|
E8694 Thawed Aph Plasma ACDA 400-600 mL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728584
|
|
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
|
|
|
E9284 Thawed Aph Plasma ACDA <24h 1
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728585
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
|
E9284 Thawed Aph Plasma ACDA <24h 1
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728585
|
|
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
|
|
|
E9285 Thawed Aph Plasma ACDA <24h 2
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728580
|
|
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
|
|
|
E9285 Thawed Aph Plasma ACDA <24h 2
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
8728580
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$80.96
|
|
|
E9467 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
|
|
|
E9468 Aph Plt ACDA LR 1
|
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
|
|
|
E9469 Aph Plt ACDA LR 2
|
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
|
|
|
E9470 Aph Plt ACDA LR 3
|
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
|
|
|
EA007 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
|
|
|
EA008 Aph Plt ACDA LR 1 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
|
|
|
EA009 Aph Plt ACDA LR 2 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
|
|
|
EA010 Aph Plt ACDA LR 3 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
|
|
|
EA011 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
|
|
|
EA012 Aph Plt ACDA LR 1 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
|
|
|
EA013 Aph Plt ACDA LR 2 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
|
|
|
EA014 Aph Plt ACDA LR 3 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
|
|
|
EA015 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
|
|
|
EA016 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
|
|
|
EA017 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
|
|
|
EA018 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
|
|
|
EA019 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
|
|
|
EA020 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
|
|
|
EA021 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
|
|
|
EA022 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
|
|
