|
Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
36010121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| 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 |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| 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 |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| 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 |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| 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
|
|
|
Incision and removal of foreign body, subcutaneous tissues simple
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
36010120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$86.38
|
| 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 |
$86.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| 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 |
$86.38
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$86.38
|
| 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
|
|
|
Incision, bone cortex (eg, osteomyelitis or bone abscess), foot
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
36028005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Incision, extensor tendon sheath, wrist (eg, de Quervains disease)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
36025000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pul
|
Facility
|
OP
|
$73,379.22
|
|
|
Service Code
|
CPT 64568
|
| Hospital Charge Code |
36064568
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.38 |
| Max. Negotiated Rate |
$73,379.22 |
| Rate for Payer: Aetna Medicare |
$42,598.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,861.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Amerigroup Medicare |
$28,398.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,628.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58,237.48
|
| Rate for Payer: BCBS of TX Medicare |
$28,398.70
|
| Rate for Payer: BCBS of TX PPO |
$73,379.22
|
| Rate for Payer: Cigna Commercial |
$64,331.26
|
| Rate for Payer: Cigna Medicaid |
$19,861.72
|
| Rate for Payer: Cigna Medicare |
$28,398.70
|
| Rate for Payer: Employer Direct Commercial |
$28,398.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,398.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,861.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Molina Medicare |
$28,398.70
|
| 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 |
$19,861.72
|
| Rate for Payer: Scott and White EPO/PPO |
$626.38
|
| Rate for Payer: Scott and White Medicare |
$28,398.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,861.72
|
| Rate for Payer: Superior Health Plan EPO |
$28,398.70
|
| Rate for Payer: Superior Health Plan Medicare |
$28,398.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Universal American Medicare |
$28,398.70
|
| Rate for Payer: Wellcare Medicare |
$28,398.70
|
| Rate for Payer: Wellmed Medicare |
$28,398.70
|
|
|
INDEFLATOR -- DHF
|
Facility
|
IP
|
$1,917.67
|
|
| Hospital Charge Code |
80811854
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,687.55
|
|
|
INDEFLATOR -- DHF
|
Facility
|
OP
|
$1,917.67
|
|
| Hospital Charge Code |
80811854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.59 |
| Max. Negotiated Rate |
$1,246.49 |
| Rate for Payer: Aetna Commercial |
$1,054.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$172.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$575.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$690.36
|
| Rate for Payer: BCBS of TX PPO |
$767.07
|
| Rate for Payer: Cash Price |
$1,687.55
|
| Rate for Payer: Multiplan Auto |
$1,246.49
|
| Rate for Payer: Multiplan Commercial |
$1,246.49
|
| Rate for Payer: Multiplan Workers Comp |
$1,246.49
|
| Rate for Payer: Scott and White EPO/PPO |
$958.84
|
| Rate for Payer: Superior Health Plan EPO |
$260.80
|
|
|
INDIGO SYSTEM SEP8
|
Facility
|
OP
|
$8,421.70
|
|
| Hospital Charge Code |
8612533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.95 |
| Max. Negotiated Rate |
$4,210.85 |
| Rate for Payer: Aetna Commercial |
$2,526.51
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$757.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,526.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,031.81
|
| Rate for Payer: BCBS of TX PPO |
$3,368.68
|
| Rate for Payer: Cash Price |
$7,411.10
|
| Rate for Payer: Multiplan Auto |
$4,210.85
|
| Rate for Payer: Multiplan Commercial |
$4,210.85
|
| Rate for Payer: Multiplan Workers Comp |
$4,210.85
|
| Rate for Payer: Scott and White EPO/PPO |
$4,210.85
|
| Rate for Payer: Superior Health Plan EPO |
$1,145.35
|
|
|
INDIGO SYSTEM SEP8
|
Facility
|
IP
|
$8,421.70
|
|
| Hospital Charge Code |
8612533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,105.42 |
| Max. Negotiated Rate |
$4,210.85 |
| Rate for Payer: Aetna Commercial |
$2,526.51
|
| Rate for Payer: Cash Price |
$7,411.10
|
| Rate for Payer: Cigna Commercial |
$2,105.42
|
| Rate for Payer: Multiplan Auto |
$4,210.85
|
| Rate for Payer: Multiplan Commercial |
$4,210.85
|
| Rate for Payer: Multiplan Workers Comp |
$4,210.85
|
| Rate for Payer: Scott and White EPO/PPO |
$4,210.85
|
|
|
indocyanine green 25 mg Inj
|
Facility
|
OP
|
$328.05
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
77632274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$213.23 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.24
|
| Rate for Payer: BCBS of TX PPO |
$0.27
|
| Rate for Payer: Cash Price |
$223.07
|
| Rate for Payer: Cash Price |
$223.07
|
| Rate for Payer: Multiplan Auto |
$213.23
|
| Rate for Payer: Multiplan Commercial |
$213.23
|
| Rate for Payer: Multiplan Workers Comp |
$213.23
|
| Rate for Payer: Scott and White EPO/PPO |
$164.02
|
| Rate for Payer: Superior Health Plan EPO |
$44.61
|
|
|
indocyanine green 25 mg Inj
|
Facility
|
IP
|
$328.05
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
77632274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$164.02 |
| Rate for Payer: Cash Price |
$223.07
|
| Rate for Payer: Cigna Commercial |
$82.01
|
| Rate for Payer: Scott and White EPO/PPO |
$164.02
|
|
|
indomethacin 50 mg Cap
|
Facility
|
IP
|
$19.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77632484
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$13.06
|
|
|
indomethacin 50 mg Cap
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77632484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.91
|
| Rate for Payer: BCBS of TX PPO |
$7.68
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Multiplan Auto |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Multiplan Workers Comp |
$12.48
|
| Rate for Payer: Scott and White EPO/PPO |
$9.60
|
| Rate for Payer: Superior Health Plan EPO |
$2.61
|
|
|
Inf agent det by nucleic acid, nos, amp prob tech 8
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| 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: 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 |
$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 |
$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
|
|
|
INFECT AGNT DETECT HB E AG
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
1700384
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$18,859.40
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$8,685.25 |
| Max. Negotiated Rate |
$18,859.40 |
| Rate for Payer: Aetna Commercial |
$11,166.75
|
| Rate for Payer: Aetna Medicare |
$14,907.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,938.03
|
| Rate for Payer: Amerigroup Medicare |
$9,938.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,012.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,529.51
|
| Rate for Payer: BCBS of TX Medicare |
$9,938.03
|
| Rate for Payer: BCBS of TX PPO |
$11,699.91
|
| Rate for Payer: Cigna Commercial |
$12,784.69
|
| Rate for Payer: Cigna Medicare |
$9,938.03
|
| Rate for Payer: Employer Direct Commercial |
$9,938.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,938.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,938.03
|
| Rate for Payer: Molina Medicare |
$9,938.03
|
| Rate for Payer: Multiplan Auto |
$18,859.40
|
| Rate for Payer: Multiplan Commercial |
$18,859.40
|
| Rate for Payer: Multiplan Workers Comp |
$18,859.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8,685.25
|
| Rate for Payer: Scott and White Medicare |
$9,938.03
|
| Rate for Payer: Superior Health Plan EPO |
$9,938.03
|
| Rate for Payer: Superior Health Plan Medicare |
$9,938.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,938.03
|
| Rate for Payer: Universal American Medicare |
$9,938.03
|
| Rate for Payer: Wellcare Medicare |
$9,938.03
|
| Rate for Payer: Wellmed Medicare |
$9,938.03
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$28,340.40
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$12,405.50 |
| Max. Negotiated Rate |
$28,340.40 |
| Rate for Payer: Aetna Commercial |
$16,780.50
|
| Rate for Payer: Aetna Medicare |
$20,248.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,498.93
|
| Rate for Payer: Amerigroup Medicare |
$13,498.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,405.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,868.65
|
| Rate for Payer: BCBS of TX Medicare |
$13,498.93
|
| Rate for Payer: BCBS of TX PPO |
$16,521.36
|
| Rate for Payer: Cigna Commercial |
$19,211.81
|
| Rate for Payer: Cigna Medicare |
$13,498.93
|
| Rate for Payer: Employer Direct Commercial |
$13,498.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,498.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,498.93
|
| Rate for Payer: Molina Medicare |
$13,498.93
|
| Rate for Payer: Multiplan Auto |
$28,340.40
|
| Rate for Payer: Multiplan Commercial |
$28,340.40
|
| Rate for Payer: Multiplan Workers Comp |
$28,340.40
|
| Rate for Payer: Scott and White EPO/PPO |
$13,051.50
|
| Rate for Payer: Scott and White Medicare |
$13,498.93
|
| Rate for Payer: Superior Health Plan EPO |
$13,498.93
|
| Rate for Payer: Superior Health Plan Medicare |
$13,498.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,498.93
|
| Rate for Payer: Universal American Medicare |
$13,498.93
|
| Rate for Payer: Wellcare Medicare |
$13,498.93
|
| Rate for Payer: Wellmed Medicare |
$13,498.93
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$12,277.80
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$5,654.25 |
| Max. Negotiated Rate |
$12,277.80 |
| Rate for Payer: Aetna Commercial |
$7,269.75
|
| Rate for Payer: Aetna Medicare |
$11,199.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,466.10
|
| Rate for Payer: Amerigroup Medicare |
$7,466.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,056.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,333.71
|
| Rate for Payer: BCBS of TX Medicare |
$7,466.10
|
| Rate for Payer: BCBS of TX PPO |
$8,148.89
|
| Rate for Payer: Cigna Commercial |
$8,323.06
|
| Rate for Payer: Cigna Medicare |
$7,466.10
|
| Rate for Payer: Employer Direct Commercial |
$7,466.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,466.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,466.10
|
| Rate for Payer: Molina Medicare |
$7,466.10
|
| Rate for Payer: Multiplan Auto |
$12,277.80
|
| Rate for Payer: Multiplan Commercial |
$12,277.80
|
| Rate for Payer: Multiplan Workers Comp |
$12,277.80
|
| Rate for Payer: Scott and White EPO/PPO |
$5,654.25
|
| Rate for Payer: Scott and White Medicare |
$7,466.10
|
| Rate for Payer: Superior Health Plan EPO |
$7,466.10
|
| Rate for Payer: Superior Health Plan Medicare |
$7,466.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,466.10
|
| Rate for Payer: Universal American Medicare |
$7,466.10
|
| Rate for Payer: Wellcare Medicare |
$7,466.10
|
| Rate for Payer: Wellmed Medicare |
$7,466.10
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$38,725.80
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$17,399.49 |
| Max. Negotiated Rate |
$38,725.80 |
| Rate for Payer: Aetna Commercial |
$22,929.75
|
| Rate for Payer: Aetna Medicare |
$26,099.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,399.49
|
| Rate for Payer: Amerigroup Medicare |
$17,399.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,343.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22,730.69
|
| Rate for Payer: BCBS of TX Medicare |
$17,399.49
|
| Rate for Payer: BCBS of TX PPO |
$25,257.30
|
| Rate for Payer: Cigna Commercial |
$26,252.02
|
| Rate for Payer: Cigna Medicare |
$17,399.49
|
| Rate for Payer: Employer Direct Commercial |
$17,399.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,399.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,399.49
|
| Rate for Payer: Molina Medicare |
$17,399.49
|
| Rate for Payer: Multiplan Auto |
$38,725.80
|
| Rate for Payer: Multiplan Commercial |
$38,725.80
|
| Rate for Payer: Multiplan Workers Comp |
$38,725.80
|
| Rate for Payer: Scott and White EPO/PPO |
$17,834.25
|
| Rate for Payer: Scott and White Medicare |
$17,399.49
|
| Rate for Payer: Superior Health Plan EPO |
$17,399.49
|
| Rate for Payer: Superior Health Plan Medicare |
$17,399.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,399.49
|
| Rate for Payer: Universal American Medicare |
$17,399.49
|
| Rate for Payer: Wellcare Medicare |
$17,399.49
|
| Rate for Payer: Wellmed Medicare |
$17,399.49
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$94,986.70
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$38,530.09 |
| Max. Negotiated Rate |
$94,986.70 |
| Rate for Payer: Aetna Commercial |
$56,242.12
|
| Rate for Payer: Aetna Medicare |
$57,795.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$38,530.09
|
| Rate for Payer: Amerigroup Medicare |
$38,530.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43,943.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52,184.21
|
| Rate for Payer: BCBS of TX Medicare |
$38,530.09
|
| Rate for Payer: BCBS of TX PPO |
$57,984.71
|
| Rate for Payer: Cigna Commercial |
$64,390.98
|
| Rate for Payer: Cigna Medicare |
$38,530.09
|
| Rate for Payer: Employer Direct Commercial |
$38,530.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$38,530.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$38,530.09
|
| Rate for Payer: Molina Medicare |
$38,530.09
|
| Rate for Payer: Multiplan Auto |
$94,986.70
|
| Rate for Payer: Multiplan Commercial |
$94,986.70
|
| Rate for Payer: Multiplan Workers Comp |
$94,986.70
|
| Rate for Payer: Scott and White EPO/PPO |
$43,743.88
|
| Rate for Payer: Scott and White Medicare |
$38,530.09
|
| Rate for Payer: Superior Health Plan EPO |
$38,530.09
|
| Rate for Payer: Superior Health Plan Medicare |
$38,530.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$38,530.09
|
| Rate for Payer: Universal American Medicare |
$38,530.09
|
| Rate for Payer: Wellcare Medicare |
$38,530.09
|
| Rate for Payer: Wellmed Medicare |
$38,530.09
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,334.20
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$13,450.40 |
| Max. Negotiated Rate |
$32,334.20 |
| Rate for Payer: Aetna Commercial |
$19,145.25
|
| Rate for Payer: Aetna Medicare |
$22,498.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,998.92
|
| Rate for Payer: Amerigroup Medicare |
$14,998.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,450.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,097.64
|
| Rate for Payer: BCBS of TX Medicare |
$14,998.92
|
| Rate for Payer: BCBS of TX PPO |
$17,886.96
|
| Rate for Payer: Cigna Commercial |
$21,919.18
|
| Rate for Payer: Cigna Medicare |
$14,998.92
|
| Rate for Payer: Employer Direct Commercial |
$14,998.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,998.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,998.92
|
| Rate for Payer: Molina Medicare |
$14,998.92
|
| Rate for Payer: Multiplan Auto |
$32,334.20
|
| Rate for Payer: Multiplan Commercial |
$32,334.20
|
| Rate for Payer: Multiplan Workers Comp |
$32,334.20
|
| Rate for Payer: Scott and White EPO/PPO |
$14,890.75
|
| Rate for Payer: Scott and White Medicare |
$14,998.92
|
| Rate for Payer: Superior Health Plan EPO |
$14,998.92
|
| Rate for Payer: Superior Health Plan Medicare |
$14,998.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,998.92
|
| Rate for Payer: Universal American Medicare |
$14,998.92
|
| Rate for Payer: Wellcare Medicare |
$14,998.92
|
| Rate for Payer: Wellmed Medicare |
$14,998.92
|
|
|
INFECTIOUS DETECT, AMP PROBE EACH
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1709039
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$347.75 |
| 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 |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| 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 |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| 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
|
|
|
Inf for Therapy, Prophylaxis, Dx Initial up to 1 Hour 96365
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
1500412
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$264.00
|
|
|
Inf for Therapy, Prophylaxis, Dx Initial up to 1 Hour 96365
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
1500412
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$444.05 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$126.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$151.42
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$168.90
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| Rate for Payer: Multiplan Auto |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Multiplan Workers Comp |
$195.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3.51
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
Inf for Therapy, Prophylaxis, Dx Initial up to 1 Hour 96368
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
1500362
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$131.12
|
|
