|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,714.97
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$10,694.96 |
| Max. Negotiated Rate |
$16,714.97 |
| Rate for Payer: Aetna Commercial |
$13,066.88
|
| Rate for Payer: Aetna Medicare |
$16,714.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,694.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,962.82
|
| Rate for Payer: BCBS of TX PPO |
$13,292.53
|
| Rate for Payer: Cigna Commercial |
$14,960.12
|
|
|
Amputation, toe; interphalangeal joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
36028825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Amputation, toe metatarsophalangeal joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
36028820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Amylase Level
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
1601624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$6.81
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Amerigroup Medicare |
$6.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.83
|
| Rate for Payer: BCBS of TX Medicare |
$6.48
|
| Rate for Payer: BCBS of TX PPO |
$14.32
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna Medicaid |
$6.48
|
| Rate for Payer: Cigna Medicare |
$6.48
|
| Rate for Payer: Employer Direct Commercial |
$6.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Molina Medicare |
$6.48
|
| Rate for Payer: Multiplan Auto |
$198.25
|
| Rate for Payer: Multiplan Commercial |
$198.25
|
| Rate for Payer: Multiplan Workers Comp |
$198.25
|
| Rate for Payer: Parkland Medicaid |
$6.48
|
| Rate for Payer: Scott and White EPO/PPO |
$8.10
|
| Rate for Payer: Scott and White Medicare |
$6.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.48
|
| Rate for Payer: Superior Health Plan EPO |
$6.48
|
| Rate for Payer: Superior Health Plan Medicare |
$6.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Universal American Medicare |
$6.48
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: Wellmed Medicare |
$6.48
|
|
|
Amylase Level 24 Hour Urine
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
1601624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$6.81
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Amerigroup Medicare |
$6.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.83
|
| Rate for Payer: BCBS of TX Medicare |
$6.48
|
| Rate for Payer: BCBS of TX PPO |
$14.32
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna Medicaid |
$6.48
|
| Rate for Payer: Cigna Medicare |
$6.48
|
| Rate for Payer: Employer Direct Commercial |
$6.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Molina Medicare |
$6.48
|
| Rate for Payer: Multiplan Auto |
$198.25
|
| Rate for Payer: Multiplan Commercial |
$198.25
|
| Rate for Payer: Multiplan Workers Comp |
$198.25
|
| Rate for Payer: Parkland Medicaid |
$6.48
|
| Rate for Payer: Scott and White EPO/PPO |
$8.10
|
| Rate for Payer: Scott and White Medicare |
$6.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.48
|
| Rate for Payer: Superior Health Plan EPO |
$6.48
|
| Rate for Payer: Superior Health Plan Medicare |
$6.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Universal American Medicare |
$6.48
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: Wellmed Medicare |
$6.48
|
|
|
Amylase Level Body Fluid
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
1601624
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$268.40
|
|
|
Amylase Level Body Fluid
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
1601624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$6.81
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Amerigroup Medicare |
$6.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.83
|
| Rate for Payer: BCBS of TX Medicare |
$6.48
|
| Rate for Payer: BCBS of TX PPO |
$14.32
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna Medicaid |
$6.48
|
| Rate for Payer: Cigna Medicare |
$6.48
|
| Rate for Payer: Employer Direct Commercial |
$6.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Molina Medicare |
$6.48
|
| Rate for Payer: Multiplan Auto |
$198.25
|
| Rate for Payer: Multiplan Commercial |
$198.25
|
| Rate for Payer: Multiplan Workers Comp |
$198.25
|
| Rate for Payer: Parkland Medicaid |
$6.48
|
| Rate for Payer: Scott and White EPO/PPO |
$8.10
|
| Rate for Payer: Scott and White Medicare |
$6.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.48
|
| Rate for Payer: Superior Health Plan EPO |
$6.48
|
| Rate for Payer: Superior Health Plan Medicare |
$6.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Universal American Medicare |
$6.48
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: Wellmed Medicare |
$6.48
|
|
|
Amylase Level Urine
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
1601624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$6.81
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Amerigroup Medicare |
$6.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.83
|
| Rate for Payer: BCBS of TX Medicare |
$6.48
|
| Rate for Payer: BCBS of TX PPO |
$14.32
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna Medicaid |
$6.48
|
| Rate for Payer: Cigna Medicare |
$6.48
|
| Rate for Payer: Employer Direct Commercial |
$6.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Molina Medicare |
$6.48
|
| Rate for Payer: Multiplan Auto |
$198.25
|
| Rate for Payer: Multiplan Commercial |
$198.25
|
| Rate for Payer: Multiplan Workers Comp |
$198.25
|
| Rate for Payer: Parkland Medicaid |
$6.48
|
| Rate for Payer: Scott and White EPO/PPO |
$8.10
|
| Rate for Payer: Scott and White Medicare |
$6.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.48
|
| Rate for Payer: Superior Health Plan EPO |
$6.48
|
| Rate for Payer: Superior Health Plan Medicare |
$6.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.48
|
| Rate for Payer: Universal American Medicare |
$6.48
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: Wellmed Medicare |
$6.48
|
|
|
ANA Comprehensive Panel SO
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
1605344
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$276.90 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$20.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Amerigroup Medicare |
$13.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.21
|
| Rate for Payer: BCBS of TX Medicare |
$13.74
|
| Rate for Payer: BCBS of TX PPO |
$30.37
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cigna Medicaid |
$13.74
|
| Rate for Payer: Cigna Medicare |
$13.74
|
| Rate for Payer: Employer Direct Commercial |
$13.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Molina Medicare |
$13.74
|
| Rate for Payer: Multiplan Auto |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$276.90
|
| Rate for Payer: Multiplan Workers Comp |
$276.90
|
| Rate for Payer: Parkland Medicaid |
$13.74
|
| Rate for Payer: Scott and White EPO/PPO |
$17.18
|
| Rate for Payer: Scott and White Medicare |
$13.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.74
|
| Rate for Payer: Superior Health Plan EPO |
$13.74
|
| Rate for Payer: Superior Health Plan Medicare |
$13.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.74
|
| Rate for Payer: Universal American Medicare |
$13.74
|
| Rate for Payer: Wellcare Medicare |
$13.74
|
| Rate for Payer: Wellmed Medicare |
$13.74
|
|
|
Anaerobic Culture
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
4107075
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$433.84
|
|
|
Anaerobic Culture
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
4107075
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Amerigroup Medicare |
$9.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.75
|
| Rate for Payer: BCBS of TX Medicare |
$9.47
|
| Rate for Payer: BCBS of TX PPO |
$20.93
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cigna Medicaid |
$9.47
|
| Rate for Payer: Cigna Medicare |
$9.47
|
| Rate for Payer: Employer Direct Commercial |
$9.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Molina Medicare |
$9.47
|
| Rate for Payer: Multiplan Auto |
$320.45
|
| Rate for Payer: Multiplan Commercial |
$320.45
|
| Rate for Payer: Multiplan Workers Comp |
$320.45
|
| Rate for Payer: Parkland Medicaid |
$9.47
|
| Rate for Payer: Scott and White EPO/PPO |
$11.84
|
| Rate for Payer: Scott and White Medicare |
$9.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.47
|
| Rate for Payer: Superior Health Plan EPO |
$9.47
|
| Rate for Payer: Superior Health Plan Medicare |
$9.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.47
|
| Rate for Payer: Universal American Medicare |
$9.47
|
| Rate for Payer: Wellcare Medicare |
$9.47
|
| Rate for Payer: Wellmed Medicare |
$9.47
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$18,212.47
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$12,446.78 |
| Max. Negotiated Rate |
$18,212.47 |
| Rate for Payer: Aetna Commercial |
$14,640.75
|
| Rate for Payer: Aetna Medicare |
$18,212.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,446.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,446.60
|
| Rate for Payer: BCBS of TX PPO |
$16,052.40
|
| Rate for Payer: Cigna Commercial |
$16,762.03
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$32,832.41
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$21,343.48 |
| Max. Negotiated Rate |
$32,832.41 |
| Rate for Payer: Aetna Commercial |
$28,677.38
|
| Rate for Payer: Aetna Medicare |
$31,567.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21,343.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,880.14
|
| Rate for Payer: BCBS of TX PPO |
$27,645.67
|
| Rate for Payer: Cigna Commercial |
$32,832.41
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,727.21
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$8,222.46 |
| Max. Negotiated Rate |
$14,727.21 |
| Rate for Payer: Aetna Commercial |
$10,977.75
|
| Rate for Payer: Aetna Medicare |
$14,727.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,222.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,799.95
|
| Rate for Payer: BCBS of TX PPO |
$10,889.26
|
| Rate for Payer: Cigna Commercial |
$12,568.30
|
|
|
ANA w/Reflex SO
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1605393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Amerigroup Medicare |
$12.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.94
|
| Rate for Payer: BCBS of TX Medicare |
$12.09
|
| Rate for Payer: BCBS of TX PPO |
$26.72
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cash Price |
$297.44
|
| Rate for Payer: Cigna Medicaid |
$12.09
|
| Rate for Payer: Cigna Medicare |
$12.09
|
| Rate for Payer: Employer Direct Commercial |
$12.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Molina Medicare |
$12.09
|
| Rate for Payer: Multiplan Auto |
$219.70
|
| Rate for Payer: Multiplan Commercial |
$219.70
|
| Rate for Payer: Multiplan Workers Comp |
$219.70
|
| Rate for Payer: Parkland Medicaid |
$12.09
|
| Rate for Payer: Scott and White EPO/PPO |
$15.11
|
| Rate for Payer: Scott and White Medicare |
$12.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.09
|
| Rate for Payer: Superior Health Plan EPO |
$12.09
|
| Rate for Payer: Superior Health Plan Medicare |
$12.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.09
|
| Rate for Payer: Universal American Medicare |
$12.09
|
| Rate for Payer: Wellcare Medicare |
$12.09
|
| Rate for Payer: Wellmed Medicare |
$12.09
|
|
|
ANCA Panel SO
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1706332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$144.30 |
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.19
|
| Rate for Payer: BCBS of TX Medicare |
$17.27
|
| Rate for Payer: BCBS of TX PPO |
$38.17
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cigna Medicaid |
$17.27
|
| Rate for Payer: Cigna Medicare |
$17.27
|
| Rate for Payer: Employer Direct Commercial |
$17.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Molina Medicare |
$17.27
|
| Rate for Payer: Multiplan Auto |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$144.30
|
| Rate for Payer: Multiplan Workers Comp |
$144.30
|
| Rate for Payer: Parkland Medicaid |
$17.27
|
| Rate for Payer: Scott and White EPO/PPO |
$21.59
|
| Rate for Payer: Scott and White Medicare |
$17.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.27
|
| Rate for Payer: Superior Health Plan EPO |
$17.27
|
| Rate for Payer: Superior Health Plan Medicare |
$17.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Universal American Medicare |
$17.27
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: Wellmed Medicare |
$17.27
|
|
|
ANCH BIO-SWIVELOCK -- DHF
|
Facility
|
IP
|
$2,892.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.03 |
| Max. Negotiated Rate |
$1,446.06 |
| Rate for Payer: Aetna Commercial |
$867.63
|
| Rate for Payer: Cash Price |
$2,545.06
|
| Rate for Payer: Cigna Commercial |
$723.03
|
| Rate for Payer: Multiplan Auto |
$1,446.06
|
| Rate for Payer: Multiplan Commercial |
$1,446.06
|
| Rate for Payer: Multiplan Workers Comp |
$1,446.06
|
| Rate for Payer: Scott and White EPO/PPO |
$1,446.06
|
|
|
ANCH BIO-SWIVELOCK -- DHF
|
Facility
|
OP
|
$2,892.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.29 |
| Max. Negotiated Rate |
$1,446.06 |
| Rate for Payer: Aetna Commercial |
$867.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$260.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$867.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,041.16
|
| Rate for Payer: BCBS of TX PPO |
$1,156.84
|
| Rate for Payer: Cash Price |
$2,545.06
|
| Rate for Payer: Multiplan Auto |
$1,446.06
|
| Rate for Payer: Multiplan Commercial |
$1,446.06
|
| Rate for Payer: Multiplan Workers Comp |
$1,446.06
|
| Rate for Payer: Scott and White EPO/PPO |
$1,446.06
|
| Rate for Payer: Superior Health Plan EPO |
$393.33
|
|
|
ANCH HEALIX PEEK -- DHF
|
Facility
|
OP
|
$1,512.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$756.02 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$453.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$544.34
|
| Rate for Payer: BCBS of TX PPO |
$604.82
|
| Rate for Payer: Cash Price |
$1,330.60
|
| Rate for Payer: Multiplan Auto |
$756.02
|
| Rate for Payer: Multiplan Commercial |
$756.02
|
| Rate for Payer: Multiplan Workers Comp |
$756.02
|
| Rate for Payer: Scott and White EPO/PPO |
$756.02
|
| Rate for Payer: Superior Health Plan EPO |
$205.64
|
|
|
ANCH HEALIX PEEK -- DHF
|
Facility
|
IP
|
$1,512.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.01 |
| Max. Negotiated Rate |
$756.02 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Cash Price |
$1,330.60
|
| Rate for Payer: Cigna Commercial |
$378.01
|
| Rate for Payer: Multiplan Auto |
$756.02
|
| Rate for Payer: Multiplan Commercial |
$756.02
|
| Rate for Payer: Multiplan Workers Comp |
$756.02
|
| Rate for Payer: Scott and White EPO/PPO |
$756.02
|
|
|
ANCHOR CUTURE Y-KNOT 1.3 BLUE RIBBON
|
Facility
|
IP
|
$5,385.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
144882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.31 |
| Max. Negotiated Rate |
$2,692.62 |
| Rate for Payer: Aetna Commercial |
$1,615.57
|
| Rate for Payer: Cash Price |
$4,739.01
|
| Rate for Payer: Cigna Commercial |
$1,346.31
|
| Rate for Payer: Multiplan Auto |
$2,692.62
|
| Rate for Payer: Multiplan Commercial |
$2,692.62
|
| Rate for Payer: Multiplan Workers Comp |
$2,692.62
|
| Rate for Payer: Scott and White EPO/PPO |
$2,692.62
|
|
|
ANCHOR CUTURE Y-KNOT 1.3 BLUE RIBBON
|
Facility
|
OP
|
$5,385.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
144882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.67 |
| Max. Negotiated Rate |
$2,692.62 |
| Rate for Payer: Aetna Commercial |
$1,615.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$484.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,615.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,938.69
|
| Rate for Payer: BCBS of TX PPO |
$2,154.10
|
| Rate for Payer: Cash Price |
$4,739.01
|
| Rate for Payer: Multiplan Auto |
$2,692.62
|
| Rate for Payer: Multiplan Commercial |
$2,692.62
|
| Rate for Payer: Multiplan Workers Comp |
$2,692.62
|
| Rate for Payer: Scott and White EPO/PPO |
$2,692.62
|
| Rate for Payer: Superior Health Plan EPO |
$732.39
|
|
|
ANCHOR FAST
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
112476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.68
|
| Rate for Payer: BCBS of TX PPO |
$15.20
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Multiplan Auto |
$24.70
|
| Rate for Payer: Multiplan Commercial |
$24.70
|
| Rate for Payer: Multiplan Workers Comp |
$24.70
|
| Rate for Payer: Scott and White EPO/PPO |
$19.00
|
| Rate for Payer: Superior Health Plan EPO |
$5.17
|
|
|
ANCHOR FAST
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
112476
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$33.44
|
|
|
ANCHOR PUNCHTAK THREADED
|
Facility
|
IP
|
$2,195.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8524480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.88 |
| Max. Negotiated Rate |
$1,097.77 |
| Rate for Payer: Aetna Commercial |
$658.66
|
| Rate for Payer: Cash Price |
$1,932.08
|
| Rate for Payer: Cigna Commercial |
$548.88
|
| Rate for Payer: Multiplan Auto |
$1,097.77
|
| Rate for Payer: Multiplan Commercial |
$1,097.77
|
| Rate for Payer: Multiplan Workers Comp |
$1,097.77
|
| Rate for Payer: Scott and White EPO/PPO |
$1,097.77
|
|
