direct Commercial |
$15.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Molina Medicare |
$15.32
|
| Rate for Payer: Multiplan Auto |
$194.35
|
| Rate for Payer: Multiplan Commercial |
$194.35
|
| Rate for Payer: Multiplan Workers Comp |
$194.35
|
| Rate for Payer: Parkland Medicaid |
$15.32
|
| Rate for Payer: Scott and White EPO/PPO |
$19.15
|
| Rate for Payer: Scott and White Medicare |
$15.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.32
|
| Rate for Payer: Superior Health Plan EPO |
$15.32
|
| Rate for Payer: Superior Health Plan Medicare |
$15.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Universal American Medicare |
$15.32
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: Wellmed Medicare |
$15.32
|
|
|
Protein S-Functional SO
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1708437
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$263.12
|
|
|
Protein S-Functional SO
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1708437
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$22.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Amerigroup Medicare |
$15.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.33
|
| Rate for Payer: BCBS of TX Medicare |
$15.32
|
| Rate for Payer: BCBS of TX PPO |
$33.86
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cigna Medicaid |
$15.32
|
| Rate for Payer: Cigna Medicare |
$15.32
|
| Rate for Payer: Employer Direct Commercial |
$15.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Molina Medicare |
$15.32
|
| Rate for Payer: Multiplan Auto |
$194.35
|
| Rate for Payer: Multiplan Commercial |
$194.35
|
| Rate for Payer: Multiplan Workers Comp |
$194.35
|
| Rate for Payer: Parkland Medicaid |
$15.32
|
| Rate for Payer: Scott and White EPO/PPO |
$19.15
|
| Rate for Payer: Scott and White Medicare |
$15.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.32
|
| Rate for Payer: Superior Health Plan EPO |
$15.32
|
| Rate for Payer: Superior Health Plan Medicare |
$15.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.32
|
| Rate for Payer: Universal American Medicare |
$15.32
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: Wellmed Medicare |
$15.32
|
|
|
Protein Total
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
1602226
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$175.12
|
|
|
Protein Total
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
1602226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
PROTEIN TOTAL EXCEPT REFRACTOMETRY
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
1602226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
Protein Total, Qn, 24hr Ur SO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
Protein,Total,Urine SO
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$140.80
|
|
|
Protein,Total,Urine SO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
PROTEIN TOT EXCEPT REFRACT URINE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
Protein Urine
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
PROTHROMBIN TIME
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1600550
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Amerigroup Medicare |
$4.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.49
|
| Rate for Payer: BCBS of TX Medicare |
$4.29
|
| Rate for Payer: BCBS of TX PPO |
$9.48
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cigna Medicaid |
$4.29
|
| Rate for Payer: Cigna Medicare |
$4.29
|
| Rate for Payer: Employer Direct Commercial |
$4.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.29
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Molina Medicare |
$4.29
|
| Rate for Payer: Multiplan Auto |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Multiplan Workers Comp |
$119.60
|
| Rate for Payer: Parkland Medicaid |
$4.29
|
| Rate for Payer: Scott and White EPO/PPO |
$5.36
|
| Rate for Payer: Scott and White Medicare |
$4.29
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.29
|
| Rate for Payer: Superior Health Plan EPO |
$4.29
|
| Rate for Payer: Superior Health Plan Medicare |
$4.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Universal American Medicare |
$4.29
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: Wellmed Medicare |
$4.29
|
|
|
Prothrombin Time and INR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1600550
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Amerigroup Medicare |
$4.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.49
|
| Rate for Payer: BCBS of TX Medicare |
$4.29
|
| Rate for Payer: BCBS of TX PPO |
$9.48
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cigna Medicaid |
$4.29
|
| Rate for Payer: Cigna Medicare |
$4.29
|
| Rate for Payer: Employer Direct Commercial |
$4.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.29
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Molina Medicare |
$4.29
|
| Rate for Payer: Multiplan Auto |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Multiplan Workers Comp |
$119.60
|
| Rate for Payer: Parkland Medicaid |
$4.29
|
| Rate for Payer: Scott and White EPO/PPO |
$5.36
|
| Rate for Payer: Scott and White Medicare |
$4.29
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.29
|
| Rate for Payer: Superior Health Plan EPO |
$4.29
|
| Rate for Payer: Superior Health Plan Medicare |
$4.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Universal American Medicare |
$4.29
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: Wellmed Medicare |
$4.29
|
|
|
Prothrombin Time (PT) SO
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1600550
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$161.92
|
|
|
Prothrombin Time (PT) SO
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1600550
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Amerigroup Medicare |
$4.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.49
|
| Rate for Payer: BCBS of TX Medicare |
$4.29
|
| Rate for Payer: BCBS of TX PPO |
$9.48
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cash Price |
$161.92
|
| Rate for Payer: Cigna Medicaid |
$4.29
|
| Rate for Payer: Cigna Medicare |
$4.29
|
| Rate for Payer: Employer Direct Commercial |
$4.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.29
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Molina Medicare |
$4.29
|
| Rate for Payer: Multiplan Auto |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Multiplan Workers Comp |
$119.60
|
| Rate for Payer: Parkland Medicaid |
$4.29
|
| Rate for Payer: Scott and White EPO/PPO |
$5.36
|
| Rate for Payer: Scott and White Medicare |
$4.29
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.29
|
| Rate for Payer: Superior Health Plan EPO |
$4.29
|
| Rate for Payer: Superior Health Plan Medicare |
$4.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.29
|
| Rate for Payer: Universal American Medicare |
$4.29
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: Wellmed Medicare |
$4.29
|
|
|
PRT FM (ALL) -- DHF
|
Facility
|
IP
|
$82.27
|
|
| Hospital Charge Code |
80337553
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$72.40
|
|
