|
clopidogrel 75 mg Tab
|
Facility
|
OP
|
$18.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.82
|
| Rate for Payer: BCBS of TX PPO |
$7.58
|
| Rate for Payer: Cash Price |
$12.89
|
| Rate for Payer: Multiplan Auto |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Multiplan Workers Comp |
$12.32
|
| Rate for Payer: Scott and White EPO/PPO |
$9.48
|
| Rate for Payer: Superior Health Plan EPO |
$2.58
|
|
|
clopidogrel 75 mg Tab
|
Facility
|
IP
|
$18.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476250
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$12.89
|
|
|
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
36025605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
36026607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Closed treatment of nasal bone fracture; with stabilization
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
36021320
|
|
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 |
$886.62
|
| 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 |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$886.62
|
| 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 |
$886.62
|
| 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 |
$886.62
|
| 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 |
$886.62
|
| 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
|
|
|
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
36026720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| 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 |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$4.76
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
Clostridium Difficile GDH Tox
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
1603927
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$17.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.72
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$26.48
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cigna Medicaid |
$11.98
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Parkland Medicaid |
$11.98
|
| Rate for Payer: Scott and White EPO/PPO |
$14.98
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.98
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium Difficile GDH Tox
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
1603927
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$421.52
|
|
|
Clostridium difficile PCR
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4108751
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$334.40
|
|
|
Clostridium difficile PCR
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4108751
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$39.13
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$61.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$73.79
|
| Rate for Payer: BCBS of TX Medicare |
$37.27
|
| Rate for Payer: BCBS of TX PPO |
$82.37
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cigna Medicaid |
$37.27
|
| Rate for Payer: Cigna Medicare |
$37.27
|
| Rate for Payer: Employer Direct Commercial |
$37.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Molina Medicare |
$37.27
|
| Rate for Payer: Multiplan Auto |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$247.00
|
| Rate for Payer: Multiplan Workers Comp |
$247.00
|
| Rate for Payer: Parkland Medicaid |
$37.27
|
| Rate for Payer: Scott and White EPO/PPO |
$46.59
|
| Rate for Payer: Scott and White Medicare |
$37.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.27
|
| Rate for Payer: Superior Health Plan EPO |
$37.27
|
| Rate for Payer: Superior Health Plan Medicare |
$37.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Universal American Medicare |
$37.27
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: Wellmed Medicare |
$37.27
|
|
|
Clostridium difficile Toxin A
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
4107449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$232.70 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$17.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.72
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$26.48
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cigna Medicaid |
$11.98
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Parkland Medicaid |
$11.98
|
| Rate for Payer: Scott and White EPO/PPO |
$14.98
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.98
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium difficile Toxin A
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
4107449
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$315.04
|
|
|
Clostridium difficile Toxin B
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
4105006
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$421.52
|
|
|
Clostridium difficile Toxin B
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
4105006
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$17.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.72
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$26.48
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cigna Medicaid |
$11.98
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Parkland Medicaid |
$11.98
|
| Rate for Payer: Scott and White EPO/PPO |
$14.98
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.98
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clozapine (Clozaril), Serum SO
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
1740988
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$30.22
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.15
|
| Rate for Payer: Amerigroup Medicare |
$20.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.90
|
| Rate for Payer: BCBS of TX Medicare |
$20.15
|
| Rate for Payer: BCBS of TX PPO |
$44.53
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cigna Medicaid |
$20.15
|
| Rate for Payer: Cigna Medicare |
$20.15
|
| Rate for Payer: Employer Direct Commercial |
$20.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.15
|
| Rate for Payer: Molina Medicare |
$20.15
|
| Rate for Payer: Multiplan Auto |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$100.75
|
| Rate for Payer: Multiplan Workers Comp |
$100.75
|
| Rate for Payer: Parkland Medicaid |
$20.15
|
| Rate for Payer: Scott and White EPO/PPO |
$25.19
|
| Rate for Payer: Scott and White Medicare |
$20.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.15
|
| Rate for Payer: Superior Health Plan EPO |
$20.15
|
| Rate for Payer: Superior Health Plan Medicare |
$20.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.15
|
| Rate for Payer: Universal American Medicare |
$20.15
|
| Rate for Payer: Wellcare Medicare |
$20.15
|
| Rate for Payer: Wellmed Medicare |
$20.15
|
|
|
Clozapine (Clozaril), Serum SO
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
1740988
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$136.40
|
|
|
CMPLX CHRON CARE ADDL 30 MIN Units
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
6019902
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$70.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55.47
|
| Rate for Payer: BCBS of TX PPO |
$61.87
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Multiplan Auto |
$83.85
|
| Rate for Payer: Multiplan Commercial |
$83.85
|
| Rate for Payer: Multiplan Workers Comp |
$83.85
|
| Rate for Payer: Scott and White EPO/PPO |
$64.50
|
|
|
Cmplx Chron Care Addl 30 Min Units BCE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
6019902
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$70.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55.47
|
| Rate for Payer: BCBS of TX PPO |
$61.87
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Multiplan Auto |
$83.85
|
| Rate for Payer: Multiplan Commercial |
$83.85
|
| Rate for Payer: Multiplan Workers Comp |
$83.85
|
| Rate for Payer: Scott and White EPO/PPO |
$64.50
|
|
|
Cmplx Chron Care Addl 30 Min Units BCE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
6019902
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$113.52
|
|
|
CMPLX CHRON CARE W/O PT VSIT Units
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
6019901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$330.32 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Aetna Medicare |
$218.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Amerigroup Medicare |
$145.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$92.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.20
|
| Rate for Payer: BCBS of TX Medicare |
$145.81
|
| Rate for Payer: BCBS of TX PPO |
$122.91
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Commercial |
$330.32
|
| Rate for Payer: Cigna Medicare |
$145.81
|
| Rate for Payer: Employer Direct Commercial |
$145.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$145.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Molina Medicare |
$145.81
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2.61
|
| Rate for Payer: Scott and White Medicare |
$145.81
|
| Rate for Payer: Superior Health Plan EPO |
$145.81
|
| Rate for Payer: Superior Health Plan Medicare |
$145.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Universal American Medicare |
$145.81
|
| Rate for Payer: Wellcare Medicare |
$145.81
|
| Rate for Payer: Wellmed Medicare |
$145.81
|
|
|
Cmplx Chron Care W/O Pt Vsit Units BCE
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
6019901
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$330.88
|
|
|
Cmplx Chron Care W/O Pt Vsit Units BCE
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
6019901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$330.32 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Aetna Medicare |
$218.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Amerigroup Medicare |
$145.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$92.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.20
|
| Rate for Payer: BCBS of TX Medicare |
$145.81
|
| Rate for Payer: BCBS of TX PPO |
$122.91
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Commercial |
$330.32
|
| Rate for Payer: Cigna Medicare |
$145.81
|
| Rate for Payer: Employer Direct Commercial |
$145.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$145.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Molina Medicare |
$145.81
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2.61
|
| Rate for Payer: Scott and White Medicare |
$145.81
|
| Rate for Payer: Superior Health Plan EPO |
$145.81
|
| Rate for Payer: Superior Health Plan Medicare |
$145.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$145.81
|
| Rate for Payer: Universal American Medicare |
$145.81
|
| Rate for Payer: Wellcare Medicare |
$145.81
|
| Rate for Payer: Wellmed Medicare |
$145.81
|
|
|
CMV Ab, IgM, CSF SO
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
1702596
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Amerigroup Medicare |
$16.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.36
|
| Rate for Payer: BCBS of TX Medicare |
$16.85
|
| Rate for Payer: BCBS of TX PPO |
$37.24
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cash Price |
$364.32
|
| Rate for Payer: Cigna Medicaid |
$16.85
|
| Rate for Payer: Cigna Medicare |
$16.85
|
| Rate for Payer: Employer Direct Commercial |
$16.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Molina Medicare |
$16.85
|
| Rate for Payer: Multiplan Auto |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$269.10
|
| Rate for Payer: Multiplan Workers Comp |
$269.10
|
| Rate for Payer: Parkland Medicaid |
$16.85
|
| Rate for Payer: Scott and White EPO/PPO |
$21.06
|
| Rate for Payer: Scott and White Medicare |
$16.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.85
|
| Rate for Payer: Superior Health Plan EPO |
$16.85
|
| Rate for Payer: Superior Health Plan Medicare |
$16.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Universal American Medicare |
$16.85
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: Wellmed Medicare |
$16.85
|
|
|
CMV PCR SO
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
1740034
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$266.64
|
|
|
CMV PCR SO
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
1740034
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$196.95 |
| 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 |
$266.64
|
| Rate for Payer: Cash Price |
$266.64
|
| 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 |
$196.95
|
| Rate for Payer: Multiplan Commercial |
$196.95
|
| Rate for Payer: Multiplan Workers Comp |
$196.95
|
| 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
|
|
