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Average Paid Differentials

November 10, 2011

The following average paid differentials have been posted to foster awareness regarding the general financial impact of facility or drug type preferences.  A physician often has freestanding facility options for select outpatient services or generic drug options in most drug classes.  The type of facility or drug may have significant financial impact on the member, employer or payer.

BCBSTX Average Paid Differentials*

CategoryBrandGenericDifferential
Rx $113 $13 $100
 HospitalNon-HospitalDifferential
Outpatient Surgery $3,002 $1,071 $1,931
Outpatient Clinical Lab $232 $34 $198
Outpatient Low Tech Radiology $219 $65 $154
Outpatient High Tech Radiology $1,194 $417 $777

*Generic drugs are not available for every drug compound and the availability of alternative treatment centers will vary by service and region. The brand drug value includes drug compounds with no generic equivalent, just as the hospital values may include services that must be performed in a hospital setting. Decisions regarding place of treatment and prescription options are ultimately at the discretion of the ordering physician. This information is provided for educational purposes.