|
AFP, Serum, Tumor Marker SO
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
1603075
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$213.84
|
|
|
After 9.1.2020 / Injection, anesthetic agent sphenopalatine ganglion
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
36064505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$70.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$119.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$142.92
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$180.08
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$70.60
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$70.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$70.60
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$70.60
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$21,509.90
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$9,222.64 |
| Max. Negotiated Rate |
$21,509.90 |
| Rate for Payer: Aetna Commercial |
$12,736.12
|
| Rate for Payer: Aetna Medicare |
$16,400.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,933.51
|
| Rate for Payer: Amerigroup Medicare |
$10,933.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,222.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,542.92
|
| Rate for Payer: BCBS of TX Medicare |
$10,933.51
|
| Rate for Payer: BCBS of TX PPO |
$11,714.81
|
| Rate for Payer: Cigna Commercial |
$14,581.45
|
| Rate for Payer: Cigna Medicare |
$10,933.51
|
| Rate for Payer: Employer Direct Commercial |
$10,933.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,933.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,933.51
|
| Rate for Payer: Molina Medicare |
$10,933.51
|
| Rate for Payer: Multiplan Auto |
$21,509.90
|
| Rate for Payer: Multiplan Commercial |
$21,509.90
|
| Rate for Payer: Multiplan Workers Comp |
$21,509.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9,905.88
|
| Rate for Payer: Scott and White Medicare |
$10,933.51
|
| Rate for Payer: Superior Health Plan EPO |
$10,933.51
|
| Rate for Payer: Superior Health Plan Medicare |
$10,933.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,933.51
|
| Rate for Payer: Universal American Medicare |
$10,933.51
|
| Rate for Payer: Wellcare Medicare |
$10,933.51
|
| Rate for Payer: Wellmed Medicare |
$10,933.51
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$35,159.50
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$16,033.84 |
| Max. Negotiated Rate |
$35,159.50 |
| Rate for Payer: Aetna Commercial |
$20,818.12
|
| Rate for Payer: Aetna Medicare |
$24,090.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,060.07
|
| Rate for Payer: Amerigroup Medicare |
$16,060.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,033.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,560.79
|
| Rate for Payer: BCBS of TX Medicare |
$16,060.07
|
| Rate for Payer: BCBS of TX PPO |
$20,623.89
|
| Rate for Payer: Cigna Commercial |
$23,834.44
|
| Rate for Payer: Cigna Medicare |
$16,060.07
|
| Rate for Payer: Employer Direct Commercial |
$16,060.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,060.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,060.07
|
| Rate for Payer: Molina Medicare |
$16,060.07
|
| Rate for Payer: Multiplan Auto |
$35,159.50
|
| Rate for Payer: Multiplan Commercial |
$35,159.50
|
| Rate for Payer: Multiplan Workers Comp |
$35,159.50
|
| Rate for Payer: Scott and White EPO/PPO |
$16,191.88
|
| Rate for Payer: Scott and White Medicare |
$16,060.07
|
| Rate for Payer: Superior Health Plan EPO |
$16,060.07
|
| Rate for Payer: Superior Health Plan Medicare |
$16,060.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,060.07
|
| Rate for Payer: Universal American Medicare |
$16,060.07
|
| Rate for Payer: Wellcare Medicare |
$16,060.07
|
| Rate for Payer: Wellmed Medicare |
$16,060.07
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$14,823.80
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$6,368.30 |
| Max. Negotiated Rate |
$14,823.80 |
| Rate for Payer: Aetna Commercial |
$8,777.25
|
| Rate for Payer: Aetna Medicare |
$12,633.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,422.33
|
| Rate for Payer: Amerigroup Medicare |
$8,422.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,368.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,802.20
|
| Rate for Payer: BCBS of TX Medicare |
$8,422.33
|
| Rate for Payer: BCBS of TX PPO |
$8,669.44
|
| Rate for Payer: Cigna Commercial |
$10,048.98
|
| Rate for Payer: Cigna Medicare |
$8,422.33
|
| Rate for Payer: Employer Direct Commercial |
$8,422.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,422.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,422.33
|
| Rate for Payer: Molina Medicare |
$8,422.33
|
| Rate for Payer: Multiplan Auto |
$14,823.80
|
| Rate for Payer: Multiplan Commercial |
$14,823.80
|
| Rate for Payer: Multiplan Workers Comp |
$14,823.80
|
| Rate for Payer: Scott and White EPO/PPO |
$6,826.75
|
| Rate for Payer: Scott and White Medicare |
$8,422.33
|
| Rate for Payer: Superior Health Plan EPO |
$8,422.33
|
| Rate for Payer: Superior Health Plan Medicare |
$8,422.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,422.33
|
| Rate for Payer: Universal American Medicare |
$8,422.33
|
| Rate for Payer: Wellcare Medicare |
$8,422.33
|
| Rate for Payer: Wellmed Medicare |
$8,422.33
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$19,685.90
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$8,120.12 |
| Max. Negotiated Rate |
$19,685.90 |
| Rate for Payer: Aetna Commercial |
$11,656.12
|
| Rate for Payer: Aetna Medicare |
$15,765.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,510.34
|
| Rate for Payer: Amerigroup Medicare |
$10,510.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,120.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,827.64
|
| Rate for Payer: BCBS of TX Medicare |
$10,510.34
|
| Rate for Payer: BCBS of TX PPO |
$13,142.33
|
| Rate for Payer: Cigna Commercial |
$13,344.97
|
| Rate for Payer: Cigna Medicare |
$10,510.34
|
| Rate for Payer: Employer Direct Commercial |
$10,510.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,510.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,510.34
|
| Rate for Payer: Molina Medicare |
$10,510.34
|
| Rate for Payer: Multiplan Auto |
$19,685.90
|
| Rate for Payer: Multiplan Commercial |
$19,685.90
|
| Rate for Payer: Multiplan Workers Comp |
$19,685.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9,065.88
|
| Rate for Payer: Scott and White Medicare |
$10,510.34
|
| Rate for Payer: Superior Health Plan EPO |
$10,510.34
|
| Rate for Payer: Superior Health Plan Medicare |
$10,510.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,510.34
|
| Rate for Payer: Universal American Medicare |
$10,510.34
|
| Rate for Payer: Wellcare Medicare |
$10,510.34
|
| Rate for Payer: Wellmed Medicare |
$10,510.34
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,935.80
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$4,867.60 |
| Max. Negotiated Rate |
$11,935.80 |
| Rate for Payer: Aetna Commercial |
$7,067.25
|
| Rate for Payer: Aetna Medicare |
$11,117.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,411.86
|
| Rate for Payer: Amerigroup Medicare |
$7,411.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,867.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,686.62
|
| Rate for Payer: BCBS of TX Medicare |
$7,411.86
|
| Rate for Payer: BCBS of TX PPO |
$8,541.02
|
| Rate for Payer: Cigna Commercial |
$8,091.22
|
| Rate for Payer: Cigna Medicare |
$7,411.86
|
| Rate for Payer: Employer Direct Commercial |
$7,411.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,411.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,411.86
|
| Rate for Payer: Molina Medicare |
$7,411.86
|
| Rate for Payer: Multiplan Auto |
$11,935.80
|
| Rate for Payer: Multiplan Commercial |
$11,935.80
|
| Rate for Payer: Multiplan Workers Comp |
$11,935.80
|
| Rate for Payer: Scott and White EPO/PPO |
$5,496.75
|
| Rate for Payer: Scott and White Medicare |
$7,411.86
|
| Rate for Payer: Superior Health Plan EPO |
$7,411.86
|
| Rate for Payer: Superior Health Plan Medicare |
$7,411.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,411.86
|
| Rate for Payer: Universal American Medicare |
$7,411.86
|
| Rate for Payer: Wellcare Medicare |
$7,411.86
|
| Rate for Payer: Wellmed Medicare |
$7,411.86
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$86,096.60
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$35,191.13 |
| Max. Negotiated Rate |
$86,096.60 |
| Rate for Payer: Aetna Commercial |
$50,978.25
|
| Rate for Payer: Aetna Medicare |
$52,786.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35,191.13
|
| Rate for Payer: Amerigroup Medicare |
$35,191.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41,061.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51,719.86
|
| Rate for Payer: BCBS of TX Medicare |
$35,191.13
|
| Rate for Payer: BCBS of TX PPO |
$57,468.74
|
| Rate for Payer: Cigna Commercial |
$58,364.43
|
| Rate for Payer: Cigna Medicare |
$35,191.13
|
| Rate for Payer: Employer Direct Commercial |
$35,191.13
|
| Rate for Payer: Humana Medicare/TRICARE |
$35,191.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35,191.13
|
| Rate for Payer: Molina Medicare |
$35,191.13
|
| Rate for Payer: Multiplan Auto |
$86,096.60
|
| Rate for Payer: Multiplan Commercial |
$86,096.60
|
| Rate for Payer: Multiplan Workers Comp |
$86,096.60
|
| Rate for Payer: Scott and White EPO/PPO |
$39,649.75
|
| Rate for Payer: Scott and White Medicare |
$35,191.13
|
| Rate for Payer: Superior Health Plan EPO |
$35,191.13
|
| Rate for Payer: Superior Health Plan Medicare |
$35,191.13
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35,191.13
|
| Rate for Payer: Universal American Medicare |
$35,191.13
|
| Rate for Payer: Wellcare Medicare |
$35,191.13
|
| Rate for Payer: Wellmed Medicare |
$35,191.13
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$67,147.90
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$27,615.46 |
| Max. Negotiated Rate |
$67,147.90 |
| Rate for Payer: Aetna Commercial |
$39,758.62
|
| Rate for Payer: Aetna Medicare |
$42,111.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,074.34
|
| Rate for Payer: Amerigroup Medicare |
$28,074.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,615.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32,161.23
|
| Rate for Payer: BCBS of TX Medicare |
$28,074.34
|
| Rate for Payer: BCBS of TX PPO |
$35,736.08
|
| Rate for Payer: Cigna Commercial |
$45,519.21
|
| Rate for Payer: Cigna Medicare |
$28,074.34
|
| Rate for Payer: Employer Direct Commercial |
$28,074.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,074.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,074.34
|
| Rate for Payer: Molina Medicare |
$28,074.34
|
| Rate for Payer: Multiplan Auto |
$67,147.90
|
| Rate for Payer: Multiplan Commercial |
$67,147.90
|
| Rate for Payer: Multiplan Workers Comp |
$67,147.90
|
| Rate for Payer: Scott and White EPO/PPO |
$30,923.38
|
| Rate for Payer: Scott and White Medicare |
$28,074.34
|
| Rate for Payer: Superior Health Plan EPO |
$28,074.34
|
| Rate for Payer: Superior Health Plan Medicare |
$28,074.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,074.34
|
| Rate for Payer: Universal American Medicare |
$28,074.34
|
| Rate for Payer: Wellcare Medicare |
$28,074.34
|
| Rate for Payer: Wellmed Medicare |
$28,074.34
|
|
|
Alanine Aminotransferase
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
1602341
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$5.56
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.30
|
| Rate for Payer: Amerigroup Medicare |
$5.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.49
|
| Rate for Payer: BCBS of TX Medicare |
$5.30
|
| Rate for Payer: BCBS of TX PPO |
$11.71
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Medicaid |
$5.30
|
| Rate for Payer: Cigna Medicare |
$5.30
|
| Rate for Payer: Employer Direct Commercial |
$5.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.30
|
| Rate for Payer: Molina Medicare |
$5.30
|
| Rate for Payer: Multiplan Auto |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Multiplan Workers Comp |
$146.25
|
| Rate for Payer: Parkland Medicaid |
$5.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6.62
|
| Rate for Payer: Scott and White Medicare |
$5.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.30
|
| Rate for Payer: Superior Health Plan EPO |
$5.30
|
| Rate for Payer: Superior Health Plan Medicare |
$5.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.30
|
| Rate for Payer: Universal American Medicare |
$5.30
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: Wellmed Medicare |
$5.30
|
|
|
Alanine Aminotransferase
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
1602341
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
Albumin, 24-Hr Urine SO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
Albumin, Body Fluid SO
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1600816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna Commercial |
$8.17
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Amerigroup Medicare |
$7.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.40
|
| Rate for Payer: BCBS of TX Medicare |
$7.78
|
| Rate for Payer: BCBS of TX PPO |
$17.19
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna Medicaid |
$7.78
|
| Rate for Payer: Cigna Medicare |
$7.78
|
| Rate for Payer: Employer Direct Commercial |
$7.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Molina Medicare |
$7.78
|
| Rate for Payer: Multiplan Auto |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$91.00
|
| Rate for Payer: Multiplan Workers Comp |
$91.00
|
| Rate for Payer: Parkland Medicaid |
$7.78
|
| Rate for Payer: Scott and White EPO/PPO |
$9.72
|
| Rate for Payer: Scott and White Medicare |
$7.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.78
|
| Rate for Payer: Superior Health Plan EPO |
$7.78
|
| Rate for Payer: Superior Health Plan Medicare |
$7.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Universal American Medicare |
$7.78
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: Wellmed Medicare |
$7.78
|
|
|
Albumin, Cerebrospinal Fluid SO
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1600816
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$123.20
|
|
|
Albumin, Cerebrospinal Fluid SO
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1600816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna Commercial |
$8.17
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Amerigroup Medicare |
$7.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.40
|
| Rate for Payer: BCBS of TX Medicare |
$7.78
|
| Rate for Payer: BCBS of TX PPO |
$17.19
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna Medicaid |
$7.78
|
| Rate for Payer: Cigna Medicare |
$7.78
|
| Rate for Payer: Employer Direct Commercial |
$7.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Molina Medicare |
$7.78
|
| Rate for Payer: Multiplan Auto |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$91.00
|
| Rate for Payer: Multiplan Workers Comp |
$91.00
|
| Rate for Payer: Parkland Medicaid |
$7.78
|
| Rate for Payer: Scott and White EPO/PPO |
$9.72
|
| Rate for Payer: Scott and White Medicare |
$7.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.78
|
| Rate for Payer: Superior Health Plan EPO |
$7.78
|
| Rate for Payer: Superior Health Plan Medicare |
$7.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Universal American Medicare |
$7.78
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: Wellmed Medicare |
$7.78
|
|
|
Albumin/Creatinine Ratio,Ur SO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
Albumin/Creatinine Ratio,Ur SO
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$198.88
|
|
|
albumin human 25% IV Soln 50 mL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS P9046
|
| Hospital Charge Code |
77358389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21.23
|
| Rate for Payer: Amerigroup Medicare |
$21.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.29
|
| Rate for Payer: BCBS of TX Medicare |
$21.23
|
| Rate for Payer: BCBS of TX PPO |
$48.02
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cigna Medicaid |
$21.23
|
| Rate for Payer: Cigna Medicare |
$21.23
|
| Rate for Payer: Employer Direct Commercial |
$21.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$21.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$21.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21.23
|
| Rate for Payer: Molina Medicare |
$21.23
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Parkland Medicaid |
$21.23
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
| Rate for Payer: Scott and White Medicare |
$21.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21.23
|
| Rate for Payer: Superior Health Plan EPO |
$21.23
|
| Rate for Payer: Superior Health Plan Medicare |
$21.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21.23
|
| Rate for Payer: Universal American Medicare |
$21.23
|
| Rate for Payer: Wellcare Medicare |
$21.23
|
| Rate for Payer: Wellmed Medicare |
$21.23
|
|
|
albumin human 25% IV Soln 50 mL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS P9046
|
| Hospital Charge Code |
77358389
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.04
|
|
|
albumin human 5% IV Soln 250 mL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
77358503
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.04
|
|
|
albumin human 5% IV Soln 250 mL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
77358503
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$120.07 |
| Rate for Payer: Aetna Medicare |
$79.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$53.08
|
| Rate for Payer: Amerigroup Medicare |
$53.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$90.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$108.25
|
| Rate for Payer: BCBS of TX Medicare |
$53.08
|
| Rate for Payer: BCBS of TX PPO |
$120.07
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cigna Medicaid |
$53.08
|
| Rate for Payer: Cigna Medicare |
$53.08
|
| Rate for Payer: Employer Direct Commercial |
$53.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$53.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$53.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$53.08
|
| Rate for Payer: Molina Medicare |
$53.08
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Parkland Medicaid |
$53.08
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
| Rate for Payer: Scott and White Medicare |
$53.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$53.08
|
| Rate for Payer: Superior Health Plan EPO |
$53.08
|
| Rate for Payer: Superior Health Plan Medicare |
$53.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$53.08
|
| Rate for Payer: Universal American Medicare |
$53.08
|
| Rate for Payer: Wellcare Medicare |
$53.08
|
| Rate for Payer: Wellmed Medicare |
$53.08
|
|
|
Albumin Level
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1601491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.80
|
| Rate for Payer: BCBS of TX Medicare |
$4.95
|
| Rate for Payer: BCBS of TX PPO |
$10.94
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Medicaid |
$4.95
|
| Rate for Payer: Cigna Medicare |
$4.95
|
| Rate for Payer: Employer Direct Commercial |
$4.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Molina Medicare |
$4.95
|
| Rate for Payer: Multiplan Auto |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Workers Comp |
$117.00
|
| Rate for Payer: Parkland Medicaid |
$4.95
|
| Rate for Payer: Scott and White EPO/PPO |
$6.19
|
| Rate for Payer: Scott and White Medicare |
$4.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.95
|
| Rate for Payer: Superior Health Plan EPO |
$4.95
|
| Rate for Payer: Superior Health Plan Medicare |
$4.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.95
|
| Rate for Payer: Universal American Medicare |
$4.95
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: Wellmed Medicare |
$4.95
|
|
|
Albumin, Random Urine SO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
ALBUMIN URINE/OTHER SOURCE QUANT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1600816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna Commercial |
$8.17
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Amerigroup Medicare |
$7.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.40
|
| Rate for Payer: BCBS of TX Medicare |
$7.78
|
| Rate for Payer: BCBS of TX PPO |
$17.19
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna Medicaid |
$7.78
|
| Rate for Payer: Cigna Medicare |
$7.78
|
| Rate for Payer: Employer Direct Commercial |
$7.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Molina Medicare |
$7.78
|
| Rate for Payer: Multiplan Auto |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$91.00
|
| Rate for Payer: Multiplan Workers Comp |
$91.00
|
| Rate for Payer: Parkland Medicaid |
$7.78
|
| Rate for Payer: Scott and White EPO/PPO |
$9.72
|
| Rate for Payer: Scott and White Medicare |
$7.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.78
|
| Rate for Payer: Superior Health Plan EPO |
$7.78
|
| Rate for Payer: Superior Health Plan Medicare |
$7.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.78
|
| Rate for Payer: Universal American Medicare |
$7.78
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: Wellmed Medicare |
$7.78
|
|
|
albuterol 2.5 mg/3 mL (0.083%) Inh Soln 3 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
78403337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
