|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36064644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.88
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$245.55
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$85.54
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.54
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Chemotherapy Inf up to 1 Hour Single or Initial Drug 96413
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
1500271
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$701.61 |
| Rate for Payer: Aetna Commercial |
$170.74
|
| Rate for Payer: Aetna Medicare |
$464.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Amerigroup Medicare |
$309.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$248.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$297.61
|
| Rate for Payer: BCBS of TX Medicare |
$309.73
|
| Rate for Payer: BCBS of TX PPO |
$331.95
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cigna Commercial |
$701.61
|
| Rate for Payer: Cigna Medicare |
$309.73
|
| Rate for Payer: Employer Direct Commercial |
$309.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$309.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Molina Medicare |
$309.73
|
| Rate for Payer: Multiplan Auto |
$360.75
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Multiplan Workers Comp |
$360.75
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Scott and White Medicare |
$309.73
|
| Rate for Payer: Superior Health Plan EPO |
$309.73
|
| Rate for Payer: Superior Health Plan Medicare |
$309.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Universal American Medicare |
$309.73
|
| Rate for Payer: Wellcare Medicare |
$309.73
|
| Rate for Payer: Wellmed Medicare |
$309.73
|
|
|
Chemotherapy Infusion Each Additional Hour 96415
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
1500289
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64.46
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$71.90
|
| 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 |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| 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: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$90,375.40
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$37,421.86 |
| Max. Negotiated Rate |
$90,375.40 |
| Rate for Payer: Aetna Commercial |
$53,511.75
|
| Rate for Payer: Aetna Medicare |
$56,132.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37,421.86
|
| Rate for Payer: Amerigroup Medicare |
$37,421.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51,657.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55,455.34
|
| Rate for Payer: BCBS of TX Medicare |
$37,421.86
|
| Rate for Payer: BCBS of TX PPO |
$61,619.43
|
| Rate for Payer: Cigna Commercial |
$61,265.01
|
| Rate for Payer: Cigna Medicare |
$37,421.86
|
| Rate for Payer: Employer Direct Commercial |
$37,421.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$37,421.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37,421.86
|
| Rate for Payer: Molina Medicare |
$37,421.86
|
| Rate for Payer: Multiplan Auto |
$90,375.40
|
| Rate for Payer: Multiplan Commercial |
$90,375.40
|
| Rate for Payer: Multiplan Workers Comp |
$90,375.40
|
| Rate for Payer: Scott and White EPO/PPO |
$41,620.25
|
| Rate for Payer: Scott and White Medicare |
$37,421.86
|
| Rate for Payer: Superior Health Plan EPO |
$37,421.86
|
| Rate for Payer: Superior Health Plan Medicare |
$37,421.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37,421.86
|
| Rate for Payer: Universal American Medicare |
$37,421.86
|
| Rate for Payer: Wellcare Medicare |
$37,421.86
|
| Rate for Payer: Wellmed Medicare |
$37,421.86
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$37,095.60
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$17,083.50 |
| Max. Negotiated Rate |
$37,095.60 |
| Rate for Payer: Aetna Commercial |
$21,964.50
|
| Rate for Payer: Aetna Medicare |
$25,708.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,139.04
|
| Rate for Payer: Amerigroup Medicare |
$17,139.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22,563.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,276.48
|
| Rate for Payer: BCBS of TX Medicare |
$17,139.04
|
| Rate for Payer: BCBS of TX PPO |
$26,974.91
|
| Rate for Payer: Cigna Commercial |
$25,146.91
|
| Rate for Payer: Cigna Medicare |
$17,139.04
|
| Rate for Payer: Employer Direct Commercial |
$17,139.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,139.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,139.04
|
| Rate for Payer: Molina Medicare |
$17,139.04
|
| Rate for Payer: Multiplan Auto |
$37,095.60
|
| Rate for Payer: Multiplan Commercial |
$37,095.60
|
| Rate for Payer: Multiplan Workers Comp |
$37,095.60
|
| Rate for Payer: Scott and White EPO/PPO |
$17,083.50
|
| Rate for Payer: Scott and White Medicare |
$17,139.04
|
| Rate for Payer: Superior Health Plan EPO |
$17,139.04
|
| Rate for Payer: Superior Health Plan Medicare |
$17,139.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,139.04
|
| Rate for Payer: Universal American Medicare |
$17,139.04
|
| Rate for Payer: Wellcare Medicare |
$17,139.04
|
| Rate for Payer: Wellmed Medicare |
$17,139.04
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$24,758.90
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$11,402.12 |
| Max. Negotiated Rate |
$24,758.90 |
| Rate for Payer: Aetna Commercial |
$14,659.88
|
| Rate for Payer: Aetna Medicare |
$18,230.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,153.78
|
| Rate for Payer: Amerigroup Medicare |
$12,153.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,610.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,959.63
|
| Rate for Payer: BCBS of TX Medicare |
$12,153.78
|
| Rate for Payer: BCBS of TX PPO |
$14,400.15
|
| Rate for Payer: Cigna Commercial |
$16,783.93
|
| Rate for Payer: Cigna Medicare |
$12,153.78
|
| Rate for Payer: Employer Direct Commercial |
$12,153.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,153.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,153.78
|
| Rate for Payer: Molina Medicare |
$12,153.78
|
| Rate for Payer: Multiplan Auto |
$24,758.90
|
| Rate for Payer: Multiplan Commercial |
$24,758.90
|
| Rate for Payer: Multiplan Workers Comp |
$24,758.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11,402.12
|
| Rate for Payer: Scott and White Medicare |
$12,153.78
|
| Rate for Payer: Superior Health Plan EPO |
$12,153.78
|
| Rate for Payer: Superior Health Plan Medicare |
$12,153.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,153.78
|
| Rate for Payer: Universal American Medicare |
$12,153.78
|
| Rate for Payer: Wellcare Medicare |
$12,153.78
|
| Rate for Payer: Wellmed Medicare |
$12,153.78
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$23,039.40
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,610.25 |
| Max. Negotiated Rate |
$23,039.40 |
| Rate for Payer: Aetna Commercial |
$13,641.75
|
| Rate for Payer: Aetna Medicare |
$17,261.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,507.96
|
| Rate for Payer: Amerigroup Medicare |
$11,507.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,756.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,688.15
|
| Rate for Payer: BCBS of TX Medicare |
$11,507.96
|
| Rate for Payer: BCBS of TX PPO |
$15,209.65
|
| Rate for Payer: Cigna Commercial |
$15,618.29
|
| Rate for Payer: Cigna Medicare |
$11,507.96
|
| Rate for Payer: Employer Direct Commercial |
$11,507.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,507.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,507.96
|
| Rate for Payer: Molina Medicare |
$11,507.96
|
| Rate for Payer: Multiplan Auto |
$23,039.40
|
| Rate for Payer: Multiplan Commercial |
$23,039.40
|
| Rate for Payer: Multiplan Workers Comp |
$23,039.40
|
| Rate for Payer: Scott and White EPO/PPO |
$10,610.25
|
| Rate for Payer: Scott and White Medicare |
$11,507.96
|
| Rate for Payer: Superior Health Plan EPO |
$11,507.96
|
| Rate for Payer: Superior Health Plan Medicare |
$11,507.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,507.96
|
| Rate for Payer: Universal American Medicare |
$11,507.96
|
| Rate for Payer: Wellcare Medicare |
$11,507.96
|
| Rate for Payer: Wellmed Medicare |
$11,507.96
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$46,436.00
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$20,295.31 |
| Max. Negotiated Rate |
$46,436.00 |
| Rate for Payer: Aetna Commercial |
$27,495.00
|
| Rate for Payer: Aetna Medicare |
$30,442.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,295.31
|
| Rate for Payer: Amerigroup Medicare |
$20,295.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21,210.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29,077.91
|
| Rate for Payer: BCBS of TX Medicare |
$20,295.31
|
| Rate for Payer: BCBS of TX PPO |
$32,310.04
|
| Rate for Payer: Cigna Commercial |
$31,478.72
|
| Rate for Payer: Cigna Medicare |
$20,295.31
|
| Rate for Payer: Employer Direct Commercial |
$20,295.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,295.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,295.31
|
| Rate for Payer: Molina Medicare |
$20,295.31
|
| Rate for Payer: Multiplan Auto |
$46,436.00
|
| Rate for Payer: Multiplan Commercial |
$46,436.00
|
| Rate for Payer: Multiplan Workers Comp |
$46,436.00
|
| Rate for Payer: Scott and White EPO/PPO |
$21,385.00
|
| Rate for Payer: Scott and White Medicare |
$20,295.31
|
| Rate for Payer: Superior Health Plan EPO |
$20,295.31
|
| Rate for Payer: Superior Health Plan Medicare |
$20,295.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,295.31
|
| Rate for Payer: Universal American Medicare |
$20,295.31
|
| Rate for Payer: Wellcare Medicare |
$20,295.31
|
| Rate for Payer: Wellmed Medicare |
$20,295.31
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,430.50
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,645.62 |
| Max. Negotiated Rate |
$14,430.50 |
| Rate for Payer: Aetna Commercial |
$8,544.38
|
| Rate for Payer: Aetna Medicare |
$13,232.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,821.96
|
| Rate for Payer: Amerigroup Medicare |
$8,821.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,852.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,623.50
|
| Rate for Payer: BCBS of TX Medicare |
$8,821.96
|
| Rate for Payer: BCBS of TX PPO |
$10,693.19
|
| Rate for Payer: Cigna Commercial |
$9,782.36
|
| Rate for Payer: Cigna Medicare |
$8,821.96
|
| Rate for Payer: Employer Direct Commercial |
$8,821.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,821.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,821.96
|
| Rate for Payer: Molina Medicare |
$8,821.96
|
| Rate for Payer: Multiplan Auto |
$14,430.50
|
| Rate for Payer: Multiplan Commercial |
$14,430.50
|
| Rate for Payer: Multiplan Workers Comp |
$14,430.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,645.62
|
| Rate for Payer: Scott and White Medicare |
$8,821.96
|
| Rate for Payer: Superior Health Plan EPO |
$8,821.96
|
| Rate for Payer: Superior Health Plan Medicare |
$8,821.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,821.96
|
| Rate for Payer: Universal American Medicare |
$8,821.96
|
| Rate for Payer: Wellcare Medicare |
$8,821.96
|
| Rate for Payer: Wellmed Medicare |
$8,821.96
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$13,748.40
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$5,768.02 |
| Max. Negotiated Rate |
$13,748.40 |
| Rate for Payer: Aetna Commercial |
$8,140.50
|
| Rate for Payer: Aetna Medicare |
$12,027.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,018.44
|
| Rate for Payer: Amerigroup Medicare |
$8,018.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,768.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,298.63
|
| Rate for Payer: BCBS of TX Medicare |
$8,018.44
|
| Rate for Payer: BCBS of TX PPO |
$8,109.90
|
| Rate for Payer: Cigna Commercial |
$9,319.97
|
| Rate for Payer: Cigna Medicare |
$8,018.44
|
| Rate for Payer: Employer Direct Commercial |
$8,018.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,018.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,018.44
|
| Rate for Payer: Molina Medicare |
$8,018.44
|
| Rate for Payer: Multiplan Auto |
$13,748.40
|
| Rate for Payer: Multiplan Commercial |
$13,748.40
|
| Rate for Payer: Multiplan Workers Comp |
$13,748.40
|
| Rate for Payer: Scott and White EPO/PPO |
$6,331.50
|
| Rate for Payer: Scott and White Medicare |
$8,018.44
|
| Rate for Payer: Superior Health Plan EPO |
$8,018.44
|
| Rate for Payer: Superior Health Plan Medicare |
$8,018.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,018.44
|
| Rate for Payer: Universal American Medicare |
$8,018.44
|
| Rate for Payer: Wellcare Medicare |
$8,018.44
|
| Rate for Payer: Wellmed Medicare |
$8,018.44
|
|
|
Chest Tube Insertion
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
4010001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
Chest Tube Insertion
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
4010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$700,011.30
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$265,766.51 |
| Max. Negotiated Rate |
$700,011.30 |
| Rate for Payer: Aetna Commercial |
$414,480.38
|
| Rate for Payer: Aetna Medicare |
$398,649.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$265,766.51
|
| Rate for Payer: Amerigroup Medicare |
$265,766.51
|
| Rate for Payer: BCBS of TX Medicare |
$265,766.51
|
| Rate for Payer: Cigna Commercial |
$474,533.98
|
| Rate for Payer: Cigna Medicare |
$265,766.51
|
| Rate for Payer: Employer Direct Commercial |
$265,766.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$265,766.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$265,766.51
|
| Rate for Payer: Molina Medicare |
$265,766.51
|
| Rate for Payer: Multiplan Auto |
$700,011.30
|
| Rate for Payer: Multiplan Commercial |
$700,011.30
|
| Rate for Payer: Multiplan Workers Comp |
$700,011.30
|
| Rate for Payer: Scott and White EPO/PPO |
$322,373.62
|
| Rate for Payer: Scott and White Medicare |
$265,766.51
|
| Rate for Payer: Superior Health Plan EPO |
$265,766.51
|
| Rate for Payer: Superior Health Plan Medicare |
$265,766.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$265,766.51
|
| Rate for Payer: Universal American Medicare |
$265,766.51
|
| Rate for Payer: Wellcare Medicare |
$265,766.51
|
| Rate for Payer: Wellmed Medicare |
$265,766.51
|
|
|
Chlamydia Antibodies, IgG SO
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
1703305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$12.41
|
| Rate for Payer: Aetna Medicare |
$17.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Amerigroup Medicare |
$11.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.40
|
| Rate for Payer: BCBS of TX Medicare |
$11.82
|
| Rate for Payer: BCBS of TX PPO |
$26.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Medicaid |
$11.82
|
| Rate for Payer: Cigna Medicare |
$11.82
|
| Rate for Payer: Employer Direct Commercial |
$11.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Molina Medicare |
$11.82
|
| 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 |
$11.82
|
| Rate for Payer: Scott and White EPO/PPO |
$14.78
|
| Rate for Payer: Scott and White Medicare |
$11.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.82
|
| Rate for Payer: Superior Health Plan EPO |
$11.82
|
| Rate for Payer: Superior Health Plan Medicare |
$11.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Universal American Medicare |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$11.82
|
| Rate for Payer: Wellmed Medicare |
$11.82
|
|
|
Chlamydia/GC Amplification SO
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
1709682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia PCR
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
4107492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia PCR BCE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
4107492
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$262.24
|
|
|
Chlamydia PCR BCE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
4107492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia pneumoniae IgG Ab SO
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
1703305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$12.41
|
| Rate for Payer: Aetna Medicare |
$17.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Amerigroup Medicare |
$11.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.40
|
| Rate for Payer: BCBS of TX Medicare |
$11.82
|
| Rate for Payer: BCBS of TX PPO |
$26.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Medicaid |
$11.82
|
| Rate for Payer: Cigna Medicare |
$11.82
|
| Rate for Payer: Employer Direct Commercial |
$11.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Molina Medicare |
$11.82
|
| 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 |
$11.82
|
| Rate for Payer: Scott and White EPO/PPO |
$14.78
|
| Rate for Payer: Scott and White Medicare |
$11.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.82
|
| Rate for Payer: Superior Health Plan EPO |
$11.82
|
| Rate for Payer: Superior Health Plan Medicare |
$11.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.82
|
| Rate for Payer: Universal American Medicare |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$11.82
|
| Rate for Payer: Wellmed Medicare |
$11.82
|
|
|
Chlamydia pneumoniae IgG Ab SO
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
1703305
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
Chlamydia pneumoniae IgM SO
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
1703313
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$104.72
|
|
|
Chlamydia pneumoniae IgM SO
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
1703313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Amerigroup Medicare |
$12.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.11
|
| Rate for Payer: BCBS of TX Medicare |
$12.68
|
| Rate for Payer: BCBS of TX PPO |
$28.02
|
| Rate for Payer: Cash Price |
$104.72
|
| Rate for Payer: Cash Price |
$104.72
|
| Rate for Payer: Cigna Medicaid |
$12.68
|
| Rate for Payer: Cigna Medicare |
$12.68
|
| Rate for Payer: Employer Direct Commercial |
$12.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Molina Medicare |
$12.68
|
| Rate for Payer: Multiplan Auto |
$77.35
|
| Rate for Payer: Multiplan Commercial |
$77.35
|
| Rate for Payer: Multiplan Workers Comp |
$77.35
|
| Rate for Payer: Parkland Medicaid |
$12.68
|
| Rate for Payer: Scott and White EPO/PPO |
$15.85
|
| Rate for Payer: Scott and White Medicare |
$12.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.68
|
| Rate for Payer: Superior Health Plan EPO |
$12.68
|
| Rate for Payer: Superior Health Plan Medicare |
$12.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.68
|
| Rate for Payer: Universal American Medicare |
$12.68
|
| Rate for Payer: Wellcare Medicare |
$12.68
|
| Rate for Payer: Wellmed Medicare |
$12.68
|
|
|
Chlamydia pneumoniae, PCR SO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
8722543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$169.00
|
| Rate for Payer: Multiplan Workers Comp |
$169.00
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Chlamydia pneumoniae, PCR SO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
8722543
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$228.80
|
|
|
Chlamydia trachomatis, NAA SO
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
1709682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
