|
Adjacent tissue transfer or rearrangement, scalp, arms and/or legs defect 10 sq cm or less
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
36014020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| 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 |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$36.79
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
Adjacent tissue transfer or rearrangement, trunk defect 10 sq cm or less
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
36014000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| 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 |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$36.79
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
360S2083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,805.34 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$1,805.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,162.08
|
| Rate for Payer: BCBS of TX PPO |
$2,724.22
|
| 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
|
|
|
Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] a
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 20693
|
| Hospital Charge Code |
36020693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
ADPT CATH -- DHF
|
Facility
|
OP
|
$56.17
|
|
| Hospital Charge Code |
80550007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$36.51 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.22
|
| Rate for Payer: BCBS of TX PPO |
$22.47
|
| Rate for Payer: Cash Price |
$49.43
|
| Rate for Payer: Multiplan Auto |
$36.51
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
| Rate for Payer: Multiplan Workers Comp |
$36.51
|
| Rate for Payer: Scott and White EPO/PPO |
$28.08
|
| Rate for Payer: Superior Health Plan EPO |
$7.64
|
|
|
ADPT CATH -- DHF
|
Facility
|
IP
|
$56.17
|
|
| Hospital Charge Code |
80550007
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$49.43
|
|
|
ADPT CATH WLL -- DHF
|
Facility
|
IP
|
$87.80
|
|
| Hospital Charge Code |
80410103
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$77.26
|
|
|
ADPT CATH WLL -- DHF
|
Facility
|
OP
|
$87.80
|
|
| Hospital Charge Code |
80410103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$57.07 |
| Rate for Payer: Aetna Commercial |
$48.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.61
|
| Rate for Payer: BCBS of TX PPO |
$35.12
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Multiplan Auto |
$57.07
|
| Rate for Payer: Multiplan Commercial |
$57.07
|
| Rate for Payer: Multiplan Workers Comp |
$57.07
|
| Rate for Payer: Scott and White EPO/PPO |
$43.90
|
| Rate for Payer: Superior Health Plan EPO |
$11.94
|
|
|
ADPT LL -- DHF
|
Facility
|
OP
|
$239.05
|
|
| Hospital Charge Code |
80310089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Aetna Commercial |
$131.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$71.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86.06
|
| Rate for Payer: BCBS of TX PPO |
$95.62
|
| Rate for Payer: Cash Price |
$210.36
|
| Rate for Payer: Multiplan Auto |
$155.38
|
| Rate for Payer: Multiplan Commercial |
$155.38
|
| Rate for Payer: Multiplan Workers Comp |
$155.38
|
| Rate for Payer: Scott and White EPO/PPO |
$119.52
|
| Rate for Payer: Superior Health Plan EPO |
$32.51
|
|
|
ADPT LL -- DHF
|
Facility
|
IP
|
$239.05
|
|
| Hospital Charge Code |
80310089
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$210.36
|
|
|
ADPT PM WIRELESS SRVCE/MRI RDY HOME TRANSMITTEE
|
Facility
|
IP
|
$2,043.00
|
|
| Hospital Charge Code |
130246
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,797.84
|
|
|
ADPT PM WIRELESS SRVCE/MRI RDY HOME TRANSMITTEE
|
Facility
|
OP
|
$2,043.00
|
|
| Hospital Charge Code |
130246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.87 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna Commercial |
$1,123.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$183.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$612.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$735.48
|
| Rate for Payer: BCBS of TX PPO |
$817.20
|
| Rate for Payer: Cash Price |
$1,797.84
|
| Rate for Payer: Multiplan Auto |
$1,327.95
|
| Rate for Payer: Multiplan Commercial |
$1,327.95
|
| Rate for Payer: Multiplan Workers Comp |
$1,327.95
|
| Rate for Payer: Scott and White EPO/PPO |
$1,021.50
|
| Rate for Payer: Superior Health Plan EPO |
$277.85
|
|
|
ADPT PORTS -- DHF
|
Facility
|
OP
|
$533.65
|
|
| Hospital Charge Code |
80310105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$346.87 |
| Rate for Payer: Aetna Commercial |
$293.51
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$160.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$192.11
|
| Rate for Payer: BCBS of TX PPO |
$213.46
|
| Rate for Payer: Cash Price |
$469.61
|
| Rate for Payer: Multiplan Auto |
$346.87
|
| Rate for Payer: Multiplan Commercial |
$346.87
|
| Rate for Payer: Multiplan Workers Comp |
$346.87
|
| Rate for Payer: Scott and White EPO/PPO |
$266.82
|
| Rate for Payer: Superior Health Plan EPO |
$72.58
|
|
|
ADPT PORTS -- DHF
|
Facility
|
IP
|
$533.65
|
|
| Hospital Charge Code |
80310105
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$469.61
|
|
|
ADPT VENT -- DHF
|
Facility
|
IP
|
$55.15
|
|
| Hospital Charge Code |
82010208
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$48.53
|
|
|
ADPT VENT -- DHF
|
Facility
|
OP
|
$55.15
|
|
| Hospital Charge Code |
82010208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Aetna Commercial |
$30.33
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.85
|
| Rate for Payer: BCBS of TX PPO |
$22.06
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Multiplan Auto |
$35.85
|
| Rate for Payer: Multiplan Commercial |
$35.85
|
| Rate for Payer: Multiplan Workers Comp |
$35.85
|
| Rate for Payer: Scott and White EPO/PPO |
$27.58
|
| Rate for Payer: Superior Health Plan EPO |
$7.50
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$42,795.60
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$18,928.04 |
| Max. Negotiated Rate |
$42,795.60 |
| Rate for Payer: Aetna Commercial |
$25,339.50
|
| Rate for Payer: Aetna Medicare |
$28,392.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,928.04
|
| Rate for Payer: Amerigroup Medicare |
$18,928.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,657.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,389.99
|
| Rate for Payer: BCBS of TX Medicare |
$18,928.04
|
| Rate for Payer: BCBS of TX PPO |
$27,101.04
|
| Rate for Payer: Cigna Commercial |
$29,010.91
|
| Rate for Payer: Cigna Medicare |
$18,928.04
|
| Rate for Payer: Employer Direct Commercial |
$18,928.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,928.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,928.04
|
| Rate for Payer: Molina Medicare |
$18,928.04
|
| Rate for Payer: Multiplan Auto |
$42,795.60
|
| Rate for Payer: Multiplan Commercial |
$42,795.60
|
| Rate for Payer: Multiplan Workers Comp |
$42,795.60
|
| Rate for Payer: Scott and White EPO/PPO |
$19,708.50
|
| Rate for Payer: Scott and White Medicare |
$18,928.04
|
| Rate for Payer: Superior Health Plan EPO |
$18,928.04
|
| Rate for Payer: Superior Health Plan Medicare |
$18,928.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,928.04
|
| Rate for Payer: Universal American Medicare |
$18,928.04
|
| Rate for Payer: Wellcare Medicare |
$18,928.04
|
| Rate for Payer: Wellmed Medicare |
$18,928.04
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,950.90
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$12,165.56 |
| Max. Negotiated Rate |
$27,950.90 |
| Rate for Payer: Aetna Commercial |
$16,549.88
|
| Rate for Payer: Aetna Medicare |
$20,028.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,352.64
|
| Rate for Payer: Amerigroup Medicare |
$13,352.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,165.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,284.50
|
| Rate for Payer: BCBS of TX Medicare |
$13,352.64
|
| Rate for Payer: BCBS of TX PPO |
$16,983.44
|
| Rate for Payer: Cigna Commercial |
$18,947.77
|
| Rate for Payer: Cigna Medicare |
$13,352.64
|
| Rate for Payer: Employer Direct Commercial |
$13,352.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,352.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,352.64
|
| Rate for Payer: Molina Medicare |
$13,352.64
|
| Rate for Payer: Multiplan Auto |
$27,950.90
|
| Rate for Payer: Multiplan Commercial |
$27,950.90
|
| Rate for Payer: Multiplan Workers Comp |
$27,950.90
|
| Rate for Payer: Scott and White EPO/PPO |
$12,872.12
|
| Rate for Payer: Scott and White Medicare |
$13,352.64
|
| Rate for Payer: Superior Health Plan EPO |
$13,352.64
|
| Rate for Payer: Superior Health Plan Medicare |
$13,352.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,352.64
|
| Rate for Payer: Universal American Medicare |
$13,352.64
|
| Rate for Payer: Wellcare Medicare |
$13,352.64
|
| Rate for Payer: Wellmed Medicare |
$13,352.64
|
|
|
Aerobe ID + Suscept SO
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
1603646
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna Commercial |
$8.49
|
| Rate for Payer: Aetna Medicare |
$12.12
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.08
|
| Rate for Payer: Amerigroup Medicare |
$8.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16.00
|
| Rate for Payer: BCBS of TX Medicare |
$8.08
|
| Rate for Payer: BCBS of TX PPO |
$17.86
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cigna Medicaid |
$8.08
|
| Rate for Payer: Cigna Medicare |
$8.08
|
| Rate for Payer: Employer Direct Commercial |
$8.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.08
|
| Rate for Payer: Molina Medicare |
$8.08
|
| Rate for Payer: Multiplan Auto |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$154.70
|
| Rate for Payer: Multiplan Workers Comp |
$154.70
|
| Rate for Payer: Parkland Medicaid |
$8.08
|
| Rate for Payer: Scott and White EPO/PPO |
$10.10
|
| Rate for Payer: Scott and White Medicare |
$8.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.08
|
| Rate for Payer: Superior Health Plan EPO |
$8.08
|
| Rate for Payer: Superior Health Plan Medicare |
$8.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.08
|
| Rate for Payer: Universal American Medicare |
$8.08
|
| Rate for Payer: Wellcare Medicare |
$8.08
|
| Rate for Payer: Wellmed Medicare |
$8.08
|
|
|
.AFB ID by DNA Probe Rflx AST 008694 SO
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
1605062
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna Medicare |
$30.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Amerigroup Medicare |
$20.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.70
|
| Rate for Payer: BCBS of TX Medicare |
$20.05
|
| Rate for Payer: BCBS of TX PPO |
$44.31
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cigna Medicaid |
$20.05
|
| Rate for Payer: Cigna Medicare |
$20.05
|
| Rate for Payer: Employer Direct Commercial |
$20.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Molina Medicare |
$20.05
|
| Rate for Payer: Multiplan Auto |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Multiplan Workers Comp |
$145.60
|
| Rate for Payer: Parkland Medicaid |
$20.05
|
| Rate for Payer: Scott and White EPO/PPO |
$25.06
|
| Rate for Payer: Scott and White Medicare |
$20.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.05
|
| Rate for Payer: Superior Health Plan EPO |
$20.05
|
| Rate for Payer: Superior Health Plan Medicare |
$20.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Universal American Medicare |
$20.05
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: Wellmed Medicare |
$20.05
|
|
|
AFB Identification SO
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
1605062
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna Medicare |
$30.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Amerigroup Medicare |
$20.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.70
|
| Rate for Payer: BCBS of TX Medicare |
$20.05
|
| Rate for Payer: BCBS of TX PPO |
$44.31
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cigna Medicaid |
$20.05
|
| Rate for Payer: Cigna Medicare |
$20.05
|
| Rate for Payer: Employer Direct Commercial |
$20.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Molina Medicare |
$20.05
|
| Rate for Payer: Multiplan Auto |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Multiplan Workers Comp |
$145.60
|
| Rate for Payer: Parkland Medicaid |
$20.05
|
| Rate for Payer: Scott and White EPO/PPO |
$25.06
|
| Rate for Payer: Scott and White Medicare |
$20.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.05
|
| Rate for Payer: Superior Health Plan EPO |
$20.05
|
| Rate for Payer: Superior Health Plan Medicare |
$20.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Universal American Medicare |
$20.05
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: Wellmed Medicare |
$20.05
|
|
|
AFB Identification SO
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
1605062
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$197.12
|
|
|
AFB ID+Susceptibilities SO
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
1605062
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna Medicare |
$30.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Amerigroup Medicare |
$20.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.70
|
| Rate for Payer: BCBS of TX Medicare |
$20.05
|
| Rate for Payer: BCBS of TX PPO |
$44.31
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cigna Medicaid |
$20.05
|
| Rate for Payer: Cigna Medicare |
$20.05
|
| Rate for Payer: Employer Direct Commercial |
$20.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Molina Medicare |
$20.05
|
| Rate for Payer: Multiplan Auto |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Multiplan Workers Comp |
$145.60
|
| Rate for Payer: Parkland Medicaid |
$20.05
|
| Rate for Payer: Scott and White EPO/PPO |
$25.06
|
| Rate for Payer: Scott and White Medicare |
$20.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.05
|
| Rate for Payer: Superior Health Plan EPO |
$20.05
|
| Rate for Payer: Superior Health Plan Medicare |
$20.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.05
|
| Rate for Payer: Universal American Medicare |
$20.05
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: Wellmed Medicare |
$20.05
|
|
|
AFB SMR CULT OTHER
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
1604248
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Aetna Commercial |
$11.34
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.80
|
| Rate for Payer: Amerigroup Medicare |
$10.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21.38
|
| Rate for Payer: BCBS of TX Medicare |
$10.80
|
| Rate for Payer: BCBS of TX PPO |
$23.87
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cigna Medicaid |
$10.80
|
| Rate for Payer: Cigna Medicare |
$10.80
|
| Rate for Payer: Employer Direct Commercial |
$10.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.80
|
| Rate for Payer: Molina Medicare |
$10.80
|
| Rate for Payer: Multiplan Auto |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$15.60
|
| Rate for Payer: Multiplan Workers Comp |
$15.60
|
| Rate for Payer: Parkland Medicaid |
$10.80
|
| Rate for Payer: Scott and White EPO/PPO |
$13.50
|
| Rate for Payer: Scott and White Medicare |
$10.80
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.80
|
| Rate for Payer: Superior Health Plan EPO |
$10.80
|
| Rate for Payer: Superior Health Plan Medicare |
$10.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.80
|
| Rate for Payer: Universal American Medicare |
$10.80
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
| Rate for Payer: Wellmed Medicare |
$10.80
|
|
|
AFP, Serum, Tumor Marker SO
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
1603075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare |
$25.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.77
|
| Rate for Payer: Amerigroup Medicare |
$16.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.20
|
| Rate for Payer: BCBS of TX Medicare |
$16.77
|
| Rate for Payer: BCBS of TX PPO |
$37.06
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cigna Medicaid |
$16.77
|
| Rate for Payer: Cigna Medicare |
$16.77
|
| Rate for Payer: Employer Direct Commercial |
$16.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.77
|
| Rate for Payer: Molina Medicare |
$16.77
|
| Rate for Payer: Multiplan Auto |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| Rate for Payer: Parkland Medicaid |
$16.77
|
| Rate for Payer: Scott and White EPO/PPO |
$20.96
|
| Rate for Payer: Scott and White Medicare |
$16.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.77
|
| Rate for Payer: Superior Health Plan EPO |
$16.77
|
| Rate for Payer: Superior Health Plan Medicare |
$16.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.77
|
| Rate for Payer: Universal American Medicare |
$16.77
|
| Rate for Payer: Wellcare Medicare |
$16.77
|
| Rate for Payer: Wellmed Medicare |
$16.77
|
|
