|
C-Reactive Protein, Cardiac SO
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
1739614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Amerigroup Medicare |
$12.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55.44
|
| Rate for Payer: BCBS of TX Medicare |
$12.95
|
| Rate for Payer: BCBS of TX PPO |
$61.60
|
| Rate for Payer: Cash Price |
$104.72
|
| Rate for Payer: Cash Price |
$104.72
|
| Rate for Payer: Cigna Medicaid |
$110.88
|
| Rate for Payer: Cigna Medicare |
$12.95
|
| Rate for Payer: Employer Direct Commercial |
$12.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$110.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Molina Medicare |
$12.95
|
| Rate for Payer: Multiplan Auto |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$100.10
|
| Rate for Payer: Multiplan Workers Comp |
$100.10
|
| Rate for Payer: Parkland Medicaid |
$110.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.19
|
| Rate for Payer: Scott and White Medicare |
$12.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$110.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.95
|
| Rate for Payer: Superior Health Plan Medicare |
$12.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Universal American Medicare |
$12.95
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
| Rate for Payer: Wellmed Medicare |
$12.95
|
|
|
C-Reactive Protein, Cardiac SO
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
1739614
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$104.72
|
|
|
Creatine Kinase (CK), MB SO
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
8520510
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$267.92
|
|
|
Creatine Kinase (CK), MB SO
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
8520510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$283.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$118.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$141.84
|
| Rate for Payer: BCBS of TX Medicare |
$11.55
|
| Rate for Payer: BCBS of TX PPO |
$157.60
|
| Rate for Payer: Cash Price |
$267.92
|
| Rate for Payer: Cash Price |
$267.92
|
| Rate for Payer: Cigna Medicaid |
$283.68
|
| Rate for Payer: Cigna Medicare |
$11.55
|
| Rate for Payer: Employer Direct Commercial |
$11.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$283.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Molina Medicare |
$11.55
|
| Rate for Payer: Multiplan Auto |
$256.10
|
| Rate for Payer: Multiplan Commercial |
$256.10
|
| Rate for Payer: Multiplan Workers Comp |
$256.10
|
| Rate for Payer: Parkland Medicaid |
$283.68
|
| Rate for Payer: Scott and White EPO/PPO |
$14.44
|
| Rate for Payer: Scott and White Medicare |
$11.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$283.68
|
| Rate for Payer: Superior Health Plan EPO |
$11.55
|
| Rate for Payer: Superior Health Plan Medicare |
$11.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Universal American Medicare |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: Wellmed Medicare |
$11.55
|
|
|
Creatine Kinase MB
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
1601764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$283.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$118.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$141.84
|
| Rate for Payer: BCBS of TX Medicare |
$11.55
|
| Rate for Payer: BCBS of TX PPO |
$157.60
|
| Rate for Payer: Cash Price |
$267.92
|
| Rate for Payer: Cash Price |
$267.92
|
| Rate for Payer: Cigna Medicaid |
$283.68
|
| Rate for Payer: Cigna Medicare |
$11.55
|
| Rate for Payer: Employer Direct Commercial |
$11.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$283.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Molina Medicare |
$11.55
|
| Rate for Payer: Multiplan Auto |
$256.10
|
| Rate for Payer: Multiplan Commercial |
$256.10
|
| Rate for Payer: Multiplan Workers Comp |
$256.10
|
| Rate for Payer: Parkland Medicaid |
$283.68
|
| Rate for Payer: Scott and White EPO/PPO |
$14.44
|
| Rate for Payer: Scott and White Medicare |
$11.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$283.68
|
| Rate for Payer: Superior Health Plan EPO |
$11.55
|
| Rate for Payer: Superior Health Plan Medicare |
$11.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.55
|
| Rate for Payer: Universal American Medicare |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: Wellmed Medicare |
$11.55
|
|
|
Creatine Kinase MB
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
1601764
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$267.92
|
|
|
Creatine Kinase,Total
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
1601756
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$188.36
|
|
|
Creatine Kinase,Total
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
1601756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$199.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Amerigroup Medicare |
$6.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$99.72
|
| Rate for Payer: BCBS of TX Medicare |
$6.51
|
| Rate for Payer: BCBS of TX PPO |
$110.80
|
| Rate for Payer: Cash Price |
$188.36
|
| Rate for Payer: Cash Price |
$188.36
|
| Rate for Payer: Cigna Medicaid |
$199.44
|
| Rate for Payer: Cigna Medicare |
$6.51
|
| Rate for Payer: Employer Direct Commercial |
$6.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.51
|
| Rate for Payer: Molina CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Molina Medicare |
$6.51
|
| Rate for Payer: Multiplan Auto |
$180.05
|
| Rate for Payer: Multiplan Commercial |
$180.05
|
| Rate for Payer: Multiplan Workers Comp |
$180.05
|
| Rate for Payer: Parkland Medicaid |
$199.44
|
| Rate for Payer: Scott and White EPO/PPO |
$8.14
|
| Rate for Payer: Scott and White Medicare |
$6.51
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$199.44
|
| Rate for Payer: Superior Health Plan EPO |
$6.51
|
| Rate for Payer: Superior Health Plan Medicare |
$6.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Universal American Medicare |
$6.51
|
| Rate for Payer: Wellcare Medicare |
$6.51
|
| Rate for Payer: Wellmed Medicare |
$6.51
|
|
|
Creatine Kinase,Total SO
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
9096973
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$199.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Amerigroup Medicare |
$6.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$99.72
|
| Rate for Payer: BCBS of TX Medicare |
$6.51
|
| Rate for Payer: BCBS of TX PPO |
$110.80
|
| Rate for Payer: Cash Price |
$188.36
|
| Rate for Payer: Cash Price |
$188.36
|
| Rate for Payer: Cigna Medicaid |
$199.44
|
| Rate for Payer: Cigna Medicare |
$6.51
|
| Rate for Payer: Employer Direct Commercial |
$6.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.51
|
| Rate for Payer: Molina CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Molina Medicare |
$6.51
|
| Rate for Payer: Multiplan Auto |
$180.05
|
| Rate for Payer: Multiplan Commercial |
$180.05
|
| Rate for Payer: Multiplan Workers Comp |
$180.05
|
| Rate for Payer: Parkland Medicaid |
$199.44
|
| Rate for Payer: Scott and White EPO/PPO |
$8.14
|
| Rate for Payer: Scott and White Medicare |
$6.51
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$199.44
|
| Rate for Payer: Superior Health Plan EPO |
$6.51
|
| Rate for Payer: Superior Health Plan Medicare |
$6.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Universal American Medicare |
$6.51
|
| Rate for Payer: Wellcare Medicare |
$6.51
|
| Rate for Payer: Wellmed Medicare |
$6.51
|
|
|
Creatine Kinase,Total SO
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
9096973
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$188.36
|
|
|
Creatinine
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 82565 QW
|
| Hospital Charge Code |
1601780
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Amerigroup Medicare |
$5.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.84
|
| Rate for Payer: BCBS of TX Medicare |
$5.12
|
| Rate for Payer: BCBS of TX PPO |
$67.60
|
| Rate for Payer: Cash Price |
$114.92
|
| Rate for Payer: Cash Price |
$114.92
|
| Rate for Payer: Cigna Medicaid |
$121.68
|
| Rate for Payer: Cigna Medicare |
$5.12
|
| Rate for Payer: Employer Direct Commercial |
$5.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$121.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Molina Medicare |
$5.12
|
| Rate for Payer: Multiplan Auto |
$109.85
|
| Rate for Payer: Multiplan Commercial |
$109.85
|
| Rate for Payer: Multiplan Workers Comp |
$109.85
|
| Rate for Payer: Parkland Medicaid |
$121.68
|
| Rate for Payer: Scott and White EPO/PPO |
$6.40
|
| Rate for Payer: Scott and White Medicare |
$5.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$121.68
|
| Rate for Payer: Superior Health Plan EPO |
$5.12
|
| Rate for Payer: Superior Health Plan Medicare |
$5.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.12
|
| Rate for Payer: Universal American Medicare |
$5.12
|
| Rate for Payer: Wellcare Medicare |
$5.12
|
| Rate for Payer: Wellmed Medicare |
$5.12
|
|
|
Creatinine
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 82565 QW
|
| Hospital Charge Code |
1601780
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$114.92
|
|
|
Creatinine Clearance
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
1602507
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$228.48
|
|
|
Creatinine Clearance
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
1602507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Amerigroup Medicare |
$9.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$100.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$120.96
|
| Rate for Payer: BCBS of TX Medicare |
$9.46
|
| Rate for Payer: BCBS of TX PPO |
$134.40
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cigna Medicaid |
$241.92
|
| Rate for Payer: Cigna Medicare |
$9.46
|
| Rate for Payer: Employer Direct Commercial |
$9.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$241.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Molina Medicare |
$9.46
|
| Rate for Payer: Multiplan Auto |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Multiplan Workers Comp |
$218.40
|
| Rate for Payer: Parkland Medicaid |
$241.92
|
| Rate for Payer: Scott and White EPO/PPO |
$11.82
|
| Rate for Payer: Scott and White Medicare |
$9.46
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$241.92
|
| Rate for Payer: Superior Health Plan EPO |
$9.46
|
| Rate for Payer: Superior Health Plan Medicare |
$9.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.46
|
| Rate for Payer: Universal American Medicare |
$9.46
|
| Rate for Payer: Wellcare Medicare |
$9.46
|
| Rate for Payer: Wellmed Medicare |
$9.46
|
|
|
Creatinine, Urine SO
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 82570 QW
|
| Hospital Charge Code |
9333006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.56
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$38.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cigna Medicaid |
$69.12
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$69.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$69.12
|
| Rate for Payer: Scott and White EPO/PPO |
$6.47
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$69.12
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
Creatinine, Urine SO
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 82570 QW
|
| Hospital Charge Code |
9333006
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$65.28
|
|
|
Creation of arteriovenous fistula
|
Facility
|
OP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
991067
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,884.93 |
| Max. Negotiated Rate |
$15,079.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,884.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Amerigroup Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cigna Commercial |
$11,815.91
|
| Rate for Payer: Cigna Medicaid |
$15,079.45
|
| Rate for Payer: Cigna Medicare |
$5,589.84
|
| Rate for Payer: Employer Direct Commercial |
$5,589.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,589.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Molina Medicare |
$5,589.84
|
| Rate for Payer: Multiplan Auto |
$13,613.39
|
| Rate for Payer: Multiplan Commercial |
$13,613.39
|
| Rate for Payer: Multiplan Workers Comp |
$13,613.39
|
| Rate for Payer: Parkland Medicaid |
$15,079.45
|
| Rate for Payer: Scott and White EPO/PPO |
$10,471.84
|
| Rate for Payer: Scott and White Medicare |
$5,589.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Superior Health Plan EPO |
$5,589.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,589.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Universal American Medicare |
$5,589.84
|
| Rate for Payer: Wellcare Medicare |
$5,589.84
|
| Rate for Payer: Wellmed Medicare |
$5,589.84
|
|
|
Creation of arteriovenous fistula
|
Facility
|
IP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
991067
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$14,241.70
|
|
|
C/R EXER PROGRAM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Amerigroup Medicare |
$129.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.40
|
| Rate for Payer: BCBS of TX Medicare |
$129.26
|
| Rate for Payer: BCBS of TX PPO |
$16.00
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cigna Medicaid |
$28.80
|
| Rate for Payer: Cigna Medicare |
$129.26
|
| Rate for Payer: Employer Direct Commercial |
$129.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$129.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$28.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Molina Medicare |
$129.26
|
| Rate for Payer: Multiplan Auto |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Workers Comp |
$26.00
|
| Rate for Payer: Parkland Medicaid |
$28.80
|
| Rate for Payer: Scott and White EPO/PPO |
$20.00
|
| Rate for Payer: Scott and White Medicare |
$129.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28.80
|
| Rate for Payer: Superior Health Plan EPO |
$129.26
|
| Rate for Payer: Superior Health Plan Medicare |
$129.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Universal American Medicare |
$129.26
|
| Rate for Payer: Wellcare Medicare |
$129.26
|
| Rate for Payer: Wellmed Medicare |
$129.26
|
|
|
C/R EXER PROGRAM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
6010154
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$27.20
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min 99292
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
5210174
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,142.40
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min 99292
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
5210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,640.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,168.00
|
| Rate for Payer: BCBS of TX PPO |
$672.00
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Medicaid |
$1,209.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,209.60
|
| Rate for Payer: Multiplan Auto |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,092.00
|
| Rate for Payer: Parkland Medicaid |
$1,209.60
|
| Rate for Payer: Scott and White EPO/PPO |
$2,900.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,209.60
|
| Rate for Payer: Superior Health Plan EPO |
$228.48
|
|
|
Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
5201678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.45 |
| Max. Negotiated Rate |
$4,117.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$324.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Amerigroup Medicare |
$829.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,640.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,168.00
|
| Rate for Payer: BCBS of TX Medicare |
$829.79
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cigna Commercial |
$4,117.38
|
| Rate for Payer: Cigna Medicaid |
$2,595.60
|
| Rate for Payer: Cigna Medicare |
$829.79
|
| Rate for Payer: Employer Direct Commercial |
$829.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,595.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Molina Medicare |
$829.79
|
| Rate for Payer: Multiplan Auto |
$2,343.25
|
| Rate for Payer: Multiplan Commercial |
$2,343.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,343.25
|
| Rate for Payer: Parkland Medicaid |
$2,595.60
|
| Rate for Payer: Scott and White EPO/PPO |
$2,900.00
|
| Rate for Payer: Scott and White Medicare |
$829.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,595.60
|
| Rate for Payer: Superior Health Plan EPO |
$829.79
|
| Rate for Payer: Superior Health Plan Medicare |
$829.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Universal American Medicare |
$829.79
|
| Rate for Payer: Wellcare Medicare |
$829.79
|
| Rate for Payer: Wellmed Medicare |
$829.79
|
|
|
Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
5201678
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,451.40
|
|
|
Crossflow inflow caseette tubing
|
Facility
|
OP
|
$335.10
|
|
| Hospital Charge Code |
993575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$241.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$100.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$120.64
|
| Rate for Payer: BCBS of TX PPO |
$134.04
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cigna Medicaid |
$241.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$241.27
|
| Rate for Payer: Multiplan Auto |
$217.81
|
| Rate for Payer: Multiplan Commercial |
$217.81
|
| Rate for Payer: Multiplan Workers Comp |
$217.81
|
| Rate for Payer: Parkland Medicaid |
$241.27
|
| Rate for Payer: Scott and White EPO/PPO |
$167.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$241.27
|
| Rate for Payer: Superior Health Plan EPO |
$45.57
|
|
