|
glucose 40% Oral Gel 37.5 g
|
Facility
|
OP
|
$17.15
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77593410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.17
|
| Rate for Payer: BCBS of TX PPO |
$6.86
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Multiplan Auto |
$11.15
|
| Rate for Payer: Multiplan Commercial |
$11.15
|
| Rate for Payer: Multiplan Workers Comp |
$11.15
|
| Rate for Payer: Scott and White EPO/PPO |
$8.58
|
| Rate for Payer: Superior Health Plan EPO |
$2.33
|
|
|
GLUCOSE BLOOD TEST
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
7150733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Amerigroup Medicare |
$3.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.49
|
| Rate for Payer: BCBS of TX Medicare |
$3.28
|
| Rate for Payer: BCBS of TX PPO |
$7.25
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cigna Medicare |
$3.28
|
| Rate for Payer: Employer Direct Commercial |
$3.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Molina Medicare |
$3.28
|
| Rate for Payer: Multiplan Auto |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$27.95
|
| Rate for Payer: Multiplan Workers Comp |
$27.95
|
| Rate for Payer: Scott and White EPO/PPO |
$4.10
|
| Rate for Payer: Scott and White Medicare |
$3.28
|
| Rate for Payer: Superior Health Plan EPO |
$3.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Universal American Medicare |
$3.28
|
| Rate for Payer: Wellcare Medicare |
$3.28
|
| Rate for Payer: Wellmed Medicare |
$3.28
|
|
|
Glucose Body Fluid
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
4102945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Amerigroup Medicare |
$3.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.78
|
| Rate for Payer: BCBS of TX Medicare |
$3.93
|
| Rate for Payer: BCBS of TX PPO |
$8.69
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cigna Medicaid |
$3.93
|
| Rate for Payer: Cigna Medicare |
$3.93
|
| Rate for Payer: Employer Direct Commercial |
$3.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Molina Medicare |
$3.93
|
| Rate for Payer: Multiplan Auto |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$101.40
|
| Rate for Payer: Multiplan Workers Comp |
$101.40
|
| Rate for Payer: Parkland Medicaid |
$3.93
|
| Rate for Payer: Scott and White EPO/PPO |
$4.91
|
| Rate for Payer: Scott and White Medicare |
$3.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.93
|
| Rate for Payer: Superior Health Plan EPO |
$3.93
|
| Rate for Payer: Superior Health Plan Medicare |
$3.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Universal American Medicare |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: Wellmed Medicare |
$3.93
|
|
|
Glucose Body Fluid
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
4102945
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$137.28
|
|
|
Glucose CSF
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
1602549
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$137.28
|
|
|
Glucose CSF
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
1602549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Amerigroup Medicare |
$3.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.78
|
| Rate for Payer: BCBS of TX Medicare |
$3.93
|
| Rate for Payer: BCBS of TX PPO |
$8.69
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cigna Medicaid |
$3.93
|
| Rate for Payer: Cigna Medicare |
$3.93
|
| Rate for Payer: Employer Direct Commercial |
$3.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Molina Medicare |
$3.93
|
| Rate for Payer: Multiplan Auto |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$101.40
|
| Rate for Payer: Multiplan Workers Comp |
$101.40
|
| Rate for Payer: Parkland Medicaid |
$3.93
|
| Rate for Payer: Scott and White EPO/PPO |
$4.91
|
| Rate for Payer: Scott and White Medicare |
$3.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.93
|
| Rate for Payer: Superior Health Plan EPO |
$3.93
|
| Rate for Payer: Superior Health Plan Medicare |
$3.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Universal American Medicare |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: Wellmed Medicare |
$3.93
|
|
|
Glucose Fasting
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
1601368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Amerigroup Medicare |
$3.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.78
|
| Rate for Payer: BCBS of TX Medicare |
$3.93
|
| Rate for Payer: BCBS of TX PPO |
$8.69
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cigna Medicaid |
$3.93
|
| Rate for Payer: Cigna Medicare |
$3.93
|
| Rate for Payer: Employer Direct Commercial |
$3.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Molina Medicare |
$3.93
|
| Rate for Payer: Multiplan Auto |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$101.40
|
| Rate for Payer: Multiplan Workers Comp |
$101.40
|
| Rate for Payer: Parkland Medicaid |
$3.93
|
| Rate for Payer: Scott and White EPO/PPO |
$4.91
|
| Rate for Payer: Scott and White Medicare |
$3.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.93
|
| Rate for Payer: Superior Health Plan EPO |
$3.93
|
| Rate for Payer: Superior Health Plan Medicare |
$3.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Universal American Medicare |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: Wellmed Medicare |
$3.93
|
|
|
Glucose Level
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
1601368
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$137.28
|
|
|
Glucose Level
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
1601368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Amerigroup Medicare |
$3.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.78
|
| Rate for Payer: BCBS of TX Medicare |
$3.93
|
| Rate for Payer: BCBS of TX PPO |
$8.69
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cigna Medicaid |
$3.93
|
| Rate for Payer: Cigna Medicare |
$3.93
|
| Rate for Payer: Employer Direct Commercial |
$3.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Molina Medicare |
$3.93
|
| Rate for Payer: Multiplan Auto |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$101.40
|
| Rate for Payer: Multiplan Workers Comp |
$101.40
|
| Rate for Payer: Parkland Medicaid |
$3.93
|
| Rate for Payer: Scott and White EPO/PPO |
$4.91
|
| Rate for Payer: Scott and White Medicare |
$3.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.93
|
| Rate for Payer: Superior Health Plan EPO |
$3.93
|
| Rate for Payer: Superior Health Plan Medicare |
$3.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.93
|
| Rate for Payer: Universal American Medicare |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: Wellmed Medicare |
$3.93
|
|
|
.Glucose Level (POCT)
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
1690014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Amerigroup Medicare |
$3.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.49
|
| Rate for Payer: BCBS of TX Medicare |
$3.28
|
| Rate for Payer: BCBS of TX PPO |
$7.25
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cigna Medicare |
$3.28
|
| Rate for Payer: Employer Direct Commercial |
$3.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Molina Medicare |
$3.28
|
| Rate for Payer: Multiplan Auto |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$27.95
|
| Rate for Payer: Multiplan Workers Comp |
$27.95
|
| Rate for Payer: Scott and White EPO/PPO |
$4.10
|
| Rate for Payer: Scott and White Medicare |
$3.28
|
| Rate for Payer: Superior Health Plan EPO |
$3.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Universal American Medicare |
$3.28
|
| Rate for Payer: Wellcare Medicare |
$3.28
|
| Rate for Payer: Wellmed Medicare |
$3.28
|
|
|
.Glucose Level (POCT)
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
1690014
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$37.84
|
|
|
Glucose Level (POCT)
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
1690001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$20.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Amerigroup Medicare |
$13.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.19
|
| Rate for Payer: BCBS of TX Medicare |
$13.73
|
| Rate for Payer: BCBS of TX PPO |
$30.34
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cigna Medicaid |
$13.73
|
| Rate for Payer: Cigna Medicare |
$13.73
|
| Rate for Payer: Employer Direct Commercial |
$13.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Molina Medicare |
$13.73
|
| Rate for Payer: Multiplan Auto |
$464.75
|
| Rate for Payer: Multiplan Commercial |
$464.75
|
| Rate for Payer: Multiplan Workers Comp |
$464.75
|
| Rate for Payer: Parkland Medicaid |
$13.73
|
| Rate for Payer: Scott and White EPO/PPO |
$17.16
|
| Rate for Payer: Scott and White Medicare |
$13.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.73
|
| Rate for Payer: Superior Health Plan EPO |
$13.73
|
| Rate for Payer: Superior Health Plan Medicare |
$13.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Universal American Medicare |
$13.73
|
| Rate for Payer: Wellcare Medicare |
$13.73
|
| Rate for Payer: Wellmed Medicare |
$13.73
|
|
|
Glucose Level (POCT) BCE
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
1690001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$20.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Amerigroup Medicare |
$13.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.19
|
| Rate for Payer: BCBS of TX Medicare |
$13.73
|
| Rate for Payer: BCBS of TX PPO |
$30.34
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cigna Medicaid |
$13.73
|
| Rate for Payer: Cigna Medicare |
$13.73
|
| Rate for Payer: Employer Direct Commercial |
$13.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Molina Medicare |
$13.73
|
| Rate for Payer: Multiplan Auto |
$464.75
|
| Rate for Payer: Multiplan Commercial |
$464.75
|
| Rate for Payer: Multiplan Workers Comp |
$464.75
|
| Rate for Payer: Parkland Medicaid |
$13.73
|
| Rate for Payer: Scott and White EPO/PPO |
$17.16
|
| Rate for Payer: Scott and White Medicare |
$13.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.73
|
| Rate for Payer: Superior Health Plan EPO |
$13.73
|
| Rate for Payer: Superior Health Plan Medicare |
$13.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.73
|
| Rate for Payer: Universal American Medicare |
$13.73
|
| Rate for Payer: Wellcare Medicare |
$13.73
|
| Rate for Payer: Wellmed Medicare |
$13.73
|
|
|
Glucose Level (POCT) BCE
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
1690001
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$629.20
|
|
|
Glucose Monitor Continuous
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
3535250
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.87 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$181.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Amerigroup Medicare |
$120.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$201.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$241.13
|
| Rate for Payer: BCBS of TX Medicare |
$120.89
|
| Rate for Payer: BCBS of TX PPO |
$268.96
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cigna Commercial |
$273.87
|
| Rate for Payer: Cigna Medicare |
$120.89
|
| Rate for Payer: Employer Direct Commercial |
$120.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Molina Medicare |
$120.89
|
| Rate for Payer: Multiplan Auto |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.89
|
| Rate for Payer: Superior Health Plan EPO |
$120.89
|
| Rate for Payer: Superior Health Plan Medicare |
$120.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Universal American Medicare |
$120.89
|
| Rate for Payer: Wellcare Medicare |
$120.89
|
| Rate for Payer: Wellmed Medicare |
$120.89
|
|
|
Glucose Monitor Continuous BCE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
3535250
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.87 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$181.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Amerigroup Medicare |
$120.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$201.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$241.13
|
| Rate for Payer: BCBS of TX Medicare |
$120.89
|
| Rate for Payer: BCBS of TX PPO |
$268.96
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cigna Commercial |
$273.87
|
| Rate for Payer: Cigna Medicare |
$120.89
|
| Rate for Payer: Employer Direct Commercial |
$120.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Molina Medicare |
$120.89
|
| Rate for Payer: Multiplan Auto |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.89
|
| Rate for Payer: Superior Health Plan EPO |
$120.89
|
| Rate for Payer: Superior Health Plan Medicare |
$120.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Universal American Medicare |
$120.89
|
| Rate for Payer: Wellcare Medicare |
$120.89
|
| Rate for Payer: Wellmed Medicare |
$120.89
|
|
|
Glucose Monitor Continuous BCE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
3535250
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$134.64
|
|
|
glycopyrrolate 0.2 mg 1 ml vial
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
77595759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.18
|
| Rate for Payer: BCBS of TX PPO |
$1.31
|
| Rate for Payer: Cash Price |
$87.16
|
| 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
|
|
|
glycopyrrolate 0.2 mg 1 ml vial
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
77595759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
glycopyrrolate 0.2 mg/mL Inj Soln 1 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
7446179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
glycopyrrolate 0.2 mg/mL Inj Soln 1 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
7446179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.18
|
| Rate for Payer: BCBS of TX PPO |
$1.31
|
| Rate for Payer: Cash Price |
$87.16
|
| 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
|
|
|
GONADOTROPIN LUTEINIZING HORMONE LH
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
1602135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna Medicare |
$27.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.52
|
| Rate for Payer: Amerigroup Medicare |
$18.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36.67
|
| Rate for Payer: BCBS of TX Medicare |
$18.52
|
| Rate for Payer: BCBS of TX PPO |
$40.93
|
| Rate for Payer: Cash Price |
$218.24
|
| Rate for Payer: Cash Price |
$218.24
|
| Rate for Payer: Cigna Medicaid |
$18.52
|
| Rate for Payer: Cigna Medicare |
$18.52
|
| Rate for Payer: Employer Direct Commercial |
$18.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.52
|
| Rate for Payer: Molina Medicare |
$18.52
|
| Rate for Payer: Multiplan Auto |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$161.20
|
| Rate for Payer: Multiplan Workers Comp |
$161.20
|
| Rate for Payer: Parkland Medicaid |
$18.52
|
| Rate for Payer: Scott and White EPO/PPO |
$23.15
|
| Rate for Payer: Scott and White Medicare |
$18.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.52
|
| Rate for Payer: Superior Health Plan EPO |
$18.52
|
| Rate for Payer: Superior Health Plan Medicare |
$18.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.52
|
| Rate for Payer: Universal American Medicare |
$18.52
|
| Rate for Payer: Wellcare Medicare |
$18.52
|
| Rate for Payer: Wellmed Medicare |
$18.52
|
|
|
Goniotomy
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 65820
|
| Hospital Charge Code |
36065820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,577.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,533.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Amerigroup Medicare |
$3,718.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,376.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,636.66
|
| Rate for Payer: BCBS of TX Medicare |
$3,718.40
|
| Rate for Payer: BCBS of TX PPO |
$9,622.19
|
| Rate for Payer: Cigna Commercial |
$8,423.25
|
| Rate for Payer: Cigna Medicaid |
$1,533.49
|
| Rate for Payer: Cigna Medicare |
$3,718.40
|
| Rate for Payer: Employer Direct Commercial |
$3,718.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,718.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,533.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Molina Medicare |
$3,718.40
|
| 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 |
$1,533.49
|
| Rate for Payer: Scott and White EPO/PPO |
$82.02
|
| Rate for Payer: Scott and White Medicare |
$3,718.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,533.49
|
| Rate for Payer: Superior Health Plan EPO |
$3,718.40
|
| Rate for Payer: Superior Health Plan Medicare |
$3,718.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Universal American Medicare |
$3,718.40
|
| Rate for Payer: Wellcare Medicare |
$3,718.40
|
| Rate for Payer: Wellmed Medicare |
$3,718.40
|
|
|
Gonorrhea PCR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
4107592
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$159.25
|
| Rate for Payer: Multiplan Workers Comp |
$159.25
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Gonorrhea PCR BCE
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
4107592
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$159.25
|
| Rate for Payer: Multiplan Workers Comp |
$159.25
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
