|
HCG Qualitative Serum
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
1602580
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$208.56
|
|
|
HCG Qualitative Urine
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1605187
|
|
Hospital Revenue Code
|
307
|
| Rate for Payer: Cash Price |
$322.96
|
|
|
HCG Qualitative Urine
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1605187
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Amerigroup Medicare |
$8.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.05
|
| Rate for Payer: BCBS of TX Medicare |
$8.61
|
| Rate for Payer: BCBS of TX PPO |
$19.03
|
| Rate for Payer: Cash Price |
$322.96
|
| Rate for Payer: Cash Price |
$322.96
|
| Rate for Payer: Cigna Medicaid |
$8.61
|
| Rate for Payer: Cigna Medicare |
$8.61
|
| Rate for Payer: Employer Direct Commercial |
$8.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Molina Medicare |
$8.61
|
| Rate for Payer: Multiplan Auto |
$238.55
|
| Rate for Payer: Multiplan Commercial |
$238.55
|
| Rate for Payer: Multiplan Workers Comp |
$238.55
|
| Rate for Payer: Parkland Medicaid |
$8.61
|
| Rate for Payer: Scott and White EPO/PPO |
$10.76
|
| Rate for Payer: Scott and White Medicare |
$8.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.61
|
| Rate for Payer: Superior Health Plan EPO |
$8.61
|
| Rate for Payer: Superior Health Plan Medicare |
$8.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Universal American Medicare |
$8.61
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: Wellmed Medicare |
$8.61
|
|
|
HCG Quantitative
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1602598
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$379.28
|
|
|
HCG Quantitative
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1602598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$15.80
|
| Rate for Payer: Aetna Medicare |
$22.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Amerigroup Medicare |
$15.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.80
|
| Rate for Payer: BCBS of TX Medicare |
$15.05
|
| Rate for Payer: BCBS of TX PPO |
$33.26
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cigna Medicaid |
$15.05
|
| Rate for Payer: Cigna Medicare |
$15.05
|
| Rate for Payer: Employer Direct Commercial |
$15.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Molina Medicare |
$15.05
|
| Rate for Payer: Multiplan Auto |
$280.15
|
| Rate for Payer: Multiplan Commercial |
$280.15
|
| Rate for Payer: Multiplan Workers Comp |
$280.15
|
| Rate for Payer: Parkland Medicaid |
$15.05
|
| Rate for Payer: Scott and White EPO/PPO |
$18.81
|
| Rate for Payer: Scott and White Medicare |
$15.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.05
|
| Rate for Payer: Superior Health Plan EPO |
$15.05
|
| Rate for Payer: Superior Health Plan Medicare |
$15.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.05
|
| Rate for Payer: Universal American Medicare |
$15.05
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: Wellmed Medicare |
$15.05
|
|
|
.HCG Urine (POCT)
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1602598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Amerigroup Medicare |
$8.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.05
|
| Rate for Payer: BCBS of TX Medicare |
$8.61
|
| Rate for Payer: BCBS of TX PPO |
$19.03
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cigna Medicaid |
$8.61
|
| Rate for Payer: Cigna Medicare |
$8.61
|
| Rate for Payer: Employer Direct Commercial |
$8.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Molina Medicare |
$8.61
|
| Rate for Payer: Multiplan Auto |
$280.15
|
| Rate for Payer: Multiplan Commercial |
$280.15
|
| Rate for Payer: Multiplan Workers Comp |
$280.15
|
| Rate for Payer: Parkland Medicaid |
$8.61
|
| Rate for Payer: Scott and White EPO/PPO |
$10.76
|
| Rate for Payer: Scott and White Medicare |
$8.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.61
|
| Rate for Payer: Superior Health Plan EPO |
$8.61
|
| Rate for Payer: Superior Health Plan Medicare |
$8.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.61
|
| Rate for Payer: Universal American Medicare |
$8.61
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: Wellmed Medicare |
$8.61
|
|
|
.HCG Urine (POCT)
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1602598
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$379.28
|
|
|
.HCV Ab Verification 144075 SO
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
1703560
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.49
|
| Rate for Payer: Amerigroup Medicare |
$15.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.67
|
| Rate for Payer: BCBS of TX Medicare |
$15.49
|
| Rate for Payer: BCBS of TX PPO |
$34.23
|
| Rate for Payer: Cash Price |
$313.28
|
| Rate for Payer: Cash Price |
$313.28
|
| Rate for Payer: Cigna Medicaid |
$15.49
|
| Rate for Payer: Cigna Medicare |
$15.49
|
| Rate for Payer: Employer Direct Commercial |
$15.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.49
|
| Rate for Payer: Molina Medicare |
$15.49
|
| Rate for Payer: Multiplan Auto |
$231.40
|
| Rate for Payer: Multiplan Commercial |
$231.40
|
| Rate for Payer: Multiplan Workers Comp |
$231.40
|
| Rate for Payer: Parkland Medicaid |
$15.49
|
| Rate for Payer: Scott and White EPO/PPO |
$19.36
|
| Rate for Payer: Scott and White Medicare |
$15.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.49
|
| Rate for Payer: Superior Health Plan EPO |
$15.49
|
| Rate for Payer: Superior Health Plan Medicare |
$15.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.49
|
| Rate for Payer: Universal American Medicare |
$15.49
|
| Rate for Payer: Wellcare Medicare |
$15.49
|
| Rate for Payer: Wellmed Medicare |
$15.49
|
|
|
.HCV Ab Verification 144075 SO
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
1703560
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$313.28
|
|
|
HCV Antibody RFX to Qual NAA SO
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1602895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Amerigroup Medicare |
$14.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.25
|
| Rate for Payer: BCBS of TX Medicare |
$14.27
|
| Rate for Payer: BCBS of TX PPO |
$31.54
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Medicaid |
$14.27
|
| Rate for Payer: Cigna Medicare |
$14.27
|
| Rate for Payer: Employer Direct Commercial |
$14.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Molina Medicare |
$14.27
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Parkland Medicaid |
$14.27
|
| Rate for Payer: Scott and White EPO/PPO |
$17.84
|
| Rate for Payer: Scott and White Medicare |
$14.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.27
|
| Rate for Payer: Superior Health Plan EPO |
$14.27
|
| Rate for Payer: Superior Health Plan Medicare |
$14.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Universal American Medicare |
$14.27
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: Wellmed Medicare |
$14.27
|
|
|
HCV Antibody SO
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1602895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Amerigroup Medicare |
$14.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.25
|
| Rate for Payer: BCBS of TX Medicare |
$14.27
|
| Rate for Payer: BCBS of TX PPO |
$31.54
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cigna Medicaid |
$14.27
|
| Rate for Payer: Cigna Medicare |
$14.27
|
| Rate for Payer: Employer Direct Commercial |
$14.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Molina Medicare |
$14.27
|
| Rate for Payer: Multiplan Auto |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$244.40
|
| Rate for Payer: Multiplan Workers Comp |
$244.40
|
| Rate for Payer: Parkland Medicaid |
$14.27
|
| Rate for Payer: Scott and White EPO/PPO |
$17.84
|
| Rate for Payer: Scott and White Medicare |
$14.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.27
|
| Rate for Payer: Superior Health Plan EPO |
$14.27
|
| Rate for Payer: Superior Health Plan Medicare |
$14.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.27
|
| Rate for Payer: Universal American Medicare |
$14.27
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: Wellmed Medicare |
$14.27
|
|
|
HCV RT-PCR, Quant (Non-Graph) SO
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
1703677
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$226.16
|
|
|
HCV RT-PCR, Quant (Non-Graph) SO
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
1703677
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: Aetna Medicare |
$64.26
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$42.84
|
| Rate for Payer: Amerigroup Medicare |
$42.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.82
|
| Rate for Payer: BCBS of TX Medicare |
$42.84
|
| Rate for Payer: BCBS of TX PPO |
$94.68
|
| Rate for Payer: Cash Price |
$226.16
|
| Rate for Payer: Cash Price |
$226.16
|
| Rate for Payer: Cigna Medicaid |
$42.84
|
| Rate for Payer: Cigna Medicare |
$42.84
|
| Rate for Payer: Employer Direct Commercial |
$42.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$42.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$42.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$42.84
|
| Rate for Payer: Molina Medicare |
$42.84
|
| Rate for Payer: Multiplan Auto |
$167.05
|
| Rate for Payer: Multiplan Commercial |
$167.05
|
| Rate for Payer: Multiplan Workers Comp |
$167.05
|
| Rate for Payer: Parkland Medicaid |
$42.84
|
| Rate for Payer: Scott and White EPO/PPO |
$53.55
|
| Rate for Payer: Scott and White Medicare |
$42.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$42.84
|
| Rate for Payer: Superior Health Plan EPO |
$42.84
|
| Rate for Payer: Superior Health Plan Medicare |
$42.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$42.84
|
| Rate for Payer: Universal American Medicare |
$42.84
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: Wellmed Medicare |
$42.84
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$22,925.40
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$9,159.00 |
| Max. Negotiated Rate |
$22,925.40 |
| Rate for Payer: Aetna Commercial |
$13,574.25
|
| Rate for Payer: Aetna Medicare |
$17,197.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,465.15
|
| Rate for Payer: Amerigroup Medicare |
$11,465.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,159.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,108.40
|
| Rate for Payer: BCBS of TX Medicare |
$11,465.15
|
| Rate for Payer: BCBS of TX PPO |
$12,343.15
|
| Rate for Payer: Cigna Commercial |
$15,541.01
|
| Rate for Payer: Cigna Medicare |
$11,465.15
|
| Rate for Payer: Employer Direct Commercial |
$11,465.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,465.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,465.15
|
| Rate for Payer: Molina Medicare |
$11,465.15
|
| Rate for Payer: Multiplan Auto |
$22,925.40
|
| Rate for Payer: Multiplan Commercial |
$22,925.40
|
| Rate for Payer: Multiplan Workers Comp |
$22,925.40
|
| Rate for Payer: Scott and White EPO/PPO |
$10,557.75
|
| Rate for Payer: Scott and White Medicare |
$11,465.15
|
| Rate for Payer: Superior Health Plan EPO |
$11,465.15
|
| Rate for Payer: Superior Health Plan Medicare |
$11,465.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,465.15
|
| Rate for Payer: Universal American Medicare |
$11,465.15
|
| Rate for Payer: Wellcare Medicare |
$11,465.15
|
| Rate for Payer: Wellmed Medicare |
$11,465.15
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$16,005.60
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$6,368.30 |
| Max. Negotiated Rate |
$16,005.60 |
| Rate for Payer: Aetna Commercial |
$9,477.00
|
| Rate for Payer: Aetna Medicare |
$13,299.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,866.18
|
| Rate for Payer: Amerigroup Medicare |
$8,866.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,368.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,063.27
|
| Rate for Payer: BCBS of TX Medicare |
$8,866.18
|
| Rate for Payer: BCBS of TX PPO |
$8,959.53
|
| Rate for Payer: Cigna Commercial |
$10,850.11
|
| Rate for Payer: Cigna Medicare |
$8,866.18
|
| Rate for Payer: Employer Direct Commercial |
$8,866.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,866.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,866.18
|
| Rate for Payer: Molina Medicare |
$8,866.18
|
| Rate for Payer: Multiplan Auto |
$16,005.60
|
| Rate for Payer: Multiplan Commercial |
$16,005.60
|
| Rate for Payer: Multiplan Workers Comp |
$16,005.60
|
| Rate for Payer: Scott and White EPO/PPO |
$7,371.00
|
| Rate for Payer: Scott and White Medicare |
$8,866.18
|
| Rate for Payer: Superior Health Plan EPO |
$8,866.18
|
| Rate for Payer: Superior Health Plan Medicare |
$8,866.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,866.18
|
| Rate for Payer: Universal American Medicare |
$8,866.18
|
| Rate for Payer: Wellcare Medicare |
$8,866.18
|
| Rate for Payer: Wellmed Medicare |
$8,866.18
|
|
|
HEADLESS SCREW 3.0MM X 24MM
|
Facility
|
IP
|
$2,409.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$1,204.82 |
| Rate for Payer: Aetna Commercial |
$722.89
|
| Rate for Payer: Cash Price |
$2,120.48
|
| Rate for Payer: Cigna Commercial |
$602.41
|
| Rate for Payer: Multiplan Auto |
$1,204.82
|
| Rate for Payer: Multiplan Commercial |
$1,204.82
|
| Rate for Payer: Multiplan Workers Comp |
$1,204.82
|
| Rate for Payer: Scott and White EPO/PPO |
$1,204.82
|
|
|
HEADLESS SCREW 3.0MM X 24MM
|
Facility
|
OP
|
$2,409.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.87 |
| Max. Negotiated Rate |
$1,204.82 |
| Rate for Payer: Aetna Commercial |
$722.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$722.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$867.47
|
| Rate for Payer: BCBS of TX PPO |
$963.86
|
| Rate for Payer: Cash Price |
$2,120.48
|
| Rate for Payer: Multiplan Auto |
$1,204.82
|
| Rate for Payer: Multiplan Commercial |
$1,204.82
|
| Rate for Payer: Multiplan Workers Comp |
$1,204.82
|
| Rate for Payer: Scott and White EPO/PPO |
$1,204.82
|
| Rate for Payer: Superior Health Plan EPO |
$327.71
|
|
|
HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$16,273.50
|
|
|
Service Code
|
MSDRG 292
|
| Min. Negotiated Rate |
$7,494.38 |
| Max. Negotiated Rate |
$16,273.50 |
| Rate for Payer: Aetna Commercial |
$9,635.62
|
| Rate for Payer: Aetna Medicare |
$13,450.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,966.81
|
| Rate for Payer: Amerigroup Medicare |
$8,966.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,233.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,491.42
|
| Rate for Payer: BCBS of TX Medicare |
$8,966.81
|
| Rate for Payer: BCBS of TX PPO |
$10,546.43
|
| Rate for Payer: Cigna Commercial |
$11,031.72
|
| Rate for Payer: Cigna Medicare |
$8,966.81
|
| Rate for Payer: Employer Direct Commercial |
$8,966.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,966.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,966.81
|
| Rate for Payer: Molina Medicare |
$8,966.81
|
| Rate for Payer: Multiplan Auto |
$16,273.50
|
| Rate for Payer: Multiplan Commercial |
$16,273.50
|
| Rate for Payer: Multiplan Workers Comp |
$16,273.50
|
| Rate for Payer: Scott and White EPO/PPO |
$7,494.38
|
| Rate for Payer: Scott and White Medicare |
$8,966.81
|
| Rate for Payer: Superior Health Plan EPO |
$8,966.81
|
| Rate for Payer: Superior Health Plan Medicare |
$8,966.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,966.81
|
| Rate for Payer: Universal American Medicare |
$8,966.81
|
| Rate for Payer: Wellcare Medicare |
$8,966.81
|
| Rate for Payer: Wellmed Medicare |
$8,966.81
|
|
|
HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$24,394.10
|
|
|
Service Code
|
MSDRG 291
|
| Min. Negotiated Rate |
$11,234.12 |
| Max. Negotiated Rate |
$24,394.10 |
| Rate for Payer: Aetna Commercial |
$14,443.88
|
| Rate for Payer: Aetna Medicare |
$18,025.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,016.77
|
| Rate for Payer: Amerigroup Medicare |
$12,016.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,724.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,883.18
|
| Rate for Payer: BCBS of TX Medicare |
$12,016.77
|
| Rate for Payer: BCBS of TX PPO |
$15,426.36
|
| Rate for Payer: Cigna Commercial |
$16,536.63
|
| Rate for Payer: Cigna Medicare |
$12,016.77
|
| Rate for Payer: Employer Direct Commercial |
$12,016.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,016.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,016.77
|
| Rate for Payer: Molina Medicare |
$12,016.77
|
| Rate for Payer: Multiplan Auto |
$24,394.10
|
| Rate for Payer: Multiplan Commercial |
$24,394.10
|
| Rate for Payer: Multiplan Workers Comp |
$24,394.10
|
| Rate for Payer: Scott and White EPO/PPO |
$11,234.12
|
| Rate for Payer: Scott and White Medicare |
$12,016.77
|
| Rate for Payer: Superior Health Plan EPO |
$12,016.77
|
| Rate for Payer: Superior Health Plan Medicare |
$12,016.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,016.77
|
| Rate for Payer: Universal American Medicare |
$12,016.77
|
| Rate for Payer: Wellcare Medicare |
$12,016.77
|
| Rate for Payer: Wellmed Medicare |
$12,016.77
|
|
|
HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$10,668.50
|
|
|
Service Code
|
MSDRG 293
|
| Min. Negotiated Rate |
$4,913.12 |
| Max. Negotiated Rate |
$10,668.50 |
| Rate for Payer: Aetna Commercial |
$6,316.88
|
| Rate for Payer: Aetna Medicare |
$10,292.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,861.69
|
| Rate for Payer: Amerigroup Medicare |
$6,861.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,691.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,868.33
|
| Rate for Payer: BCBS of TX Medicare |
$6,861.69
|
| Rate for Payer: BCBS of TX PPO |
$7,631.77
|
| Rate for Payer: Cigna Commercial |
$7,232.12
|
| Rate for Payer: Cigna Medicare |
$6,861.69
|
| Rate for Payer: Employer Direct Commercial |
$6,861.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,861.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,861.69
|
| Rate for Payer: Molina Medicare |
$6,861.69
|
| Rate for Payer: Multiplan Auto |
$10,668.50
|
| Rate for Payer: Multiplan Commercial |
$10,668.50
|
| Rate for Payer: Multiplan Workers Comp |
$10,668.50
|
| Rate for Payer: Scott and White EPO/PPO |
$4,913.12
|
| Rate for Payer: Scott and White Medicare |
$6,861.69
|
| Rate for Payer: Superior Health Plan EPO |
$6,861.69
|
| Rate for Payer: Superior Health Plan Medicare |
$6,861.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,861.69
|
| Rate for Payer: Universal American Medicare |
$6,861.69
|
| Rate for Payer: Wellcare Medicare |
$6,861.69
|
| Rate for Payer: Wellmed Medicare |
$6,861.69
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$514,873.40
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$196,232.03 |
| Max. Negotiated Rate |
$514,873.40 |
| Rate for Payer: Aetna Commercial |
$304,859.25
|
| Rate for Payer: Aetna Medicare |
$294,348.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196,232.03
|
| Rate for Payer: Amerigroup Medicare |
$196,232.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$233,069.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$272,530.98
|
| Rate for Payer: BCBS of TX Medicare |
$196,232.03
|
| Rate for Payer: BCBS of TX PPO |
$302,823.94
|
| Rate for Payer: Cigna Commercial |
$349,029.97
|
| Rate for Payer: Cigna Medicare |
$196,232.03
|
| Rate for Payer: Employer Direct Commercial |
$196,232.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196,232.03
|
| Rate for Payer: Molina Medicare |
$196,232.03
|
| Rate for Payer: Multiplan Auto |
$514,873.40
|
| Rate for Payer: Multiplan Commercial |
$514,873.40
|
| Rate for Payer: Multiplan Workers Comp |
$514,873.40
|
| Rate for Payer: Scott and White EPO/PPO |
$237,112.75
|
| Rate for Payer: Scott and White Medicare |
$196,232.03
|
| Rate for Payer: Superior Health Plan EPO |
$196,232.03
|
| Rate for Payer: Superior Health Plan Medicare |
$196,232.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196,232.03
|
| Rate for Payer: Universal American Medicare |
$196,232.03
|
| Rate for Payer: Wellcare Medicare |
$196,232.03
|
| Rate for Payer: Wellmed Medicare |
$196,232.03
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$232,637.90
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$90,229.41 |
| Max. Negotiated Rate |
$232,637.90 |
| Rate for Payer: Aetna Commercial |
$137,746.12
|
| Rate for Payer: Aetna Medicare |
$135,344.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$90,229.41
|
| Rate for Payer: Amerigroup Medicare |
$90,229.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$138,932.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$138,508.84
|
| Rate for Payer: BCBS of TX Medicare |
$90,229.41
|
| Rate for Payer: BCBS of TX PPO |
$153,904.68
|
| Rate for Payer: Cigna Commercial |
$157,704.01
|
| Rate for Payer: Cigna Medicare |
$90,229.41
|
| Rate for Payer: Employer Direct Commercial |
$90,229.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$90,229.41
|
| Rate for Payer: Molina Medicare |
$90,229.41
|
| Rate for Payer: Multiplan Auto |
$232,637.90
|
| Rate for Payer: Multiplan Commercial |
$232,637.90
|
| Rate for Payer: Multiplan Workers Comp |
$232,637.90
|
| Rate for Payer: Scott and White EPO/PPO |
$107,135.88
|
| Rate for Payer: Scott and White Medicare |
$90,229.41
|
| Rate for Payer: Superior Health Plan EPO |
$90,229.41
|
| Rate for Payer: Superior Health Plan Medicare |
$90,229.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$90,229.41
|
| Rate for Payer: Universal American Medicare |
$90,229.41
|
| Rate for Payer: Wellcare Medicare |
$90,229.41
|
| Rate for Payer: Wellmed Medicare |
$90,229.41
|
|
|
HEEL/ELBW PROTCT -- DHF
|
Facility
|
OP
|
$132.02
|
|
| Hospital Charge Code |
81142952
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$85.81 |
| Rate for Payer: Aetna Commercial |
$72.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$47.53
|
| Rate for Payer: BCBS of TX PPO |
$52.81
|
| Rate for Payer: Cash Price |
$116.18
|
| Rate for Payer: Multiplan Auto |
$85.81
|
| Rate for Payer: Multiplan Commercial |
$85.81
|
| Rate for Payer: Multiplan Workers Comp |
$85.81
|
| Rate for Payer: Scott and White EPO/PPO |
$66.01
|
| Rate for Payer: Superior Health Plan EPO |
$17.95
|
|
|
HEEL/ELBW PROTCT -- DHF
|
Facility
|
IP
|
$132.02
|
|
| Hospital Charge Code |
81142952
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$116.18
|
|
|
Helicobacter pylori, IgA SO
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
1604990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Amerigroup Medicare |
$16.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.36
|
| Rate for Payer: BCBS of TX Medicare |
$16.85
|
| Rate for Payer: BCBS of TX PPO |
$37.24
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cigna Medicaid |
$16.85
|
| Rate for Payer: Cigna Medicare |
$16.85
|
| Rate for Payer: Employer Direct Commercial |
$16.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Molina Medicare |
$16.85
|
| Rate for Payer: Multiplan Auto |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: Multiplan Workers Comp |
$140.40
|
| Rate for Payer: Parkland Medicaid |
$16.85
|
| Rate for Payer: Scott and White EPO/PPO |
$21.06
|
| Rate for Payer: Scott and White Medicare |
$16.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.85
|
| Rate for Payer: Superior Health Plan EPO |
$16.85
|
| Rate for Payer: Superior Health Plan Medicare |
$16.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.85
|
| Rate for Payer: Universal American Medicare |
$16.85
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: Wellmed Medicare |
$16.85
|
|
