|
ED Wound Dehiscence Superficial BCE
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
5202583
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$902.55
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$1,444.08
|
| Rate for Payer: Cash Price |
$1,444.08
|
| Rate for Payer: Cash Price |
$1,444.08
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$1,066.65
|
| Rate for Payer: Multiplan Commercial |
$1,066.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,066.65
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
EEG 24 hr Intermittent Monitoring w/o video 95709
|
Facility
|
OP
|
$4,128.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
8794578
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,683.82 |
| Rate for Payer: Aetna Commercial |
$2,270.93
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$371.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$844.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,010.07
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$1,126.62
|
| Rate for Payer: Cash Price |
$3,633.48
|
| Rate for Payer: Cash Price |
$3,633.48
|
| Rate for Payer: Cash Price |
$3,633.48
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,683.82
|
| Rate for Payer: Multiplan Commercial |
$2,683.82
|
| Rate for Payer: Multiplan Workers Comp |
$2,683.82
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
EEG 24 hr Intermittent Monitoring w/o video 95709
|
Facility
|
IP
|
$4,128.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
8794578
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$3,633.48
|
|
|
EEG 24 hr Intermittent Monitoring w/ video 95715
|
Facility
|
OP
|
$5,225.24
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
8794577
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$3,396.41 |
| Rate for Payer: Aetna Commercial |
$2,873.88
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$470.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$844.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,010.07
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$1,126.62
|
| Rate for Payer: Cash Price |
$4,598.21
|
| Rate for Payer: Cash Price |
$4,598.21
|
| Rate for Payer: Cash Price |
$4,598.21
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$3,396.41
|
| Rate for Payer: Multiplan Commercial |
$3,396.41
|
| Rate for Payer: Multiplan Workers Comp |
$3,396.41
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
EEG 24 hr Intermittent Monitoring w/ video 95715
|
Facility
|
IP
|
$5,225.24
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
8794577
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$4,598.21
|
|
|
EEG 24 hr Unmonitored w/o video 95708
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
8794575
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$2,772.00
|
|
|
EEG 24 hr Unmonitored w/o video 95708
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
8794575
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$283.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$844.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,010.07
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$1,126.62
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,047.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
EEG 24 hr Unmonitored w/ video 95714
|
Facility
|
OP
|
$4,301.75
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
8794576
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,796.14 |
| Rate for Payer: Aetna Commercial |
$2,365.96
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$387.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$844.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,010.07
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$1,126.62
|
| Rate for Payer: Cash Price |
$3,785.54
|
| Rate for Payer: Cash Price |
$3,785.54
|
| Rate for Payer: Cash Price |
$3,785.54
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,796.14
|
| Rate for Payer: Multiplan Commercial |
$2,796.14
|
| Rate for Payer: Multiplan Workers Comp |
$2,796.14
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
EEG 24 hr Unmonitored w/ video 95714
|
Facility
|
IP
|
$4,301.75
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
8794576
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$3,785.54
|
|
|
EEG Awake/Asleep 95819
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,338.35 |
| Rate for Payer: Aetna Commercial |
$1,132.45
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$654.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$781.85
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$872.06
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,338.35
|
| Rate for Payer: Multiplan Commercial |
$1,338.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,338.35
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
EEG Awake/Asleep 95819
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3000023
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$1,811.92
|
|
|
EEG Awake/Asleep 95819 BCE
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,338.35 |
| Rate for Payer: Aetna Commercial |
$1,132.45
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$654.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$781.85
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$872.06
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,338.35
|
| Rate for Payer: Multiplan Commercial |
$1,338.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,338.35
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
EEG Awake/Drowsy 95816
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3000015
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$1,679.04
|
|
|
EEG Awake/Drowsy 95816
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3000015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$540.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$646.17
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$720.73
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,240.20
|
| Rate for Payer: Multiplan Commercial |
$1,240.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,240.20
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
EEG Awake/Drowsy 95816 BCE
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3000015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$540.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$646.17
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$720.73
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cash Price |
$1,679.04
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,240.20
|
| Rate for Payer: Multiplan Commercial |
$1,240.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,240.20
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
EKG Charges - ED: Routine ECG 12 lead/15 lead tracing only
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$616.00
|
|
|
EKG Charges - ED: Routine ECG 12 lead/15 lead tracing only
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
EKG Charges - ED Routine ECG 12 lead/15 lead tracing only BC
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
ELCTRD BALL -- DHF
|
Facility
|
IP
|
$2,150.54
|
|
| Hospital Charge Code |
81812000
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,892.48
|
|
|
ELCTRD BALL -- DHF
|
Facility
|
OP
|
$2,150.54
|
|
| Hospital Charge Code |
81812000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$1,397.85 |
| Rate for Payer: Aetna Commercial |
$1,182.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$193.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$645.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$774.19
|
| Rate for Payer: BCBS of TX PPO |
$860.22
|
| Rate for Payer: Cash Price |
$1,892.48
|
| Rate for Payer: Multiplan Auto |
$1,397.85
|
| Rate for Payer: Multiplan Commercial |
$1,397.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,397.85
|
| Rate for Payer: Scott and White EPO/PPO |
$1,075.27
|
| Rate for Payer: Superior Health Plan EPO |
$292.47
|
|
|
ELCTRD EXPACE -- DHF
|
Facility
|
IP
|
$2,192.88
|
|
| Hospital Charge Code |
82030453
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,929.73
|
|
|
ELCTRD EXPACE -- DHF
|
Facility
|
OP
|
$2,192.88
|
|
| Hospital Charge Code |
82030453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$197.36 |
| Max. Negotiated Rate |
$1,425.37 |
| Rate for Payer: Aetna Commercial |
$1,206.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$197.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$657.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$789.44
|
| Rate for Payer: BCBS of TX PPO |
$877.15
|
| Rate for Payer: Cash Price |
$1,929.73
|
| Rate for Payer: Multiplan Auto |
$1,425.37
|
| Rate for Payer: Multiplan Commercial |
$1,425.37
|
| Rate for Payer: Multiplan Workers Comp |
$1,425.37
|
| Rate for Payer: Scott and White EPO/PPO |
$1,096.44
|
| Rate for Payer: Superior Health Plan EPO |
$298.23
|
|
|
ELCTRD FETAL -- DHF
|
Facility
|
IP
|
$293.75
|
|
| Hospital Charge Code |
82030503
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$258.50
|
|
|
ELCTRD FETAL -- DHF
|
Facility
|
OP
|
$293.75
|
|
| Hospital Charge Code |
82030503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$190.94 |
| Rate for Payer: Aetna Commercial |
$161.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$88.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$105.75
|
| Rate for Payer: BCBS of TX PPO |
$117.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Multiplan Auto |
$190.94
|
| Rate for Payer: Multiplan Commercial |
$190.94
|
| Rate for Payer: Multiplan Workers Comp |
$190.94
|
| Rate for Payer: Scott and White EPO/PPO |
$146.88
|
| Rate for Payer: Superior Health Plan EPO |
$39.95
|
|
|
ELCTRD LOOP -- DHF
|
Facility
|
OP
|
$80.69
|
|
| Hospital Charge Code |
81823155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$52.45 |
| Rate for Payer: Aetna Commercial |
$44.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.05
|
| Rate for Payer: BCBS of TX PPO |
$32.28
|
| Rate for Payer: Cash Price |
$71.01
|
| Rate for Payer: Multiplan Auto |
$52.45
|
| Rate for Payer: Multiplan Commercial |
$52.45
|
| Rate for Payer: Multiplan Workers Comp |
$52.45
|
| Rate for Payer: Scott and White EPO/PPO |
$40.34
|
| Rate for Payer: Superior Health Plan EPO |
$10.97
|
|
