|
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
|
|
|
Bill Only BB Pool Fee Only
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
2403376
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.45
|
| 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 |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| 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 |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Workers Comp |
$133.25
|
| 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 Pool Fee Only
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
2403376
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$180.40
|
|
|
Bill Only BB RBC Antigen Type Patient
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| 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 |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| 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 CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| 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 RBC Treat w/Enzymes
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
2403632
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$626.34 |
| Rate for Payer: Aetna Commercial |
$25.36
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| 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 |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| 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 |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Multiplan Workers Comp |
$68.25
|
| 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 RBC Treat w/Enzymes
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
2403632
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$92.40
|
|
|
Bill Only BB Rh Type
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2400414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$83.09 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| 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 |
$99.44
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cigna Commercial |
$83.09
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| 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 |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare |
$36.68
|
| Rate for Payer: Multiplan Auto |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$73.45
|
| Rate for Payer: Multiplan Workers Comp |
$73.45
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$36.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| 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 Thaw FFP
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2400547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.68
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$28.66
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$76.56
|
| 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 |
$56.55
|
| Rate for Payer: Multiplan Commercial |
$56.55
|
| Rate for Payer: Multiplan Workers Comp |
$56.55
|
| 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 Thaw FFP
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2400547
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$76.56
|
|
|
Bill Only Cell Count without Differential
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1620061
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$100.32
|
|
|
Bill Only Cell Count without Differential
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1620061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Medicare |
$4.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.35
|
| Rate for Payer: BCBS of TX Medicare |
$4.72
|
| Rate for Payer: BCBS of TX PPO |
$10.43
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cigna Medicaid |
$4.72
|
| Rate for Payer: Cigna Medicare |
$4.72
|
| Rate for Payer: Employer Direct Commercial |
$4.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Molina Medicare |
$4.72
|
| Rate for Payer: Multiplan Auto |
$74.10
|
| Rate for Payer: Multiplan Commercial |
$74.10
|
| Rate for Payer: Multiplan Workers Comp |
$74.10
|
| Rate for Payer: Parkland Medicaid |
$4.72
|
| Rate for Payer: Scott and White EPO/PPO |
$5.90
|
| Rate for Payer: Scott and White Medicare |
$4.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.72
|
| Rate for Payer: Superior Health Plan EPO |
$4.72
|
| Rate for Payer: Superior Health Plan Medicare |
$4.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.72
|
| Rate for Payer: Universal American Medicare |
$4.72
|
| Rate for Payer: Wellcare Medicare |
$4.72
|
| Rate for Payer: Wellmed Medicare |
$4.72
|
|
|
Bill Only GTT 1st 3 Specimens
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1602853
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Commercial |
$13.51
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Amerigroup Medicare |
$12.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.48
|
| Rate for Payer: BCBS of TX Medicare |
$12.87
|
| Rate for Payer: BCBS of TX PPO |
$28.44
|
| Rate for Payer: Cash Price |
$333.52
|
| Rate for Payer: Cash Price |
$333.52
|
| Rate for Payer: Cigna Medicaid |
$12.87
|
| Rate for Payer: Cigna Medicare |
$12.87
|
| Rate for Payer: Employer Direct Commercial |
$12.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Molina Medicare |
$12.87
|
| Rate for Payer: Multiplan Auto |
$246.35
|
| Rate for Payer: Multiplan Commercial |
$246.35
|
| Rate for Payer: Multiplan Workers Comp |
$246.35
|
| Rate for Payer: Parkland Medicaid |
$12.87
|
| Rate for Payer: Scott and White EPO/PPO |
$16.09
|
| Rate for Payer: Scott and White Medicare |
$12.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.87
|
| Rate for Payer: Superior Health Plan EPO |
$12.87
|
| Rate for Payer: Superior Health Plan Medicare |
$12.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Universal American Medicare |
$12.87
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: Wellmed Medicare |
$12.87
|
|
|
Bill Only Specimen Processing
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
1605815
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$121.44
|
|
|
Bill Only Specimen Processing
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
1605815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.14
|
| Rate for Payer: BCBS of TX PPO |
$13.55
|
| Rate for Payer: Cash Price |
$121.44
|
| Rate for Payer: Cash Price |
$121.44
|
| Rate for Payer: Cigna Medicaid |
$13.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.07
|
| Rate for Payer: Multiplan Auto |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$89.70
|
| Rate for Payer: Multiplan Workers Comp |
$89.70
|
| Rate for Payer: Parkland Medicaid |
$13.07
|
| Rate for Payer: Scott and White EPO/PPO |
$69.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.07
|
| Rate for Payer: Superior Health Plan EPO |
$18.77
|
|
|
Bill Only Urinalysis Screen
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1605211
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Medicare |
$2.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.46
|
| Rate for Payer: BCBS of TX Medicare |
$2.25
|
| Rate for Payer: BCBS of TX PPO |
$4.97
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cigna Medicaid |
$2.25
|
| Rate for Payer: Cigna Medicare |
$2.25
|
| Rate for Payer: Employer Direct Commercial |
$2.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$2.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Molina Medicare |
$2.25
|
| Rate for Payer: Multiplan Auto |
$79.30
|
| Rate for Payer: Multiplan Commercial |
$79.30
|
| Rate for Payer: Multiplan Workers Comp |
$79.30
|
| Rate for Payer: Parkland Medicaid |
$2.25
|
| Rate for Payer: Scott and White EPO/PPO |
$2.81
|
| Rate for Payer: Scott and White Medicare |
$2.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.25
|
| Rate for Payer: Superior Health Plan EPO |
$2.25
|
| Rate for Payer: Superior Health Plan Medicare |
$2.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Universal American Medicare |
$2.25
|
| Rate for Payer: Wellcare Medicare |
$2.25
|
| Rate for Payer: Wellmed Medicare |
$2.25
|
|
|
BINDER, ABDOMINAL KNIT ELASTIC 12'''' SIZE 30-45 -- DHF
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
80240104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$29.43
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.26
|
| Rate for Payer: BCBS of TX PPO |
$21.40
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Multiplan Auto |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$34.78
|
| Rate for Payer: Multiplan Workers Comp |
$34.78
|
| Rate for Payer: Scott and White EPO/PPO |
$26.76
|
| Rate for Payer: Superior Health Plan EPO |
$7.28
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$45,290.30
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$19,278.62 |
| Max. Negotiated Rate |
$45,290.30 |
| Rate for Payer: Aetna Commercial |
$26,816.62
|
| Rate for Payer: Aetna Medicare |
$29,797.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,865.02
|
| Rate for Payer: Amerigroup Medicare |
$19,865.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,278.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,519.06
|
| Rate for Payer: BCBS of TX Medicare |
$19,865.02
|
| Rate for Payer: BCBS of TX PPO |
$26,133.31
|
| Rate for Payer: Cigna Commercial |
$30,702.06
|
| Rate for Payer: Cigna Medicare |
$19,865.02
|
| Rate for Payer: Employer Direct Commercial |
$19,865.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,865.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,865.02
|
| Rate for Payer: Molina Medicare |
$19,865.02
|
| Rate for Payer: Multiplan Auto |
$45,290.30
|
| Rate for Payer: Multiplan Commercial |
$45,290.30
|
| Rate for Payer: Multiplan Workers Comp |
$45,290.30
|
| Rate for Payer: Scott and White EPO/PPO |
$20,857.38
|
| Rate for Payer: Scott and White Medicare |
$19,865.02
|
| Rate for Payer: Superior Health Plan EPO |
$19,865.02
|
| Rate for Payer: Superior Health Plan Medicare |
$19,865.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,865.02
|
| Rate for Payer: Universal American Medicare |
$19,865.02
|
| Rate for Payer: Wellcare Medicare |
$19,865.02
|
| Rate for Payer: Wellmed Medicare |
$19,865.02
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$64,011.00
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$26,130.24 |
| Max. Negotiated Rate |
$64,011.00 |
| Rate for Payer: Aetna Commercial |
$37,901.25
|
| Rate for Payer: Aetna Medicare |
$40,344.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,896.15
|
| Rate for Payer: Amerigroup Medicare |
$26,896.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,130.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32,385.15
|
| Rate for Payer: BCBS of TX Medicare |
$26,896.15
|
| Rate for Payer: BCBS of TX PPO |
$35,984.89
|
| Rate for Payer: Cigna Commercial |
$43,392.72
|
| Rate for Payer: Cigna Medicare |
$26,896.15
|
| Rate for Payer: Employer Direct Commercial |
$26,896.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,896.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,896.15
|
| Rate for Payer: Molina Medicare |
$26,896.15
|
| Rate for Payer: Multiplan Auto |
$64,011.00
|
| Rate for Payer: Multiplan Commercial |
$64,011.00
|
| Rate for Payer: Multiplan Workers Comp |
$64,011.00
|
| Rate for Payer: Scott and White EPO/PPO |
$29,478.75
|
| Rate for Payer: Scott and White Medicare |
$26,896.15
|
| Rate for Payer: Superior Health Plan EPO |
$26,896.15
|
| Rate for Payer: Superior Health Plan Medicare |
$26,896.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,896.15
|
| Rate for Payer: Universal American Medicare |
$26,896.15
|
| Rate for Payer: Wellcare Medicare |
$26,896.15
|
| Rate for Payer: Wellmed Medicare |
$26,896.15
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$35,416.00
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$15,034.52 |
| Max. Negotiated Rate |
$35,416.00 |
| Rate for Payer: Aetna Commercial |
$20,970.00
|
| Rate for Payer: Aetna Medicare |
$24,234.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,156.40
|
| Rate for Payer: Amerigroup Medicare |
$16,156.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,034.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,553.56
|
| Rate for Payer: BCBS of TX Medicare |
$16,156.40
|
| Rate for Payer: BCBS of TX PPO |
$20,615.87
|
| Rate for Payer: Cigna Commercial |
$24,008.32
|
| Rate for Payer: Cigna Medicare |
$16,156.40
|
| Rate for Payer: Employer Direct Commercial |
$16,156.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,156.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,156.40
|
| Rate for Payer: Molina Medicare |
$16,156.40
|
| Rate for Payer: Multiplan Auto |
$35,416.00
|
| Rate for Payer: Multiplan Commercial |
$35,416.00
|
| Rate for Payer: Multiplan Workers Comp |
$35,416.00
|
| Rate for Payer: Scott and White EPO/PPO |
$16,310.00
|
| Rate for Payer: Scott and White Medicare |
$16,156.40
|
| Rate for Payer: Superior Health Plan EPO |
$16,156.40
|
| Rate for Payer: Superior Health Plan Medicare |
$16,156.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,156.40
|
| Rate for Payer: Universal American Medicare |
$16,156.40
|
| Rate for Payer: Wellcare Medicare |
$16,156.40
|
| Rate for Payer: Wellmed Medicare |
$16,156.40
|
|
|
BIOPSY BONE OPEN
|
Facility
|
OP
|
$4,752.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
7150911
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$4,181.76
|
| Rate for Payer: Cash Price |
$4,181.76
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicaid |
$815.20
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$815.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$815.20
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
36020220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Biopsy of liver, needle when done for indicated purpose at time of other major procedure (List sepa
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
36047001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
|
|
Biopsy of tongue posterior one-third
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
36041105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$4,416.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Amerigroup Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$204.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$245.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$309.20
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$109.63
|
| Rate for Payer: Cigna Medicare |
$2,944.49
|
| Rate for Payer: Employer Direct Commercial |
$2,944.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,944.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$109.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Molina Medicare |
$2,944.49
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$109.63
|
| Rate for Payer: Scott and White EPO/PPO |
$64.95
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$109.63
|
| Rate for Payer: Superior Health Plan EPO |
$2,944.49
|
| Rate for Payer: Superior Health Plan Medicare |
$2,944.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Universal American Medicare |
$2,944.49
|
| Rate for Payer: Wellcare Medicare |
$2,944.49
|
| Rate for Payer: Wellmed Medicare |
$2,944.49
|
|
|
Biopsy or excision of lymph node(s) open, deep cervical node(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
36038510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$76.89
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
Biopsy oropharynx
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 42800
|
| Hospital Charge Code |
36042800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,092.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Amerigroup Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$172.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$206.44
|
| Rate for Payer: BCBS of TX Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX PPO |
$260.11
|
| Rate for Payer: Cigna Commercial |
$3,159.45
|
| Rate for Payer: Cigna Medicaid |
$85.54
|
| Rate for Payer: Cigna Medicare |
$1,394.72
|
| Rate for Payer: Employer Direct Commercial |
$1,394.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,394.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Molina Medicare |
$1,394.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$85.54
|
| Rate for Payer: Scott and White EPO/PPO |
$30.76
|
| Rate for Payer: Scott and White Medicare |
$1,394.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.54
|
| Rate for Payer: Superior Health Plan EPO |
$1,394.72
|
| Rate for Payer: Superior Health Plan Medicare |
$1,394.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Universal American Medicare |
$1,394.72
|
| Rate for Payer: Wellcare Medicare |
$1,394.72
|
| Rate for Payer: Wellmed Medicare |
$1,394.72
|
|
