|
Creatine Kinase (CK), MB SO
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8520510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.87
|
| Rate for Payer: BCBS of TX Medicare |
$11.55
|
| Rate for Payer: BCBS of TX PPO |
$25.53
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cigna Medicaid |
$11.55
|
| Rate for Payer: Cigna Medicare |
$11.55
|
| Rate for Payer: Employer Direct Commercial |
$11.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Molina Medicare |
$11.55
|
| Rate for Payer: Multiplan Auto |
$256.10
|
| Rate for Payer: Multiplan Commercial |
$256.10
|
| Rate for Payer: Multiplan Workers Comp |
$256.10
|
| Rate for Payer: Parkland Medicaid |
$11.55
|
| Rate for Payer: Scott and White EPO/PPO |
$14.44
|
| Rate for Payer: Scott and White Medicare |
$11.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.55
|
| Rate for Payer: Superior Health Plan EPO |
$11.55
|
| Rate for Payer: Superior Health Plan Medicare |
$11.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Universal American Medicare |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: Wellmed Medicare |
$11.55
|
|
|
Creatine Kinase (CK), MB SO
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8520510
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$346.72
|
|
|
Creatine Kinase MB
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
1601764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.87
|
| Rate for Payer: BCBS of TX Medicare |
$11.55
|
| Rate for Payer: BCBS of TX PPO |
$25.53
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cigna Medicaid |
$11.55
|
| Rate for Payer: Cigna Medicare |
$11.55
|
| Rate for Payer: Employer Direct Commercial |
$11.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Molina Medicare |
$11.55
|
| Rate for Payer: Multiplan Auto |
$256.10
|
| Rate for Payer: Multiplan Commercial |
$256.10
|
| Rate for Payer: Multiplan Workers Comp |
$256.10
|
| Rate for Payer: Parkland Medicaid |
$11.55
|
| Rate for Payer: Scott and White EPO/PPO |
$14.44
|
| Rate for Payer: Scott and White Medicare |
$11.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.55
|
| Rate for Payer: Superior Health Plan EPO |
$11.55
|
| Rate for Payer: Superior Health Plan Medicare |
$11.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Universal American Medicare |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: Wellmed Medicare |
$11.55
|
|
|
Creatine Kinase MB BCE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
1601764
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$346.72
|
|
|
Creatine Kinase MB BCE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
1601764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.87
|
| Rate for Payer: BCBS of TX Medicare |
$11.55
|
| Rate for Payer: BCBS of TX PPO |
$25.53
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cash Price |
$346.72
|
| Rate for Payer: Cigna Medicaid |
$11.55
|
| Rate for Payer: Cigna Medicare |
$11.55
|
| Rate for Payer: Employer Direct Commercial |
$11.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Molina Medicare |
$11.55
|
| Rate for Payer: Multiplan Auto |
$256.10
|
| Rate for Payer: Multiplan Commercial |
$256.10
|
| Rate for Payer: Multiplan Workers Comp |
$256.10
|
| Rate for Payer: Parkland Medicaid |
$11.55
|
| Rate for Payer: Scott and White EPO/PPO |
$14.44
|
| Rate for Payer: Scott and White Medicare |
$11.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.55
|
| Rate for Payer: Superior Health Plan EPO |
$11.55
|
| Rate for Payer: Superior Health Plan Medicare |
$11.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Universal American Medicare |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: Wellmed Medicare |
$11.55
|
|
|
Creatinine
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
1601780
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$5.37
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Amerigroup Medicare |
$5.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.14
|
| Rate for Payer: BCBS of TX Medicare |
$5.12
|
| Rate for Payer: BCBS of TX PPO |
$11.32
|
| Rate for Payer: Cash Price |
$148.72
|
| Rate for Payer: Cash Price |
$148.72
|
| Rate for Payer: Cigna Medicaid |
$5.12
|
| Rate for Payer: Cigna Medicare |
$5.12
|
| Rate for Payer: Employer Direct Commercial |
$5.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Molina Medicare |
$5.12
|
| Rate for Payer: Multiplan Auto |
$109.85
|
| Rate for Payer: Multiplan Commercial |
$109.85
|
| Rate for Payer: Multiplan Workers Comp |
$109.85
|
| Rate for Payer: Parkland Medicaid |
$5.12
|
| Rate for Payer: Scott and White EPO/PPO |
$6.40
|
| Rate for Payer: Scott and White Medicare |
$5.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.12
|
| Rate for Payer: Superior Health Plan EPO |
$5.12
|
| Rate for Payer: Superior Health Plan Medicare |
$5.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Universal American Medicare |
$5.12
|
| Rate for Payer: Wellcare Medicare |
$5.12
|
| Rate for Payer: Wellmed Medicare |
$5.12
|
|
|
Creatinine
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
1601780
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$148.72
|
|
|
Creatinine 24 Hour Urine
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1601152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
Creatinine, 24hr Ur SO
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1601152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
Creatinine, Body Fluid SO
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1601152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
Creatinine Clearance
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
1602507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: Aetna Medicare |
$14.19
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Amerigroup Medicare |
$9.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.73
|
| Rate for Payer: BCBS of TX Medicare |
$9.46
|
| Rate for Payer: BCBS of TX PPO |
$20.91
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cigna Medicaid |
$9.46
|
| Rate for Payer: Cigna Medicare |
$9.46
|
| Rate for Payer: Employer Direct Commercial |
$9.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Molina Medicare |
$9.46
|
| Rate for Payer: Multiplan Auto |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Multiplan Workers Comp |
$218.40
|
| Rate for Payer: Parkland Medicaid |
$9.46
|
| Rate for Payer: Scott and White EPO/PPO |
$11.82
|
| Rate for Payer: Scott and White Medicare |
$9.46
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.46
|
| Rate for Payer: Superior Health Plan EPO |
$9.46
|
| Rate for Payer: Superior Health Plan Medicare |
$9.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Universal American Medicare |
$9.46
|
| Rate for Payer: Wellcare Medicare |
$9.46
|
| Rate for Payer: Wellmed Medicare |
$9.46
|
|
|
Creatinine Clearance
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
1602507
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$295.68
|
|
|
Creatinine Urine
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1601152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
C/R EXER PROGRAM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$35.20
|
|
|
C/R EXER PROGRAM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Workers Comp |
$26.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
C/R Exer Program BCE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$36.40
|
| Rate for Payer: Multiplan Workers Comp |
$36.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
C/R Exer Program BCE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$49.28
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min 99292
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
5210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$2,900.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$197.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$236.12
|
| Rate for Payer: BCBS of TX PPO |
$263.37
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Multiplan Auto |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,092.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,900.00
|
| Rate for Payer: Superior Health Plan EPO |
$228.48
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min 99292
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
5210174
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,478.40
|
|
|
Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
5201678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$4,315.36 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Aetna Medicare |
$1,217.31
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$324.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Amerigroup Medicare |
$811.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,159.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,386.65
|
| Rate for Payer: BCBS of TX Medicare |
$811.54
|
| Rate for Payer: BCBS of TX PPO |
$1,546.65
|
| Rate for Payer: Cash Price |
$3,172.40
|
| Rate for Payer: Cash Price |
$3,172.40
|
| Rate for Payer: Cigna Commercial |
$4,315.36
|
| Rate for Payer: Cigna Medicare |
$811.54
|
| Rate for Payer: Employer Direct Commercial |
$811.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$811.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Molina Medicare |
$811.54
|
| Rate for Payer: Multiplan Auto |
$2,343.25
|
| Rate for Payer: Multiplan Commercial |
$2,343.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,343.25
|
| Rate for Payer: Scott and White EPO/PPO |
$14.51
|
| Rate for Payer: Scott and White Medicare |
$811.54
|
| Rate for Payer: Superior Health Plan EPO |
$811.54
|
| Rate for Payer: Superior Health Plan Medicare |
$811.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Universal American Medicare |
$811.54
|
| Rate for Payer: Wellcare Medicare |
$811.54
|
| Rate for Payer: Wellmed Medicare |
$811.54
|
|
|
Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
5201678
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,172.40
|
|
|
Crossmatch Extended Interpretation
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2400158
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$261.36
|
|
|
Crossmatch Extended Interpretation
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2400158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
CRUTCHES-ALL SIZES
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
131433
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cigna Commercial |
$9.75
|
| Rate for Payer: Multiplan Auto |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Workers Comp |
$19.50
|
| Rate for Payer: Scott and White EPO/PPO |
$19.50
|
|
|
CRUTCHES-ALL SIZES
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
131433
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.04
|
| Rate for Payer: BCBS of TX PPO |
$15.60
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Multiplan Auto |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Workers Comp |
$19.50
|
| Rate for Payer: Scott and White EPO/PPO |
$19.50
|
| Rate for Payer: Superior Health Plan EPO |
$5.30
|
|
