|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$14,149.30
|
|
|
Service Code
|
MSDRG 149
|
| Min. Negotiated Rate |
$5,848.00 |
| Max. Negotiated Rate |
$14,149.30 |
| Rate for Payer: Aetna Commercial |
$8,377.88
|
| Rate for Payer: Aetna Medicare |
$12,253.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,169.01
|
| Rate for Payer: Amerigroup Medicare |
$8,169.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,848.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,337.84
|
| Rate for Payer: BCBS of TX Medicare |
$8,169.01
|
| Rate for Payer: BCBS of TX PPO |
$8,153.47
|
| Rate for Payer: Cigna Commercial |
$9,591.74
|
| Rate for Payer: Cigna Medicare |
$8,169.01
|
| Rate for Payer: Employer Direct Commercial |
$8,169.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,169.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,169.01
|
| Rate for Payer: Molina Medicare |
$8,169.01
|
| Rate for Payer: Multiplan Auto |
$14,149.30
|
| Rate for Payer: Multiplan Commercial |
$14,149.30
|
| Rate for Payer: Multiplan Workers Comp |
$14,149.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,516.12
|
| Rate for Payer: Scott and White Medicare |
$8,169.01
|
| Rate for Payer: Superior Health Plan EPO |
$8,169.01
|
| Rate for Payer: Superior Health Plan Medicare |
$8,169.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,169.01
|
| Rate for Payer: Universal American Medicare |
$8,169.01
|
| Rate for Payer: Wellcare Medicare |
$8,169.01
|
| Rate for Payer: Wellmed Medicare |
$8,169.01
|
|
|
E1408 Thawed Aph FFP NaCitrate >600mL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728583
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna Commercial |
$50.60
|
| Rate for Payer: Aetna Medicare |
$104.49
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Amerigroup Medicare |
$69.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.12
|
| Rate for Payer: BCBS of TX Medicare |
$69.66
|
| Rate for Payer: BCBS of TX PPO |
$36.80
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cigna Commercial |
$157.80
|
| Rate for Payer: Cigna Medicaid |
$51.00
|
| Rate for Payer: Cigna Medicare |
$69.66
|
| Rate for Payer: Employer Direct Commercial |
$69.66
|
| Rate for Payer: Humana Medicare/TRICARE |
$69.66
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Molina Medicare |
$69.66
|
| Rate for Payer: Multiplan Auto |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$59.80
|
| Rate for Payer: Multiplan Workers Comp |
$59.80
|
| Rate for Payer: Parkland Medicaid |
$51.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1.25
|
| Rate for Payer: Scott and White Medicare |
$69.66
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.00
|
| Rate for Payer: Superior Health Plan EPO |
$69.66
|
| Rate for Payer: Superior Health Plan Medicare |
$69.66
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Universal American Medicare |
$69.66
|
| Rate for Payer: Wellcare Medicare |
$69.66
|
| Rate for Payer: Wellmed Medicare |
$69.66
|
|
|
E1408 Thawed Aph FFP NaCitrate >600mL
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728583
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
|
E3090 Aph Plt ACDA LR
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E4655 Thawed FFP CPD
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728582
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna Commercial |
$50.60
|
| Rate for Payer: Aetna Medicare |
$104.49
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Amerigroup Medicare |
$69.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.12
|
| Rate for Payer: BCBS of TX Medicare |
$69.66
|
| Rate for Payer: BCBS of TX PPO |
$36.80
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cigna Commercial |
$157.80
|
| Rate for Payer: Cigna Medicaid |
$51.00
|
| Rate for Payer: Cigna Medicare |
$69.66
|
| Rate for Payer: Employer Direct Commercial |
$69.66
|
| Rate for Payer: Humana Medicare/TRICARE |
$69.66
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Molina Medicare |
$69.66
|
| Rate for Payer: Multiplan Auto |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$59.80
|
| Rate for Payer: Multiplan Workers Comp |
$59.80
|
| Rate for Payer: Parkland Medicaid |
$51.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1.25
|
| Rate for Payer: Scott and White Medicare |
$69.66
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.00
|
| Rate for Payer: Superior Health Plan EPO |
$69.66
|
| Rate for Payer: Superior Health Plan Medicare |
$69.66
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Universal American Medicare |
$69.66
|
| Rate for Payer: Wellcare Medicare |
$69.66
|
| Rate for Payer: Wellmed Medicare |
$69.66
|
|
|
E4655 Thawed FFP CPD
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728582
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
|
E5030 Aph Plt ACDA LR Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E5031 Aph Plt ACDA LR 1 Bacti Mntr
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E5032 Aph Plt ACDA LR 2 Bacti Mntr
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E5033 Aph Plt ACDA LR 3 Bacti Mntr
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E5034 Aph Plt ACDA LR Irr Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E5035 Aph Plt ACDA LR Irr 1 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E5036 Aph Plt ACDA LR Irr 2 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E5037 Aph Plt ACDA LR Irr 3 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E5075 Aph Plt ACDA LR Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.11
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
E7916 Thawed FFP CPD LR
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728581
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
|
E7916 Thawed FFP CPD LR
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728581
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna Commercial |
$50.60
|
| Rate for Payer: Aetna Medicare |
$104.49
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Amerigroup Medicare |
$69.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.12
|
| Rate for Payer: BCBS of TX Medicare |
$69.66
|
| Rate for Payer: BCBS of TX PPO |
$36.80
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cigna Commercial |
$157.80
|
| Rate for Payer: Cigna Medicaid |
$51.00
|
| Rate for Payer: Cigna Medicare |
$69.66
|
| Rate for Payer: Employer Direct Commercial |
$69.66
|
| Rate for Payer: Humana Medicare/TRICARE |
$69.66
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Molina Medicare |
$69.66
|
| Rate for Payer: Multiplan Auto |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$59.80
|
| Rate for Payer: Multiplan Workers Comp |
$59.80
|
| Rate for Payer: Parkland Medicaid |
$51.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1.25
|
| Rate for Payer: Scott and White Medicare |
$69.66
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.00
|
| Rate for Payer: Superior Health Plan EPO |
$69.66
|
| Rate for Payer: Superior Health Plan Medicare |
$69.66
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$69.66
|
| Rate for Payer: Universal American Medicare |
$69.66
|
| Rate for Payer: Wellcare Medicare |
$69.66
|
| Rate for Payer: Wellmed Medicare |
$69.66
|
|
|
E8081 Aph Plt ACDA LR Irr 3
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E8082 Aph Plt ACDA LR Irr 2
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E8083 Aph Plt ACDA LR Irr 1
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E8084 Aph Plt ACDA LR Irr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$11.54
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
E8343 Aph Plt ACDA
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9034
|
| Hospital Charge Code |
2402568
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$738.40 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$463.41
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Amerigroup Medicare |
$308.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.94
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$699.85
|
| Rate for Payer: Cigna Medicaid |
$343.82
|
| Rate for Payer: Cigna Medicare |
$308.94
|
| Rate for Payer: Employer Direct Commercial |
$308.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$343.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Molina Medicare |
$308.94
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$343.82
|
| Rate for Payer: Scott and White EPO/PPO |
$5.53
|
| Rate for Payer: Scott and White Medicare |
$308.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$343.82
|
| Rate for Payer: Superior Health Plan EPO |
$308.94
|
| Rate for Payer: Superior Health Plan Medicare |
$308.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Universal American Medicare |
$308.94
|
| Rate for Payer: Wellcare Medicare |
$308.94
|
| Rate for Payer: Wellmed Medicare |
$308.94
|
|
|
E8344 Aph Plt ACDA
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9034
|
| Hospital Charge Code |
2402568
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$999.68
|
|
|
E8344 Aph Plt ACDA
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9034
|
| Hospital Charge Code |
2402568
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$738.40 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$463.41
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Amerigroup Medicare |
$308.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.94
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$699.85
|
| Rate for Payer: Cigna Medicaid |
$343.82
|
| Rate for Payer: Cigna Medicare |
$308.94
|
| Rate for Payer: Employer Direct Commercial |
$308.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$343.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Molina Medicare |
$308.94
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$343.82
|
| Rate for Payer: Scott and White EPO/PPO |
$5.53
|
| Rate for Payer: Scott and White Medicare |
$308.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$343.82
|
| Rate for Payer: Superior Health Plan EPO |
$308.94
|
| Rate for Payer: Superior Health Plan Medicare |
$308.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.94
|
| Rate for Payer: Universal American Medicare |
$308.94
|
| Rate for Payer: Wellcare Medicare |
$308.94
|
| Rate for Payer: Wellmed Medicare |
$308.94
|
|
|
E8694 Thawed Aph Plasma ACDA 400-600 mL
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728584
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
