|
chlordiazePOXIDE 5 mg Cap
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77454854
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
chlordiazePOXIDE 5 mg Cap
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77454854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
CHLORDIAZEPOXIDE HCL 25 MG CAP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77454801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
CHLORDIAZEPOXIDE HCL 25 MG CAP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77454801
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Chloride, 24 hr Urine SO
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Amerigroup Medicare |
$5.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX Medicare |
$5.75
|
| Rate for Payer: BCBS of TX PPO |
$12.71
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cigna Medicaid |
$5.75
|
| Rate for Payer: Cigna Medicare |
$5.75
|
| Rate for Payer: Employer Direct Commercial |
$5.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare |
$5.75
|
| Rate for Payer: Multiplan Auto |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Multiplan Workers Comp |
$93.60
|
| Rate for Payer: Parkland Medicaid |
$5.75
|
| Rate for Payer: Scott and White EPO/PPO |
$7.19
|
| Rate for Payer: Scott and White Medicare |
$5.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.75
|
| Rate for Payer: Superior Health Plan EPO |
$5.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Universal American Medicare |
$5.75
|
| Rate for Payer: Wellcare Medicare |
$5.75
|
| Rate for Payer: Wellmed Medicare |
$5.75
|
|
|
Chloride, Fecal SO
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
1602432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.25
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.00
|
| Rate for Payer: Amerigroup Medicare |
$5.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.90
|
| Rate for Payer: BCBS of TX Medicare |
$5.00
|
| Rate for Payer: BCBS of TX PPO |
$11.05
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cigna Medicaid |
$5.00
|
| Rate for Payer: Cigna Medicare |
$5.00
|
| Rate for Payer: Employer Direct Commercial |
$5.00
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.00
|
| Rate for Payer: Molina Medicare |
$5.00
|
| Rate for Payer: Multiplan Auto |
$4.55
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Multiplan Workers Comp |
$4.55
|
| Rate for Payer: Parkland Medicaid |
$5.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6.25
|
| Rate for Payer: Scott and White Medicare |
$5.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.00
|
| Rate for Payer: Superior Health Plan EPO |
$5.00
|
| Rate for Payer: Superior Health Plan Medicare |
$5.00
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.00
|
| Rate for Payer: Universal American Medicare |
$5.00
|
| Rate for Payer: Wellcare Medicare |
$5.00
|
| Rate for Payer: Wellmed Medicare |
$5.00
|
|
|
Chloride, Fecal SO
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
1602432
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.16
|
|
|
Chloride Level
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
1601715
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$97.68
|
|
|
Chloride Level
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
1601715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Aetna Commercial |
$4.83
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.60
|
| Rate for Payer: Amerigroup Medicare |
$4.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.11
|
| Rate for Payer: BCBS of TX Medicare |
$4.60
|
| Rate for Payer: BCBS of TX PPO |
$10.17
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cigna Medicaid |
$4.60
|
| Rate for Payer: Cigna Medicare |
$4.60
|
| Rate for Payer: Employer Direct Commercial |
$4.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.60
|
| Rate for Payer: Molina Medicare |
$4.60
|
| Rate for Payer: Multiplan Auto |
$72.15
|
| Rate for Payer: Multiplan Commercial |
$72.15
|
| Rate for Payer: Multiplan Workers Comp |
$72.15
|
| Rate for Payer: Parkland Medicaid |
$4.60
|
| Rate for Payer: Scott and White EPO/PPO |
$5.75
|
| Rate for Payer: Scott and White Medicare |
$4.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.60
|
| Rate for Payer: Superior Health Plan EPO |
$4.60
|
| Rate for Payer: Superior Health Plan Medicare |
$4.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.60
|
| Rate for Payer: Universal American Medicare |
$4.60
|
| Rate for Payer: Wellcare Medicare |
$4.60
|
| Rate for Payer: Wellmed Medicare |
$4.60
|
|
|
Chloride Level 24 Hour Urine
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Amerigroup Medicare |
$5.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX Medicare |
$5.75
|
| Rate for Payer: BCBS of TX PPO |
$12.71
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cigna Medicaid |
$5.75
|
| Rate for Payer: Cigna Medicare |
$5.75
|
| Rate for Payer: Employer Direct Commercial |
$5.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare |
$5.75
|
| Rate for Payer: Multiplan Auto |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Multiplan Workers Comp |
$93.60
|
| Rate for Payer: Parkland Medicaid |
$5.75
|
| Rate for Payer: Scott and White EPO/PPO |
$7.19
|
| Rate for Payer: Scott and White Medicare |
$5.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.75
|
| Rate for Payer: Superior Health Plan EPO |
$5.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Universal American Medicare |
$5.75
|
| Rate for Payer: Wellcare Medicare |
$5.75
|
| Rate for Payer: Wellmed Medicare |
$5.75
|
|
|
Chloride Level Urine
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Amerigroup Medicare |
$5.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX Medicare |
$5.75
|
| Rate for Payer: BCBS of TX PPO |
$12.71
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cigna Medicaid |
$5.75
|
| Rate for Payer: Cigna Medicare |
$5.75
|
| Rate for Payer: Employer Direct Commercial |
$5.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare |
$5.75
|
| Rate for Payer: Multiplan Auto |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Multiplan Workers Comp |
$93.60
|
| Rate for Payer: Parkland Medicaid |
$5.75
|
| Rate for Payer: Scott and White EPO/PPO |
$7.19
|
| Rate for Payer: Scott and White Medicare |
$5.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.75
|
| Rate for Payer: Superior Health Plan EPO |
$5.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Universal American Medicare |
$5.75
|
| Rate for Payer: Wellcare Medicare |
$5.75
|
| Rate for Payer: Wellmed Medicare |
$5.75
|
|
|
Chloride, Urine SO
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Amerigroup Medicare |
$5.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX Medicare |
$5.75
|
| Rate for Payer: BCBS of TX PPO |
$12.71
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cigna Medicaid |
$5.75
|
| Rate for Payer: Cigna Medicare |
$5.75
|
| Rate for Payer: Employer Direct Commercial |
$5.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare |
$5.75
|
| Rate for Payer: Multiplan Auto |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Multiplan Workers Comp |
$93.60
|
| Rate for Payer: Parkland Medicaid |
$5.75
|
| Rate for Payer: Scott and White EPO/PPO |
$7.19
|
| Rate for Payer: Scott and White Medicare |
$5.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.75
|
| Rate for Payer: Superior Health Plan EPO |
$5.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.75
|
| Rate for Payer: Universal American Medicare |
$5.75
|
| Rate for Payer: Wellcare Medicare |
$5.75
|
| Rate for Payer: Wellmed Medicare |
$5.75
|
|
|
Chloride, Urine SO
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
1602473
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$126.72
|
|
|
CHNG EXT/INT URETR STENT
|
Facility
|
OP
|
$3,529.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
4614483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$652.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Amerigroup Medicare |
$1,862.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$1,862.76
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| Rate for Payer: Cash Price |
$3,105.52
|
| Rate for Payer: Cash Price |
$3,105.52
|
| Rate for Payer: Cigna Commercial |
$4,219.69
|
| Rate for Payer: Cigna Medicaid |
$652.80
|
| Rate for Payer: Cigna Medicare |
$1,862.76
|
| Rate for Payer: Employer Direct Commercial |
$1,862.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,862.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$652.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Molina Medicare |
$1,862.76
|
| 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 |
$652.80
|
| Rate for Payer: Scott and White EPO/PPO |
$41.09
|
| Rate for Payer: Scott and White Medicare |
$1,862.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$652.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,862.76
|
| Rate for Payer: Superior Health Plan Medicare |
$1,862.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Universal American Medicare |
$1,862.76
|
| Rate for Payer: Wellcare Medicare |
$1,862.76
|
| Rate for Payer: Wellmed Medicare |
$1,862.76
|
|
|
CHNG EXT/INT URETR STENT
|
Facility
|
IP
|
$3,529.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
4614483
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,105.52
|
|
|
CHOLANGIO+INJ EXIST CTH
|
Facility
|
OP
|
$7,278.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
4617531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$655.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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 |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
CHOLANGIO+INJ EXIST CTH
|
Facility
|
IP
|
$7,278.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
4617531
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,404.64
|
|
|
CHOLANGIO+INJ NEW
|
Facility
|
OP
|
$7,278.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
4617532
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$655.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cash Price |
$6,404.64
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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 |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
CHOLANGIO+INJ NEW
|
Facility
|
IP
|
$7,278.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
4617532
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,404.64
|
|
|
cholecalciferol 1,000 intl units Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77464294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
cholecalciferol 1,000 intl units Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77464294
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$37,540.20
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$16,954.21 |
| Max. Negotiated Rate |
$37,540.20 |
| Rate for Payer: Aetna Commercial |
$22,227.75
|
| Rate for Payer: Aetna Medicare |
$25,431.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,954.21
|
| Rate for Payer: Amerigroup Medicare |
$16,954.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,402.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,832.00
|
| Rate for Payer: BCBS of TX Medicare |
$16,954.21
|
| Rate for Payer: BCBS of TX PPO |
$23,147.56
|
| Rate for Payer: Cigna Commercial |
$25,448.30
|
| Rate for Payer: Cigna Medicare |
$16,954.21
|
| Rate for Payer: Employer Direct Commercial |
$16,954.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,954.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,954.21
|
| Rate for Payer: Molina Medicare |
$16,954.21
|
| Rate for Payer: Multiplan Auto |
$37,540.20
|
| Rate for Payer: Multiplan Commercial |
$37,540.20
|
| Rate for Payer: Multiplan Workers Comp |
$37,540.20
|
| Rate for Payer: Scott and White EPO/PPO |
$17,288.25
|
| Rate for Payer: Scott and White Medicare |
$16,954.21
|
| Rate for Payer: Superior Health Plan EPO |
$16,954.21
|
| Rate for Payer: Superior Health Plan Medicare |
$16,954.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,954.21
|
| Rate for Payer: Universal American Medicare |
$16,954.21
|
| Rate for Payer: Wellcare Medicare |
$16,954.21
|
| Rate for Payer: Wellmed Medicare |
$16,954.21
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$66,978.80
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$28,010.82 |
| Max. Negotiated Rate |
$66,978.80 |
| Rate for Payer: Aetna Commercial |
$39,658.50
|
| Rate for Payer: Aetna Medicare |
$42,016.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,010.82
|
| Rate for Payer: Amerigroup Medicare |
$28,010.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30,181.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36,913.13
|
| Rate for Payer: BCBS of TX Medicare |
$28,010.82
|
| Rate for Payer: BCBS of TX PPO |
$41,016.18
|
| Rate for Payer: Cigna Commercial |
$45,404.58
|
| Rate for Payer: Cigna Medicare |
$28,010.82
|
| Rate for Payer: Employer Direct Commercial |
$28,010.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,010.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,010.82
|
| Rate for Payer: Molina Medicare |
$28,010.82
|
| Rate for Payer: Multiplan Auto |
$66,978.80
|
| Rate for Payer: Multiplan Commercial |
$66,978.80
|
| Rate for Payer: Multiplan Workers Comp |
$66,978.80
|
| Rate for Payer: Scott and White EPO/PPO |
$30,845.50
|
| Rate for Payer: Scott and White Medicare |
$28,010.82
|
| Rate for Payer: Superior Health Plan EPO |
$28,010.82
|
| Rate for Payer: Superior Health Plan Medicare |
$28,010.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,010.82
|
| Rate for Payer: Universal American Medicare |
$28,010.82
|
| Rate for Payer: Wellcare Medicare |
$28,010.82
|
| Rate for Payer: Wellmed Medicare |
$28,010.82
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$25,444.80
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$11,402.74 |
| Max. Negotiated Rate |
$25,444.80 |
| Rate for Payer: Aetna Commercial |
$15,066.00
|
| Rate for Payer: Aetna Medicare |
$18,617.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,411.40
|
| Rate for Payer: Amerigroup Medicare |
$12,411.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,402.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,375.40
|
| Rate for Payer: BCBS of TX Medicare |
$12,411.40
|
| Rate for Payer: BCBS of TX PPO |
$15,973.28
|
| Rate for Payer: Cigna Commercial |
$17,248.90
|
| Rate for Payer: Cigna Medicare |
$12,411.40
|
| Rate for Payer: Employer Direct Commercial |
$12,411.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,411.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,411.40
|
| Rate for Payer: Molina Medicare |
$12,411.40
|
| Rate for Payer: Multiplan Auto |
$25,444.80
|
| Rate for Payer: Multiplan Commercial |
$25,444.80
|
| Rate for Payer: Multiplan Workers Comp |
$25,444.80
|
| Rate for Payer: Scott and White EPO/PPO |
$11,718.00
|
| Rate for Payer: Scott and White Medicare |
$12,411.40
|
| Rate for Payer: Superior Health Plan EPO |
$12,411.40
|
| Rate for Payer: Superior Health Plan Medicare |
$12,411.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,411.40
|
| Rate for Payer: Universal American Medicare |
$12,411.40
|
| Rate for Payer: Wellcare Medicare |
$12,411.40
|
| Rate for Payer: Wellmed Medicare |
$12,411.40
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$38,864.50
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$17,598.59 |
| Max. Negotiated Rate |
$38,864.50 |
| Rate for Payer: Aetna Commercial |
$23,011.88
|
| Rate for Payer: Aetna Medicare |
$26,397.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,598.59
|
| Rate for Payer: Amerigroup Medicare |
$17,598.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,400.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,578.83
|
| Rate for Payer: BCBS of TX Medicare |
$17,598.59
|
| Rate for Payer: BCBS of TX PPO |
$27,310.87
|
| Rate for Payer: Cigna Commercial |
$26,346.04
|
| Rate for Payer: Cigna Medicare |
$17,598.59
|
| Rate for Payer: Employer Direct Commercial |
$17,598.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,598.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,598.59
|
| Rate for Payer: Molina Medicare |
$17,598.59
|
| Rate for Payer: Multiplan Auto |
$38,864.50
|
| Rate for Payer: Multiplan Commercial |
$38,864.50
|
| Rate for Payer: Multiplan Workers Comp |
$38,864.50
|
| Rate for Payer: Scott and White EPO/PPO |
$17,898.12
|
| Rate for Payer: Scott and White Medicare |
$17,598.59
|
| Rate for Payer: Superior Health Plan EPO |
$17,598.59
|
| Rate for Payer: Superior Health Plan Medicare |
$17,598.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,598.59
|
| Rate for Payer: Universal American Medicare |
$17,598.59
|
| Rate for Payer: Wellcare Medicare |
$17,598.59
|
| Rate for Payer: Wellmed Medicare |
$17,598.59
|
|
