|
CONTRST EVAL EXISTNG CVD
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
4616598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$506.55
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$155.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$185.68
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$233.96
|
| Rate for Payer: Cash Price |
$810.48
|
| Rate for Payer: Cash Price |
$810.48
|
| Rate for Payer: Cash Price |
$810.48
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicaid |
$79.46
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$79.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| 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: Parkland Medicaid |
$79.46
|
| Rate for Payer: Scott and White EPO/PPO |
$4.32
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$79.46
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
Co-Ox RT Carboxyhemoglobin BCE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
4000584
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$168.96
|
|
|
Co-Ox RT Carboxyhemoglobin BCE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
4000584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Amerigroup Medicare |
$12.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.39
|
| Rate for Payer: BCBS of TX Medicare |
$12.32
|
| Rate for Payer: BCBS of TX PPO |
$27.23
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cigna Medicaid |
$12.32
|
| Rate for Payer: Cigna Medicare |
$12.32
|
| Rate for Payer: Employer Direct Commercial |
$12.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Molina Medicare |
$12.32
|
| Rate for Payer: Multiplan Auto |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Multiplan Workers Comp |
$124.80
|
| Rate for Payer: Parkland Medicaid |
$12.32
|
| Rate for Payer: Scott and White EPO/PPO |
$15.40
|
| Rate for Payer: Scott and White Medicare |
$12.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.32
|
| Rate for Payer: Superior Health Plan EPO |
$12.32
|
| Rate for Payer: Superior Health Plan Medicare |
$12.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Universal American Medicare |
$12.32
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: Wellmed Medicare |
$12.32
|
|
|
Co-Ox RT Methemoglobin BCE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
4049193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$85.15 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.20
|
| Rate for Payer: Amerigroup Medicare |
$8.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16.24
|
| Rate for Payer: BCBS of TX Medicare |
$8.20
|
| Rate for Payer: BCBS of TX PPO |
$18.12
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cigna Medicaid |
$8.20
|
| Rate for Payer: Cigna Medicare |
$8.20
|
| Rate for Payer: Employer Direct Commercial |
$8.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.20
|
| Rate for Payer: Molina Medicare |
$8.20
|
| Rate for Payer: Multiplan Auto |
$85.15
|
| Rate for Payer: Multiplan Commercial |
$85.15
|
| Rate for Payer: Multiplan Workers Comp |
$85.15
|
| Rate for Payer: Parkland Medicaid |
$8.20
|
| Rate for Payer: Scott and White EPO/PPO |
$10.25
|
| Rate for Payer: Scott and White Medicare |
$8.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.20
|
| Rate for Payer: Superior Health Plan EPO |
$8.20
|
| Rate for Payer: Superior Health Plan Medicare |
$8.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.20
|
| Rate for Payer: Universal American Medicare |
$8.20
|
| Rate for Payer: Wellcare Medicare |
$8.20
|
| Rate for Payer: Wellmed Medicare |
$8.20
|
|
|
Co-Ox RT Methemoglobin BCE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
4049193
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$115.28
|
|
|
Co-Ox RT O2 Sat Meas BCE
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 82810
|
| Hospital Charge Code |
4049206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.77
|
| Rate for Payer: Amerigroup Medicare |
$9.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.34
|
| Rate for Payer: BCBS of TX Medicare |
$9.77
|
| Rate for Payer: BCBS of TX PPO |
$21.59
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna Medicaid |
$9.77
|
| Rate for Payer: Cigna Medicare |
$9.77
|
| Rate for Payer: Employer Direct Commercial |
$9.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.77
|
| Rate for Payer: Molina Medicare |
$9.77
|
| Rate for Payer: Multiplan Auto |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Multiplan Workers Comp |
$208.00
|
| Rate for Payer: Parkland Medicaid |
$9.77
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| Rate for Payer: Scott and White Medicare |
$9.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.77
|
| Rate for Payer: Superior Health Plan EPO |
$9.77
|
| Rate for Payer: Superior Health Plan Medicare |
$9.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.77
|
| Rate for Payer: Universal American Medicare |
$9.77
|
| Rate for Payer: Wellcare Medicare |
$9.77
|
| Rate for Payer: Wellmed Medicare |
$9.77
|
|
|
Co-Ox RT O2 Sat Meas BCE
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 82810
|
| Hospital Charge Code |
4049206
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$281.60
|
|
|
Copper, Serum SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1700426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.04
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Amerigroup Medicare |
$12.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.57
|
| Rate for Payer: BCBS of TX Medicare |
$12.41
|
| Rate for Payer: BCBS of TX PPO |
$27.43
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.41
|
| Rate for Payer: Cigna Medicare |
$12.41
|
| Rate for Payer: Employer Direct Commercial |
$12.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.41
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Molina Medicare |
$12.41
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.41
|
| Rate for Payer: Scott and White EPO/PPO |
$15.51
|
| Rate for Payer: Scott and White Medicare |
$12.41
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.41
|
| Rate for Payer: Superior Health Plan EPO |
$12.41
|
| Rate for Payer: Superior Health Plan Medicare |
$12.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Universal American Medicare |
$12.41
|
| Rate for Payer: Wellcare Medicare |
$12.41
|
| Rate for Payer: Wellmed Medicare |
$12.41
|
|
|
Copper, Urine SO
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1700426
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$130.24
|
|
|
Copper, Urine SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1700426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.04
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Amerigroup Medicare |
$12.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.57
|
| Rate for Payer: BCBS of TX Medicare |
$12.41
|
| Rate for Payer: BCBS of TX PPO |
$27.43
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.41
|
| Rate for Payer: Cigna Medicare |
$12.41
|
| Rate for Payer: Employer Direct Commercial |
$12.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.41
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Molina Medicare |
$12.41
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.41
|
| Rate for Payer: Scott and White EPO/PPO |
$15.51
|
| Rate for Payer: Scott and White Medicare |
$12.41
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.41
|
| Rate for Payer: Superior Health Plan EPO |
$12.41
|
| Rate for Payer: Superior Health Plan Medicare |
$12.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.41
|
| Rate for Payer: Universal American Medicare |
$12.41
|
| Rate for Payer: Wellcare Medicare |
$12.41
|
| Rate for Payer: Wellmed Medicare |
$12.41
|
|
|
COR ANGIO CATH INLUD INJ IMAG
|
Facility
|
OP
|
$19,325.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
2320523
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$12,561.25 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,470.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,739.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Amerigroup Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$17,006.00
|
| Rate for Payer: Cash Price |
$17,006.00
|
| Rate for Payer: Cash Price |
$17,006.00
|
| Rate for Payer: Cigna Commercial |
$6,750.80
|
| Rate for Payer: Cigna Medicare |
$2,980.11
|
| Rate for Payer: Employer Direct Commercial |
$2,980.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,980.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Molina Medicare |
$2,980.11
|
| Rate for Payer: Multiplan Auto |
$12,561.25
|
| Rate for Payer: Multiplan Commercial |
$12,561.25
|
| Rate for Payer: Multiplan Workers Comp |
$12,561.25
|
| Rate for Payer: Scott and White EPO/PPO |
$53.30
|
| Rate for Payer: Scott and White Medicare |
$2,980.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,980.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,980.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Universal American Medicare |
$2,980.11
|
| Rate for Payer: Wellcare Medicare |
$2,980.11
|
| Rate for Payer: Wellmed Medicare |
$2,980.11
|
|
|
COR ANGIO CATH INLUD INJ IMAG
|
Facility
|
IP
|
$19,325.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
2320523
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$17,006.00
|
|
|
COR ANGIO CATH+LT HT CATH+LVCG+GRAF
|
Facility
|
OP
|
$22,774.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
2320528
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$14,803.10 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,470.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,049.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Amerigroup Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$20,041.12
|
| Rate for Payer: Cash Price |
$20,041.12
|
| Rate for Payer: Cash Price |
$20,041.12
|
| Rate for Payer: Cigna Commercial |
$6,750.80
|
| Rate for Payer: Cigna Medicare |
$2,980.11
|
| Rate for Payer: Employer Direct Commercial |
$2,980.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,980.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Molina Medicare |
$2,980.11
|
| Rate for Payer: Multiplan Auto |
$14,803.10
|
| Rate for Payer: Multiplan Commercial |
$14,803.10
|
| Rate for Payer: Multiplan Workers Comp |
$14,803.10
|
| Rate for Payer: Scott and White EPO/PPO |
$53.30
|
| Rate for Payer: Scott and White Medicare |
$2,980.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,980.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,980.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Universal American Medicare |
$2,980.11
|
| Rate for Payer: Wellcare Medicare |
$2,980.11
|
| Rate for Payer: Wellmed Medicare |
$2,980.11
|
|
|
COR ANGIO CATH+LT HT CATH+LVCG+GRAF
|
Facility
|
IP
|
$22,774.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
2320528
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$20,041.12
|
|
|
Cord ABO/Rh
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2400406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$98.80
|
| Rate for Payer: Multiplan Commercial |
$98.80
|
| Rate for Payer: Multiplan Workers Comp |
$98.80
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
CORD, ACTIVE UNIV FOR ELECTROSURGICAL 10' DISP -- DHF
|
Facility
|
OP
|
$75.90
|
|
| Hospital Charge Code |
81739021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: Aetna Commercial |
$41.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.32
|
| Rate for Payer: BCBS of TX PPO |
$30.36
|
| Rate for Payer: Cash Price |
$66.79
|
| Rate for Payer: Multiplan Auto |
$49.34
|
| Rate for Payer: Multiplan Commercial |
$49.34
|
| Rate for Payer: Multiplan Workers Comp |
$49.34
|
| Rate for Payer: Scott and White EPO/PPO |
$37.95
|
| Rate for Payer: Superior Health Plan EPO |
$10.32
|
|
|
CORD BI-POLAR -- DHF
|
Facility
|
OP
|
$198.05
|
|
| Hospital Charge Code |
81739005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$128.73 |
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$59.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$71.30
|
| Rate for Payer: BCBS of TX PPO |
$79.22
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Multiplan Auto |
$128.73
|
| Rate for Payer: Multiplan Commercial |
$128.73
|
| Rate for Payer: Multiplan Workers Comp |
$128.73
|
| Rate for Payer: Scott and White EPO/PPO |
$99.02
|
| Rate for Payer: Superior Health Plan EPO |
$26.93
|
|
|
CORD BI-POLAR -- DHF
|
Facility
|
IP
|
$198.05
|
|
| Hospital Charge Code |
81739005
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$174.28
|
|
|
Cord DAT
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| 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 |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
CORD DISP -- DHF
|
Facility
|
OP
|
$722.01
|
|
| Hospital Charge Code |
80318504
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$469.31 |
| Rate for Payer: Aetna Commercial |
$397.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$216.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$259.92
|
| Rate for Payer: BCBS of TX PPO |
$288.80
|
| Rate for Payer: Cash Price |
$635.37
|
| Rate for Payer: Multiplan Auto |
$469.31
|
| Rate for Payer: Multiplan Commercial |
$469.31
|
| Rate for Payer: Multiplan Workers Comp |
$469.31
|
| Rate for Payer: Scott and White EPO/PPO |
$361.00
|
| Rate for Payer: Superior Health Plan EPO |
$98.19
|
|
|
CORD DISP -- DHF
|
Facility
|
IP
|
$722.01
|
|
| Hospital Charge Code |
80318504
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$635.37
|
|
|
CORD, FOR BIPOLAR FORCEPS 12' DISPOSABLE STERILE -- DHF
|
Facility
|
OP
|
$75.90
|
|
| Hospital Charge Code |
81739021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: Aetna Commercial |
$41.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.32
|
| Rate for Payer: BCBS of TX PPO |
$30.36
|
| Rate for Payer: Cash Price |
$66.79
|
| Rate for Payer: Multiplan Auto |
$49.34
|
| Rate for Payer: Multiplan Commercial |
$49.34
|
| Rate for Payer: Multiplan Workers Comp |
$49.34
|
| Rate for Payer: Scott and White EPO/PPO |
$37.95
|
| Rate for Payer: Superior Health Plan EPO |
$10.32
|
|
|
CORD, FOR BIPOLAR FORCEPS 12' DISPOSABLE STERILE -- DHF
|
Facility
|
IP
|
$75.90
|
|
| Hospital Charge Code |
81739021
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$66.79
|
|
|
CORO CATH ANGIO+RT HT CATH
|
Facility
|
IP
|
$23,666.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
2320525
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$20,826.08
|
|
|
CORO CATH ANGIO+RT HT CATH
|
Facility
|
OP
|
$23,666.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
2320525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$15,382.90 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,470.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,129.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Amerigroup Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$20,826.08
|
| Rate for Payer: Cash Price |
$20,826.08
|
| Rate for Payer: Cash Price |
$20,826.08
|
| Rate for Payer: Cigna Commercial |
$6,750.80
|
| Rate for Payer: Cigna Medicare |
$2,980.11
|
| Rate for Payer: Employer Direct Commercial |
$2,980.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,980.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Molina Medicare |
$2,980.11
|
| Rate for Payer: Multiplan Auto |
$15,382.90
|
| Rate for Payer: Multiplan Commercial |
$15,382.90
|
| Rate for Payer: Multiplan Workers Comp |
$15,382.90
|
| Rate for Payer: Scott and White EPO/PPO |
$53.30
|
| Rate for Payer: Scott and White Medicare |
$2,980.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,980.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,980.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Universal American Medicare |
$2,980.11
|
| Rate for Payer: Wellcare Medicare |
$2,980.11
|
| Rate for Payer: Wellmed Medicare |
$2,980.11
|
|
