|
Bilirubin Total
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
1602408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Medicare |
$5.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.94
|
| Rate for Payer: BCBS of TX Medicare |
$5.02
|
| Rate for Payer: BCBS of TX PPO |
$11.09
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cigna Medicaid |
$5.02
|
| Rate for Payer: Cigna Medicare |
$5.02
|
| Rate for Payer: Employer Direct Commercial |
$5.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.02
|
| Rate for Payer: Molina Medicare |
$5.02
|
| Rate for Payer: Multiplan Auto |
$123.50
|
| Rate for Payer: Multiplan Commercial |
$123.50
|
| Rate for Payer: Multiplan Workers Comp |
$123.50
|
| Rate for Payer: Parkland Medicaid |
$5.02
|
| Rate for Payer: Scott and White EPO/PPO |
$6.28
|
| Rate for Payer: Scott and White Medicare |
$5.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.02
|
| Rate for Payer: Superior Health Plan EPO |
$5.02
|
| Rate for Payer: Superior Health Plan Medicare |
$5.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.02
|
| Rate for Payer: Universal American Medicare |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: Wellmed Medicare |
$5.02
|
|
|
Bilirubin Total
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
1602408
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$167.20
|
|
|
Bill Only BB Ab ID Each Absorption
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
2403616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| 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 |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$227.50
|
| Rate for Payer: Multiplan Workers Comp |
$227.50
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
Bill Only BB Ab ID Each Absorption
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
2403616
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$308.00
|
|
|
Bill Only BB AB ID Panel
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2403061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$302.90
|
| Rate for Payer: Multiplan Commercial |
$302.90
|
| Rate for Payer: Multiplan Workers Comp |
$302.90
|
| Rate for Payer: Scott and White EPO/PPO |
$5.88
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Bill Only BB ABO Type
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2400406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$98.80
|
| Rate for Payer: Multiplan Commercial |
$98.80
|
| Rate for Payer: Multiplan Workers Comp |
$98.80
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
Bill Only BB Antibody Elution
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
2403095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$34.30
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
Bill Only BB Antibody Elution
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
2403095
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$261.36
|
|
|
Bill Only BB Antibody Screen RBC
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$222.64
|
|
|
Bill Only BB Antibody Screen RBC
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Amerigroup Medicare |
$49.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.95
|
| Rate for Payer: BCBS of TX Medicare |
$49.56
|
| Rate for Payer: BCBS of TX PPO |
$109.33
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$112.25
|
| Rate for Payer: Cigna Medicare |
$49.56
|
| Rate for Payer: Employer Direct Commercial |
$49.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Molina Medicare |
$49.56
|
| Rate for Payer: Multiplan Auto |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| Rate for Payer: Scott and White Medicare |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$49.56
|
| Rate for Payer: Superior Health Plan Medicare |
$49.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Universal American Medicare |
$49.56
|
| Rate for Payer: Wellcare Medicare |
$49.56
|
| Rate for Payer: Wellmed Medicare |
$49.56
|
|
|
Bill Only BB Autologous Fee
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
4206891
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$490.16
|
|
|
Bill Only BB Autologous Fee
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
4206891
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$362.05 |
| Rate for Payer: Aetna Commercial |
$108.12
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$490.16
|
| Rate for Payer: Cash Price |
$490.16
|
| Rate for Payer: Cash Price |
$490.16
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$362.05
|
| Rate for Payer: Multiplan Commercial |
$362.05
|
| Rate for Payer: Multiplan Workers Comp |
$362.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
Bill Only BB Cell Separation
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
2403970
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$155.76
|
|
|
Bill Only BB Cell Separation
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
2403970
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$155.76
|
| Rate for Payer: Cash Price |
$155.76
|
| Rate for Payer: Cash Price |
$155.76
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$115.05
|
| Rate for Payer: Multiplan Commercial |
$115.05
|
| Rate for Payer: Multiplan Workers Comp |
$115.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
Bill Only BB CMV
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
7256915
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$364.32
|
|
|
Bill Only BB CMV
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
7256915
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.49
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$31.80
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cigna Medicaid |
$14.39
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| 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 |
$14.39
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.39
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Bill Only BB Cold Agglutinin Screen
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
7106050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Amerigroup Medicare |
$8.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.98
|
| Rate for Payer: BCBS of TX Medicare |
$8.07
|
| Rate for Payer: BCBS of TX PPO |
$17.83
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cigna Medicaid |
$8.07
|
| Rate for Payer: Cigna Medicare |
$8.07
|
| Rate for Payer: Employer Direct Commercial |
$8.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Molina Medicare |
$8.07
|
| Rate for Payer: Multiplan Auto |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Multiplan Workers Comp |
$114.40
|
| Rate for Payer: Parkland Medicaid |
$8.07
|
| Rate for Payer: Scott and White EPO/PPO |
$10.09
|
| Rate for Payer: Scott and White Medicare |
$8.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.07
|
| Rate for Payer: Superior Health Plan EPO |
$8.07
|
| Rate for Payer: Superior Health Plan Medicare |
$8.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Universal American Medicare |
$8.07
|
| Rate for Payer: Wellcare Medicare |
$8.07
|
| Rate for Payer: Wellmed Medicare |
$8.07
|
|
|
Bill Only BB Cold Agglutinin Screen
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
7106050
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$154.88
|
|
|
Bill Only BB Compatibility AHG
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2400158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
Bill Only BB Direct Antiglobulin Test
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| 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 |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
Bill Only BB Irradiate Product Fee
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
4506125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Aetna Commercial |
$31.69
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.94
|
| 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 |
$146.08
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cash Price |
$146.08
|
| 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 |
$107.90
|
| Rate for Payer: Multiplan Commercial |
$107.90
|
| Rate for Payer: Multiplan Workers Comp |
$107.90
|
| 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
|
|
|
Bill Only BB Irradiate Product Fee
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
4506125
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$146.08
|
|
|
Bill Only BB Molecular RBC Genotype
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 0084U
|
| Hospital Charge Code |
8590514
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$733.92
|
|
|
Bill Only BB Molecular RBC Genotype
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 0084U
|
| Hospital Charge Code |
8590514
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Aetna Commercial |
$458.70
|
| Rate for Payer: Aetna Medicare |
$1,080.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Amerigroup Medicare |
$720.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,188.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,425.60
|
| Rate for Payer: BCBS of TX Medicare |
$720.00
|
| Rate for Payer: BCBS of TX PPO |
$1,591.20
|
| Rate for Payer: Cash Price |
$733.92
|
| Rate for Payer: Cash Price |
$733.92
|
| Rate for Payer: Cigna Medicare |
$720.00
|
| Rate for Payer: Employer Direct Commercial |
$720.00
|
| Rate for Payer: Humana Medicare/TRICARE |
$720.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Molina Medicare |
$720.00
|
| Rate for Payer: Multiplan Auto |
$542.10
|
| Rate for Payer: Multiplan Commercial |
$542.10
|
| Rate for Payer: Multiplan Workers Comp |
$542.10
|
| Rate for Payer: Scott and White EPO/PPO |
$900.00
|
| Rate for Payer: Scott and White Medicare |
$720.00
|
| Rate for Payer: Superior Health Plan EPO |
$720.00
|
| Rate for Payer: Superior Health Plan Medicare |
$720.00
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$720.00
|
| Rate for Payer: Universal American Medicare |
$720.00
|
| Rate for Payer: Wellcare Medicare |
$720.00
|
| Rate for Payer: Wellmed Medicare |
$720.00
|
|
|
Bill Only BB Patient RBC Phenotype
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
2403020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.02
|
| 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 |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$83.09
|
| Rate for Payer: Cigna Medicaid |
$7.75
|
| 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 CHIP/Medicaid |
$7.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare |
$36.68
|
| Rate for Payer: Multiplan Auto |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Workers Comp |
$87.75
|
| Rate for Payer: Parkland Medicaid |
$7.75
|
| Rate for Payer: Scott and White EPO/PPO |
$9.69
|
| Rate for Payer: Scott and White Medicare |
$36.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.75
|
| 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
|
|
