|
Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
36076000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.50
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$70.87
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$43.44
|
| 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 |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| 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 |
$43.44
|
| 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 |
$43.44
|
| 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
|
|
|
FLUoxetine 20 mg Cap
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77578790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$6.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3.38
|
| Rate for Payer: BCBS of TX PPO |
$3.75
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Multiplan Auto |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.10
|
| Rate for Payer: Multiplan Workers Comp |
$6.10
|
| Rate for Payer: Scott and White EPO/PPO |
$4.69
|
| Rate for Payer: Superior Health Plan EPO |
$1.28
|
|
|
FLUoxetine 20 mg Cap
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77578790
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$6.38
|
|
|
FLURESCENT NONINFECT ANTI,TITER
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
1700285
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$182.16
|
|
|
FLURESCENT NONINFECT ANTI,TITER
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
1700285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$182.16
|
| Rate for Payer: Cash Price |
$182.16
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$134.55
|
| Rate for Payer: Multiplan Workers Comp |
$134.55
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
fluticasone 50 mcg/inh Nasal Spray 16 g
|
Facility
|
IP
|
$231.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77581254
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$157.15
|
|
|
fluticasone 50 mcg/inh Nasal Spray 16 g
|
Facility
|
OP
|
$231.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77581254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$20.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.20
|
| Rate for Payer: BCBS of TX PPO |
$92.44
|
| Rate for Payer: Cash Price |
$157.15
|
| Rate for Payer: Multiplan Auto |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$150.22
|
| Rate for Payer: Multiplan Workers Comp |
$150.22
|
| Rate for Payer: Scott and White EPO/PPO |
$115.55
|
| Rate for Payer: Superior Health Plan EPO |
$31.43
|
|
|
FOAM, POSITIONING DEVICE (DONUT) 9'''' O.D. -- DHF
|
Facility
|
IP
|
$119.61
|
|
| Hospital Charge Code |
80319650
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$105.26
|
|
|
FOAM, POSITIONING DEVICE (DONUT) 9'''' O.D. -- DHF
|
Facility
|
OP
|
$119.61
|
|
| Hospital Charge Code |
80319650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$77.75 |
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.06
|
| Rate for Payer: BCBS of TX PPO |
$47.84
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Multiplan Auto |
$77.75
|
| Rate for Payer: Multiplan Commercial |
$77.75
|
| Rate for Payer: Multiplan Workers Comp |
$77.75
|
| Rate for Payer: Scott and White EPO/PPO |
$59.80
|
| Rate for Payer: Superior Health Plan EPO |
$16.27
|
|
|
Folate, Hemolysate SO
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
1601863
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$39.01 |
| Rate for Payer: Aetna Commercial |
$18.53
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Amerigroup Medicare |
$17.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.95
|
| Rate for Payer: BCBS of TX Medicare |
$17.65
|
| Rate for Payer: BCBS of TX PPO |
$39.01
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cigna Medicaid |
$17.65
|
| Rate for Payer: Cigna Medicare |
$17.65
|
| Rate for Payer: Employer Direct Commercial |
$17.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Molina Medicare |
$17.65
|
| Rate for Payer: Multiplan Auto |
$4.55
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Multiplan Workers Comp |
$4.55
|
| Rate for Payer: Parkland Medicaid |
$17.65
|
| Rate for Payer: Scott and White EPO/PPO |
$22.06
|
| Rate for Payer: Scott and White Medicare |
$17.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.65
|
| Rate for Payer: Superior Health Plan EPO |
$17.65
|
| Rate for Payer: Superior Health Plan Medicare |
$17.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Universal American Medicare |
$17.65
|
| Rate for Payer: Wellcare Medicare |
$17.65
|
| Rate for Payer: Wellmed Medicare |
$17.65
|
|
|
Folate Level
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
1601855
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$291.28
|
|
|
Folate Level
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
1601855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$215.15 |
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Medicare |
$22.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.70
|
| Rate for Payer: Amerigroup Medicare |
$14.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.11
|
| Rate for Payer: BCBS of TX Medicare |
$14.70
|
| Rate for Payer: BCBS of TX PPO |
$32.49
|
| Rate for Payer: Cash Price |
$291.28
|
| Rate for Payer: Cash Price |
$291.28
|
| Rate for Payer: Cigna Medicaid |
$14.70
|
| Rate for Payer: Cigna Medicare |
$14.70
|
| Rate for Payer: Employer Direct Commercial |
$14.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.70
|
| Rate for Payer: Molina Medicare |
$14.70
|
| Rate for Payer: Multiplan Auto |
$215.15
|
| Rate for Payer: Multiplan Commercial |
$215.15
|
| Rate for Payer: Multiplan Workers Comp |
$215.15
|
| Rate for Payer: Parkland Medicaid |
$14.70
|
| Rate for Payer: Scott and White EPO/PPO |
$18.38
|
| Rate for Payer: Scott and White Medicare |
$14.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.70
|
| Rate for Payer: Superior Health Plan EPO |
$14.70
|
| Rate for Payer: Superior Health Plan Medicare |
$14.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.70
|
| Rate for Payer: Universal American Medicare |
$14.70
|
| Rate for Payer: Wellcare Medicare |
$14.70
|
| Rate for Payer: Wellmed Medicare |
$14.70
|
|
|
Folate, RBC SO
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
1601863
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$39.01 |
| Rate for Payer: Aetna Commercial |
$18.53
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Amerigroup Medicare |
$17.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.95
|
| Rate for Payer: BCBS of TX Medicare |
$17.65
|
| Rate for Payer: BCBS of TX PPO |
$39.01
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cigna Medicaid |
$17.65
|
| Rate for Payer: Cigna Medicare |
$17.65
|
| Rate for Payer: Employer Direct Commercial |
$17.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Molina Medicare |
$17.65
|
| Rate for Payer: Multiplan Auto |
$4.55
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Multiplan Workers Comp |
$4.55
|
| Rate for Payer: Parkland Medicaid |
$17.65
|
| Rate for Payer: Scott and White EPO/PPO |
$22.06
|
| Rate for Payer: Scott and White Medicare |
$17.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.65
|
| Rate for Payer: Superior Health Plan EPO |
$17.65
|
| Rate for Payer: Superior Health Plan Medicare |
$17.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.65
|
| Rate for Payer: Universal American Medicare |
$17.65
|
| Rate for Payer: Wellcare Medicare |
$17.65
|
| Rate for Payer: Wellmed Medicare |
$17.65
|
|
|
Folate, RBC SO
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
1601863
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.16
|
|
|
folic acid 1 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77582494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
folic acid 1 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77582494
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
folic acid 5 mg/mL Inj Soln 10 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77582549
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.16
|
|
|
folic acid 5 mg/mL Inj Soln 10 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77582549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.14
|
| Rate for Payer: BCBS of TX PPO |
$51.27
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
FOLIC ACID RBC
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
1600493
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2.37
|
| Rate for Payer: Amerigroup Medicare |
$2.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.69
|
| Rate for Payer: BCBS of TX Medicare |
$2.37
|
| Rate for Payer: BCBS of TX PPO |
$5.24
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cigna Medicaid |
$2.37
|
| Rate for Payer: Cigna Medicare |
$2.37
|
| Rate for Payer: Employer Direct Commercial |
$2.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$2.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.37
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2.37
|
| Rate for Payer: Molina Medicare |
$2.37
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$2.37
|
| Rate for Payer: Scott and White EPO/PPO |
$2.96
|
| Rate for Payer: Scott and White Medicare |
$2.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.37
|
| Rate for Payer: Superior Health Plan EPO |
$2.37
|
| Rate for Payer: Superior Health Plan Medicare |
$2.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2.37
|
| Rate for Payer: Universal American Medicare |
$2.37
|
| Rate for Payer: Wellcare Medicare |
$2.37
|
| Rate for Payer: Wellmed Medicare |
$2.37
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$32,814.90
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$13,512.32 |
| Max. Negotiated Rate |
$32,814.90 |
| Rate for Payer: Aetna Commercial |
$19,429.88
|
| Rate for Payer: Aetna Medicare |
$22,769.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,179.47
|
| Rate for Payer: Amerigroup Medicare |
$15,179.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,512.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,846.71
|
| Rate for Payer: BCBS of TX Medicare |
$15,179.47
|
| Rate for Payer: BCBS of TX PPO |
$19,830.45
|
| Rate for Payer: Cigna Commercial |
$22,245.05
|
| Rate for Payer: Cigna Medicare |
$15,179.47
|
| Rate for Payer: Employer Direct Commercial |
$15,179.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,179.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,179.47
|
| Rate for Payer: Molina Medicare |
$15,179.47
|
| Rate for Payer: Multiplan Auto |
$32,814.90
|
| Rate for Payer: Multiplan Commercial |
$32,814.90
|
| Rate for Payer: Multiplan Workers Comp |
$32,814.90
|
| Rate for Payer: Scott and White EPO/PPO |
$15,112.12
|
| Rate for Payer: Scott and White Medicare |
$15,179.47
|
| Rate for Payer: Superior Health Plan EPO |
$15,179.47
|
| Rate for Payer: Superior Health Plan Medicare |
$15,179.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,179.47
|
| Rate for Payer: Universal American Medicare |
$15,179.47
|
| Rate for Payer: Wellcare Medicare |
$15,179.47
|
| Rate for Payer: Wellmed Medicare |
$15,179.47
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$50,956.10
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$20,762.12 |
| Max. Negotiated Rate |
$50,956.10 |
| Rate for Payer: Aetna Commercial |
$30,171.38
|
| Rate for Payer: Aetna Medicare |
$32,989.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,992.99
|
| Rate for Payer: Amerigroup Medicare |
$21,992.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,762.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,439.34
|
| Rate for Payer: BCBS of TX Medicare |
$21,992.99
|
| Rate for Payer: BCBS of TX PPO |
$29,378.19
|
| Rate for Payer: Cigna Commercial |
$34,542.87
|
| Rate for Payer: Cigna Medicare |
$21,992.99
|
| Rate for Payer: Employer Direct Commercial |
$21,992.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,992.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,992.99
|
| Rate for Payer: Molina Medicare |
$21,992.99
|
| Rate for Payer: Multiplan Auto |
$50,956.10
|
| Rate for Payer: Multiplan Commercial |
$50,956.10
|
| Rate for Payer: Multiplan Workers Comp |
$50,956.10
|
| Rate for Payer: Scott and White EPO/PPO |
$23,466.62
|
| Rate for Payer: Scott and White Medicare |
$21,992.99
|
| Rate for Payer: Superior Health Plan EPO |
$21,992.99
|
| Rate for Payer: Superior Health Plan Medicare |
$21,992.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,992.99
|
| Rate for Payer: Universal American Medicare |
$21,992.99
|
| Rate for Payer: Wellcare Medicare |
$21,992.99
|
| Rate for Payer: Wellmed Medicare |
$21,992.99
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,408.30
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$11,288.36 |
| Max. Negotiated Rate |
$32,408.30 |
| Rate for Payer: Aetna Commercial |
$19,189.12
|
| Rate for Payer: Aetna Medicare |
$22,540.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,026.76
|
| Rate for Payer: Amerigroup Medicare |
$15,026.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,288.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,301.96
|
| Rate for Payer: BCBS of TX Medicare |
$15,026.76
|
| Rate for Payer: BCBS of TX PPO |
$18,113.99
|
| Rate for Payer: Cigna Commercial |
$21,969.42
|
| Rate for Payer: Cigna Medicare |
$15,026.76
|
| Rate for Payer: Employer Direct Commercial |
$15,026.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,026.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,026.76
|
| Rate for Payer: Molina Medicare |
$15,026.76
|
| Rate for Payer: Multiplan Auto |
$32,408.30
|
| Rate for Payer: Multiplan Commercial |
$32,408.30
|
| Rate for Payer: Multiplan Workers Comp |
$32,408.30
|
| Rate for Payer: Scott and White EPO/PPO |
$14,924.88
|
| Rate for Payer: Scott and White Medicare |
$15,026.76
|
| Rate for Payer: Superior Health Plan EPO |
$15,026.76
|
| Rate for Payer: Superior Health Plan Medicare |
$15,026.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,026.76
|
| Rate for Payer: Universal American Medicare |
$15,026.76
|
| Rate for Payer: Wellcare Medicare |
$15,026.76
|
| Rate for Payer: Wellmed Medicare |
$15,026.76
|
|
|
FORCEP BIPOLAR BAYONET 7" 20-1370I
|
Facility
|
IP
|
$180.37
|
|
| Hospital Charge Code |
133208
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$158.73
|
|
|
FORCEP BIPOLAR BAYONET 7" 20-1370I
|
Facility
|
OP
|
$180.37
|
|
| Hospital Charge Code |
133208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$117.24 |
| Rate for Payer: Aetna Commercial |
$99.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$54.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64.93
|
| Rate for Payer: BCBS of TX PPO |
$72.15
|
| Rate for Payer: Cash Price |
$158.73
|
| Rate for Payer: Multiplan Auto |
$117.24
|
| Rate for Payer: Multiplan Commercial |
$117.24
|
| Rate for Payer: Multiplan Workers Comp |
$117.24
|
| Rate for Payer: Scott and White EPO/PPO |
$90.18
|
| Rate for Payer: Superior Health Plan EPO |
$24.53
|
|
|
forcep bronch bx 1.8mmx100cm
|
Facility
|
OP
|
$131.66
|
|
| Hospital Charge Code |
8626514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$72.41
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$47.40
|
| Rate for Payer: BCBS of TX PPO |
$52.66
|
| Rate for Payer: Cash Price |
$115.86
|
| Rate for Payer: Multiplan Auto |
$85.58
|
| Rate for Payer: Multiplan Commercial |
$85.58
|
| Rate for Payer: Multiplan Workers Comp |
$85.58
|
| Rate for Payer: Scott and White EPO/PPO |
$65.83
|
| Rate for Payer: Superior Health Plan EPO |
$17.91
|
|
