|
ibuprofen 100 mg/5 mL Oral Susp 480 mL
|
Facility
|
IP
|
$81.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627059
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$55.73
|
|
|
ibuprofen 100 mg/5 mL Oral Susp 5 mL
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627112
|
|
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
|
|
|
ibuprofen 100 mg/5 mL Oral Susp 5 mL
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627112
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
ibuprofen 400 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627436
|
|
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
|
|
|
ibuprofen 400 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627436
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
ibuprofen 600 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627650
|
|
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
|
|
|
ibuprofen 600 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77627650
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
ibuprofen 800 mg / 200 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
79495460
|
|
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
|
|
|
ibuprofen 800 mg / 200 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
79495460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3.50
|
| Rate for Payer: BCBS of TX PPO |
$3.88
|
| 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
|
|
|
I&D Abscess, Comp Or Mult
|
Facility
|
OP
|
$1,574.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
7150097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,023.10 |
| Rate for Payer: Aetna Commercial |
$865.70
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.98
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cash Price |
$1,385.12
|
| Rate for Payer: Cash Price |
$1,385.12
|
| Rate for Payer: Cash Price |
$1,385.12
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$98.28
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$98.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$1,023.10
|
| Rate for Payer: Multiplan Commercial |
$1,023.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,023.10
|
| Rate for Payer: Parkland Medicaid |
$98.28
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98.28
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
I&D Abscess, Simple
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
7150089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$533.65 |
| Rate for Payer: Aetna Commercial |
$451.55
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.89
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$65.06
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$65.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$533.65
|
| Rate for Payer: Multiplan Commercial |
$533.65
|
| Rate for Payer: Multiplan Workers Comp |
$533.65
|
| Rate for Payer: Parkland Medicaid |
$65.06
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$65.06
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
I&D Hematoma/Seroma
|
Facility
|
OP
|
$3,948.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
7150105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,358.84 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$355.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cash Price |
$3,474.24
|
| Rate for Payer: Cash Price |
$3,474.24
|
| Rate for Payer: Cash Price |
$3,474.24
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$90.81
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$90.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$2,566.20
|
| Rate for Payer: Multiplan Commercial |
$2,566.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,566.20
|
| Rate for Payer: Parkland Medicaid |
$90.81
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$90.81
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
IFE and PE SO
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
1602044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$271.05 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Amerigroup Medicare |
$22.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.23
|
| Rate for Payer: BCBS of TX Medicare |
$22.34
|
| Rate for Payer: BCBS of TX PPO |
$49.37
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cigna Medicaid |
$22.34
|
| Rate for Payer: Cigna Medicare |
$22.34
|
| Rate for Payer: Employer Direct Commercial |
$22.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$22.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Molina Medicare |
$22.34
|
| Rate for Payer: Multiplan Auto |
$271.05
|
| Rate for Payer: Multiplan Commercial |
$271.05
|
| Rate for Payer: Multiplan Workers Comp |
$271.05
|
| Rate for Payer: Parkland Medicaid |
$22.34
|
| Rate for Payer: Scott and White EPO/PPO |
$27.92
|
| Rate for Payer: Scott and White Medicare |
$22.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.34
|
| Rate for Payer: Superior Health Plan EPO |
$22.34
|
| Rate for Payer: Superior Health Plan Medicare |
$22.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Universal American Medicare |
$22.34
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: Wellmed Medicare |
$22.34
|
|
|
.IFE Reflex, Random Urine SO
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
1605849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$297.05 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Amerigroup Medicare |
$29.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58.11
|
| Rate for Payer: BCBS of TX Medicare |
$29.35
|
| Rate for Payer: BCBS of TX PPO |
$64.86
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cigna Medicaid |
$29.35
|
| Rate for Payer: Cigna Medicare |
$29.35
|
| Rate for Payer: Employer Direct Commercial |
$29.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$29.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$29.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Molina Medicare |
$29.35
|
| Rate for Payer: Multiplan Auto |
$297.05
|
| Rate for Payer: Multiplan Commercial |
$297.05
|
| Rate for Payer: Multiplan Workers Comp |
$297.05
|
| Rate for Payer: Parkland Medicaid |
$29.35
|
| Rate for Payer: Scott and White EPO/PPO |
$36.69
|
| Rate for Payer: Scott and White Medicare |
$29.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$29.35
|
| Rate for Payer: Superior Health Plan EPO |
$29.35
|
| Rate for Payer: Superior Health Plan Medicare |
$29.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29.35
|
| Rate for Payer: Universal American Medicare |
$29.35
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: Wellmed Medicare |
$29.35
|
|
|
IGF-1 SO
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
1707140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Aetna Medicare |
$31.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.29
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21.26
|
| Rate for Payer: Amerigroup Medicare |
$21.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$42.09
|
| Rate for Payer: BCBS of TX Medicare |
$21.26
|
| Rate for Payer: BCBS of TX PPO |
$46.98
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cigna Medicaid |
$21.26
|
| Rate for Payer: Cigna Medicare |
$21.26
|
| Rate for Payer: Employer Direct Commercial |
$21.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$21.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$21.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21.26
|
| Rate for Payer: Molina Medicare |
$21.26
|
| Rate for Payer: Multiplan Auto |
$37.05
|
| Rate for Payer: Multiplan Commercial |
$37.05
|
| Rate for Payer: Multiplan Workers Comp |
$37.05
|
| Rate for Payer: Parkland Medicaid |
$21.26
|
| Rate for Payer: Scott and White EPO/PPO |
$26.58
|
| Rate for Payer: Scott and White Medicare |
$21.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21.26
|
| Rate for Payer: Superior Health Plan EPO |
$21.26
|
| Rate for Payer: Superior Health Plan Medicare |
$21.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21.26
|
| Rate for Payer: Universal American Medicare |
$21.26
|
| Rate for Payer: Wellcare Medicare |
$21.26
|
| Rate for Payer: Wellmed Medicare |
$21.26
|
|
|
IGF-1 SO
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
1707140
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$50.16
|
|
|
IgG, Subclasses(1-4) SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1602069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.41
|
| Rate for Payer: BCBS of TX Medicare |
$9.30
|
| Rate for Payer: BCBS of TX PPO |
$20.55
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$9.30
|
| Rate for Payer: Cigna Medicare |
$9.30
|
| Rate for Payer: Employer Direct Commercial |
$9.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Molina Medicare |
$9.30
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$9.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11.62
|
| Rate for Payer: Scott and White Medicare |
$9.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.30
|
| Rate for Payer: Superior Health Plan EPO |
$9.30
|
| Rate for Payer: Superior Health Plan Medicare |
$9.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.30
|
| Rate for Payer: Universal American Medicare |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: Wellmed Medicare |
$9.30
|
|
|
illuminator surg 60mm
|
Facility
|
IP
|
$4,199.50
|
|
| Hospital Charge Code |
8672529
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$3,695.56
|
|
|
illuminator surg 60mm
|
Facility
|
OP
|
$4,199.50
|
|
| Hospital Charge Code |
8672529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.96 |
| Max. Negotiated Rate |
$2,729.68 |
| Rate for Payer: Aetna Commercial |
$2,309.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$377.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,259.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,511.82
|
| Rate for Payer: BCBS of TX PPO |
$1,679.80
|
| Rate for Payer: Cash Price |
$3,695.56
|
| Rate for Payer: Multiplan Auto |
$2,729.68
|
| Rate for Payer: Multiplan Commercial |
$2,729.68
|
| Rate for Payer: Multiplan Workers Comp |
$2,729.68
|
| Rate for Payer: Scott and White EPO/PPO |
$2,099.75
|
| Rate for Payer: Superior Health Plan EPO |
$571.13
|
|
|
Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
|
Facility
|
OP
|
$13,509.82
|
|
|
Service Code
|
CPT 19340
|
| Hospital Charge Code |
36019340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$13,509.82 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,945.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Amerigroup Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,746.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,474.58
|
| Rate for Payer: BCBS of TX Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX PPO |
$13,197.97
|
| Rate for Payer: Cigna Commercial |
$13,509.82
|
| Rate for Payer: Cigna Medicaid |
$1,845.21
|
| Rate for Payer: Cigna Medicare |
$5,963.84
|
| Rate for Payer: Employer Direct Commercial |
$5,963.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,963.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Molina Medicare |
$5,963.84
|
| 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 |
$1,845.21
|
| Rate for Payer: Scott and White EPO/PPO |
$131.54
|
| Rate for Payer: Scott and White Medicare |
$5,963.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Superior Health Plan EPO |
$5,963.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,963.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Universal American Medicare |
$5,963.84
|
| Rate for Payer: Wellcare Medicare |
$5,963.84
|
| Rate for Payer: Wellmed Medicare |
$5,963.84
|
|
|
immobilizer shoulder mini kahuna
|
Facility
|
IP
|
$352.76
|
|
| Hospital Charge Code |
144898
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$310.43
|
|
|
immobilizer shoulder mini kahuna
|
Facility
|
OP
|
$352.76
|
|
| Hospital Charge Code |
144898
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$229.29 |
| Rate for Payer: Aetna Commercial |
$194.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$126.99
|
| Rate for Payer: BCBS of TX PPO |
$141.10
|
| Rate for Payer: Cash Price |
$310.43
|
| Rate for Payer: Multiplan Auto |
$229.29
|
| Rate for Payer: Multiplan Commercial |
$229.29
|
| Rate for Payer: Multiplan Workers Comp |
$229.29
|
| Rate for Payer: Scott and White EPO/PPO |
$176.38
|
| Rate for Payer: Superior Health Plan EPO |
$47.98
|
|
|
IMMUNOASSAY ANALYTE QUANTITAVE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1703461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Amerigroup Medicare |
$18.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36.43
|
| Rate for Payer: BCBS of TX Medicare |
$18.40
|
| Rate for Payer: BCBS of TX PPO |
$40.66
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cigna Medicaid |
$18.40
|
| Rate for Payer: Cigna Medicare |
$18.40
|
| Rate for Payer: Employer Direct Commercial |
$18.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Molina Medicare |
$18.40
|
| Rate for Payer: Multiplan Auto |
$200.85
|
| Rate for Payer: Multiplan Commercial |
$200.85
|
| Rate for Payer: Multiplan Workers Comp |
$200.85
|
| Rate for Payer: Parkland Medicaid |
$18.40
|
| Rate for Payer: Scott and White EPO/PPO |
$23.00
|
| Rate for Payer: Scott and White Medicare |
$18.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.40
|
| Rate for Payer: Superior Health Plan EPO |
$18.40
|
| Rate for Payer: Superior Health Plan Medicare |
$18.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Universal American Medicare |
$18.40
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: Wellmed Medicare |
$18.40
|
|
|
IMMUNOASSAY QUANTITATIVE NOS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1706332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$144.30 |
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$25.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.19
|
| Rate for Payer: BCBS of TX Medicare |
$17.27
|
| Rate for Payer: BCBS of TX PPO |
$38.17
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cash Price |
$195.36
|
| Rate for Payer: Cigna Medicaid |
$17.27
|
| Rate for Payer: Cigna Medicare |
$17.27
|
| Rate for Payer: Employer Direct Commercial |
$17.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Molina Medicare |
$17.27
|
| Rate for Payer: Multiplan Auto |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$144.30
|
| Rate for Payer: Multiplan Workers Comp |
$144.30
|
| Rate for Payer: Parkland Medicaid |
$17.27
|
| Rate for Payer: Scott and White EPO/PPO |
$21.59
|
| Rate for Payer: Scott and White Medicare |
$17.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.27
|
| Rate for Payer: Superior Health Plan EPO |
$17.27
|
| Rate for Payer: Superior Health Plan Medicare |
$17.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.27
|
| Rate for Payer: Universal American Medicare |
$17.27
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: Wellmed Medicare |
$17.27
|
|
|
.Immunofixation Elect 001686 SO
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
1602044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$271.05 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Amerigroup Medicare |
$22.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.23
|
| Rate for Payer: BCBS of TX Medicare |
$22.34
|
| Rate for Payer: BCBS of TX PPO |
$49.37
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cash Price |
$366.96
|
| Rate for Payer: Cigna Medicaid |
$22.34
|
| Rate for Payer: Cigna Medicare |
$22.34
|
| Rate for Payer: Employer Direct Commercial |
$22.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$22.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Molina Medicare |
$22.34
|
| Rate for Payer: Multiplan Auto |
$271.05
|
| Rate for Payer: Multiplan Commercial |
$271.05
|
| Rate for Payer: Multiplan Workers Comp |
$271.05
|
| Rate for Payer: Parkland Medicaid |
$22.34
|
| Rate for Payer: Scott and White EPO/PPO |
$27.92
|
| Rate for Payer: Scott and White Medicare |
$22.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.34
|
| Rate for Payer: Superior Health Plan EPO |
$22.34
|
| Rate for Payer: Superior Health Plan Medicare |
$22.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22.34
|
| Rate for Payer: Universal American Medicare |
$22.34
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: Wellmed Medicare |
$22.34
|
|
