|
Echocardiogram w/o Contrast 93307
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
2800159
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,594.15 |
| Rate for Payer: Aetna Commercial |
$164.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$359.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$168.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$201.66
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$224.92
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$136.66
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$136.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,594.15
|
| Rate for Payer: Multiplan Commercial |
$2,594.15
|
| Rate for Payer: Multiplan Workers Comp |
$2,594.15
|
| Rate for Payer: Parkland Medicaid |
$136.66
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$136.66
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
Echocardiogram w/o Contrast 93307 BCE
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
2800159
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$3,512.08
|
|
|
Echocardiogram w/o Contrast 93307 BCE
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
2800159
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,594.15 |
| Rate for Payer: Aetna Commercial |
$164.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$359.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$168.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$201.66
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$224.92
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cash Price |
$3,512.08
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$136.66
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$136.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,594.15
|
| Rate for Payer: Multiplan Commercial |
$2,594.15
|
| Rate for Payer: Multiplan Workers Comp |
$2,594.15
|
| Rate for Payer: Parkland Medicaid |
$136.66
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$136.66
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
Echo Doppler LTD or Follow Up 93321
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
2810002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Aetna Commercial |
$31.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.23
|
| Rate for Payer: BCBS of TX PPO |
$45.98
|
| Rate for Payer: Cash Price |
$613.36
|
| Rate for Payer: Cash Price |
$613.36
|
| Rate for Payer: Multiplan Auto |
$453.05
|
| Rate for Payer: Multiplan Commercial |
$453.05
|
| Rate for Payer: Multiplan Workers Comp |
$453.05
|
| Rate for Payer: Scott and White EPO/PPO |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$94.79
|
|
|
Echo Doppler LTD or Follow Up 93321 BCE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
2810002
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$613.36
|
|
|
Echo Doppler LTD or Follow Up 93321 BCE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
2810002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Aetna Commercial |
$31.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.23
|
| Rate for Payer: BCBS of TX PPO |
$45.98
|
| Rate for Payer: Cash Price |
$613.36
|
| Rate for Payer: Cash Price |
$613.36
|
| Rate for Payer: Multiplan Auto |
$453.05
|
| Rate for Payer: Multiplan Commercial |
$453.05
|
| Rate for Payer: Multiplan Workers Comp |
$453.05
|
| Rate for Payer: Scott and White EPO/PPO |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$94.79
|
|
|
Echo Trans ESO w/ Probe w/ Contrast 93312
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$2,086.50 |
| Rate for Payer: Aetna Commercial |
$230.32
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$242.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$289.35
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$322.74
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$235.90
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$235.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$235.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$235.90
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
Echo Trans ESO w/ Probe w/ Contrast 93312 BCE
|
Facility
|
IP
|
$3,210.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,824.80
|
|
|
Echo Trans ESO w/ Probe w/ Contrast 93312 BCE
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$2,086.50 |
| Rate for Payer: Aetna Commercial |
$230.32
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$242.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$289.35
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$322.74
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$235.90
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$235.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$235.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$235.90
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
Echo Transthoracic LTD 93304
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$210.12
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$218.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$261.62
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$291.81
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$155.38
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$155.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$1,093.95
|
| Rate for Payer: Multiplan Commercial |
$1,093.95
|
| Rate for Payer: Multiplan Workers Comp |
$1,093.95
|
| Rate for Payer: Parkland Medicaid |
$155.38
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$155.38
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
Echo Transthoracic LTD 93304 BCE
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,481.04
|
|
|
Echo Transthoracic LTD 93304 BCE
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$210.12
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$218.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$261.62
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$291.81
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cash Price |
$1,481.04
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$155.38
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$155.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$1,093.95
|
| Rate for Payer: Multiplan Commercial |
$1,093.95
|
| Rate for Payer: Multiplan Workers Comp |
$1,093.95
|
| Rate for Payer: Parkland Medicaid |
$155.38
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$155.38
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$405,085.70
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$154,365.70 |
| Max. Negotiated Rate |
$405,085.70 |
| Rate for Payer: Aetna Commercial |
$239,853.38
|
| Rate for Payer: Aetna Medicare |
$232,496.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$154,997.72
|
| Rate for Payer: Amerigroup Medicare |
$154,997.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$154,365.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$188,810.87
|
| Rate for Payer: BCBS of TX Medicare |
$154,997.72
|
| Rate for Payer: BCBS of TX PPO |
$209,797.99
|
| Rate for Payer: Cigna Commercial |
$274,605.46
|
| Rate for Payer: Cigna Medicare |
$154,997.72
|
| Rate for Payer: Employer Direct Commercial |
$154,997.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$154,997.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$154,997.72
|
| Rate for Payer: Molina Medicare |
$154,997.72
|
| Rate for Payer: Multiplan Auto |
$405,085.70
|
| Rate for Payer: Multiplan Commercial |
$405,085.70
|
| Rate for Payer: Multiplan Workers Comp |
$405,085.70
|
| Rate for Payer: Scott and White EPO/PPO |
$186,552.62
|
| Rate for Payer: Scott and White Medicare |
$154,997.72
|
| Rate for Payer: Superior Health Plan EPO |
$154,997.72
|
| Rate for Payer: Superior Health Plan Medicare |
$154,997.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$154,997.72
|
| Rate for Payer: Universal American Medicare |
$154,997.72
|
| Rate for Payer: Wellcare Medicare |
$154,997.72
|
| Rate for Payer: Wellmed Medicare |
$154,997.72
|
|
|
ED - Addl Admin Charge 90472
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
5200068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.98
|
| Rate for Payer: BCBS of TX PPO |
$30.09
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Multiplan Auto |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$57.20
|
| Rate for Payer: Multiplan Workers Comp |
$57.20
|
| Rate for Payer: Scott and White EPO/PPO |
$44.00
|
| Rate for Payer: Superior Health Plan EPO |
$11.97
|
|
|
ED - Addl Admin Charge 90472
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
5200068
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$77.44
|
|
|
ED Addl Admin Charge 90472 BCE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
5200068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.98
|
| Rate for Payer: BCBS of TX PPO |
$30.09
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Multiplan Auto |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$57.20
|
| Rate for Payer: Multiplan Workers Comp |
$57.20
|
| Rate for Payer: Scott and White EPO/PPO |
$44.00
|
| Rate for Payer: Superior Health Plan EPO |
$11.97
|
|
|
ED Airway/Intubation Procedure: Chest Tube Insertion
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$532.35
|
| Rate for Payer: Multiplan Commercial |
$532.35
|
| Rate for Payer: Multiplan Workers Comp |
$532.35
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
ED Airway/Intubation Procedure: Cricothyrotomy
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
5202589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$708.50 |
| Rate for Payer: Aetna Commercial |
$599.50
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$708.50
|
| Rate for Payer: Multiplan Commercial |
$708.50
|
| Rate for Payer: Multiplan Workers Comp |
$708.50
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
ED Airway/Intubation Procedure: Endotracheal Intubation
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
300533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$681.85 |
| Rate for Payer: Aetna Commercial |
$576.95
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$94.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$681.85
|
| Rate for Payer: Multiplan Commercial |
$681.85
|
| Rate for Payer: Multiplan Workers Comp |
$681.85
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
ED Airway/Intubation Procedure: Insert pleural catheter w/ imaging
|
Facility
|
OP
|
$6,427.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
2151249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$7,835.54 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$578.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicaid |
$1,551.50
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| Rate for Payer: Multiplan Auto |
$4,177.55
|
| Rate for Payer: Multiplan Commercial |
$4,177.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,177.55
|
| Rate for Payer: Parkland Medicaid |
$1,551.50
|
| Rate for Payer: Scott and White EPO/PPO |
$56.58
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
ED Airway/Intubation Procedure: Laryngoscopy, direct
|
Facility
|
OP
|
$5,290.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$3,605.14 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$476.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| Rate for Payer: Multiplan Auto |
$3,438.50
|
| Rate for Payer: Multiplan Commercial |
$3,438.50
|
| Rate for Payer: Multiplan Workers Comp |
$3,438.50
|
| Rate for Payer: Parkland Medicaid |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$27.76
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
ED Airway/Intubation Procedure: Laryngoscopy, flexible
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Aetna Medicare |
$271.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Amerigroup Medicare |
$181.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$181.15
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cigna Commercial |
$410.36
|
| Rate for Payer: Cigna Medicaid |
$68.14
|
| Rate for Payer: Cigna Medicare |
$181.15
|
| Rate for Payer: Employer Direct Commercial |
$181.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$181.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Molina Medicare |
$181.15
|
| Rate for Payer: Multiplan Auto |
$459.55
|
| Rate for Payer: Multiplan Commercial |
$459.55
|
| Rate for Payer: Multiplan Workers Comp |
$459.55
|
| Rate for Payer: Parkland Medicaid |
$68.14
|
| Rate for Payer: Scott and White EPO/PPO |
$3.24
|
| Rate for Payer: Scott and White Medicare |
$181.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.14
|
| Rate for Payer: Superior Health Plan EPO |
$181.15
|
| Rate for Payer: Superior Health Plan Medicare |
$181.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Universal American Medicare |
$181.15
|
| Rate for Payer: Wellcare Medicare |
$181.15
|
| Rate for Payer: Wellmed Medicare |
$181.15
|
|
|
ED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$532.35
|
| Rate for Payer: Multiplan Commercial |
$532.35
|
| Rate for Payer: Multiplan Workers Comp |
$532.35
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
ED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
ED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
5202589
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$959.20
|
|
