|
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
|
|
|
Inf for Therapy, Prophylaxis or Dx Each Addl Hour 96366
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
1500347
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.72
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$50.99
|
| 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 |
$98.40
|
| Rate for Payer: Cigna Medicare |
$43.44
|
| Rate for Payer: Employer Direct Commercial |
$43.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Molina Medicare |
$43.44
|
| 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 |
$0.78
|
| Rate for Payer: Scott and White Medicare |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$43.44
|
| Rate for Payer: Superior Health Plan Medicare |
$43.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Universal American Medicare |
$43.44
|
| Rate for Payer: Wellcare Medicare |
$43.44
|
| Rate for Payer: Wellmed Medicare |
$43.44
|
|
|
Inf for Therapy, Prophylaxis or Dx Each Addl Hour 96366
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
1500347
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$134.64
|
|
|
Inf for Tx Prophylaxis Dx Addl Seq Infusion New Drug 96367
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
7003627
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$154.00
|
|
|
Inf for Tx Prophylaxis Dx Addl Seq Infusion New Drug 96367
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
7003627
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65.96
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$73.57
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$30,799.00
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$11,843.06 |
| Max. Negotiated Rate |
$30,799.00 |
| Rate for Payer: Aetna Commercial |
$18,236.25
|
| Rate for Payer: Aetna Medicare |
$21,633.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,422.33
|
| Rate for Payer: Amerigroup Medicare |
$14,422.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,843.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,838.72
|
| Rate for Payer: BCBS of TX Medicare |
$14,422.33
|
| Rate for Payer: BCBS of TX PPO |
$16,488.11
|
| Rate for Payer: Cigna Commercial |
$20,878.48
|
| Rate for Payer: Cigna Medicare |
$14,422.33
|
| Rate for Payer: Employer Direct Commercial |
$14,422.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,422.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,422.33
|
| Rate for Payer: Molina Medicare |
$14,422.33
|
| Rate for Payer: Multiplan Auto |
$30,799.00
|
| Rate for Payer: Multiplan Commercial |
$30,799.00
|
| Rate for Payer: Multiplan Workers Comp |
$30,799.00
|
| Rate for Payer: Scott and White EPO/PPO |
$14,183.75
|
| Rate for Payer: Scott and White Medicare |
$14,422.33
|
| Rate for Payer: Superior Health Plan EPO |
$14,422.33
|
| Rate for Payer: Superior Health Plan Medicare |
$14,422.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,422.33
|
| Rate for Payer: Universal American Medicare |
$14,422.33
|
| Rate for Payer: Wellcare Medicare |
$14,422.33
|
| Rate for Payer: Wellmed Medicare |
$14,422.33
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$15,201.90
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,947.08 |
| Max. Negotiated Rate |
$15,201.90 |
| Rate for Payer: Aetna Commercial |
$9,001.12
|
| Rate for Payer: Aetna Medicare |
$12,846.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,564.35
|
| Rate for Payer: Amerigroup Medicare |
$8,564.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,947.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,166.46
|
| Rate for Payer: BCBS of TX Medicare |
$8,564.35
|
| Rate for Payer: BCBS of TX PPO |
$9,074.19
|
| Rate for Payer: Cigna Commercial |
$10,305.29
|
| Rate for Payer: Cigna Medicare |
$8,564.35
|
| Rate for Payer: Employer Direct Commercial |
$8,564.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,564.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,564.35
|
| Rate for Payer: Molina Medicare |
$8,564.35
|
| Rate for Payer: Multiplan Auto |
$15,201.90
|
| Rate for Payer: Multiplan Commercial |
$15,201.90
|
| Rate for Payer: Multiplan Workers Comp |
$15,201.90
|
| Rate for Payer: Scott and White EPO/PPO |
$7,000.88
|
| Rate for Payer: Scott and White Medicare |
$8,564.35
|
| Rate for Payer: Superior Health Plan EPO |
$8,564.35
|
| Rate for Payer: Superior Health Plan Medicare |
$8,564.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,564.35
|
| Rate for Payer: Universal American Medicare |
$8,564.35
|
| Rate for Payer: Wellcare Medicare |
$8,564.35
|
| Rate for Payer: Wellmed Medicare |
$8,564.35
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$18,460.40
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$8,344.58 |
| Max. Negotiated Rate |
$18,460.40 |
| Rate for Payer: Aetna Commercial |
$10,930.50
|
| Rate for Payer: Aetna Medicare |
$14,682.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,788.17
|
| Rate for Payer: Amerigroup Medicare |
$9,788.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,344.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,113.65
|
| Rate for Payer: BCBS of TX Medicare |
$9,788.17
|
| Rate for Payer: BCBS of TX PPO |
$11,237.83
|
| Rate for Payer: Cigna Commercial |
$12,514.21
|
| Rate for Payer: Cigna Medicare |
$9,788.17
|
| Rate for Payer: Employer Direct Commercial |
$9,788.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,788.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,788.17
|
| Rate for Payer: Molina Medicare |
$9,788.17
|
| Rate for Payer: Multiplan Auto |
$18,460.40
|
| Rate for Payer: Multiplan Commercial |
$18,460.40
|
| Rate for Payer: Multiplan Workers Comp |
$18,460.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8,501.50
|
| Rate for Payer: Scott and White Medicare |
$9,788.17
|
| Rate for Payer: Superior Health Plan EPO |
$9,788.17
|
| Rate for Payer: Superior Health Plan Medicare |
$9,788.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,788.17
|
| Rate for Payer: Universal American Medicare |
$9,788.17
|
| Rate for Payer: Wellcare Medicare |
$9,788.17
|
| Rate for Payer: Wellmed Medicare |
$9,788.17
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$29,771.10
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$13,710.38 |
| Max. Negotiated Rate |
$29,771.10 |
| Rate for Payer: Aetna Commercial |
$17,627.62
|
| Rate for Payer: Aetna Medicare |
$21,054.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,036.27
|
| Rate for Payer: Amerigroup Medicare |
$14,036.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,023.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,520.63
|
| Rate for Payer: BCBS of TX Medicare |
$14,036.27
|
| Rate for Payer: BCBS of TX PPO |
$19,468.12
|
| Rate for Payer: Cigna Commercial |
$20,181.67
|
| Rate for Payer: Cigna Medicare |
$14,036.27
|
| Rate for Payer: Employer Direct Commercial |
$14,036.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,036.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,036.27
|
| Rate for Payer: Molina Medicare |
$14,036.27
|
| Rate for Payer: Multiplan Auto |
$29,771.10
|
| Rate for Payer: Multiplan Commercial |
$29,771.10
|
| Rate for Payer: Multiplan Workers Comp |
$29,771.10
|
| Rate for Payer: Scott and White EPO/PPO |
$13,710.38
|
| Rate for Payer: Scott and White Medicare |
$14,036.27
|
| Rate for Payer: Superior Health Plan EPO |
$14,036.27
|
| Rate for Payer: Superior Health Plan Medicare |
$14,036.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,036.27
|
| Rate for Payer: Universal American Medicare |
$14,036.27
|
| Rate for Payer: Wellcare Medicare |
$14,036.27
|
| Rate for Payer: Wellmed Medicare |
$14,036.27
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$12,997.90
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$5,985.88 |
| Max. Negotiated Rate |
$12,997.90 |
| Rate for Payer: Aetna Commercial |
$7,696.12
|
| Rate for Payer: Aetna Medicare |
$11,604.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,736.57
|
| Rate for Payer: Amerigroup Medicare |
$7,736.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,382.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,189.25
|
| Rate for Payer: BCBS of TX Medicare |
$7,736.57
|
| Rate for Payer: BCBS of TX PPO |
$7,988.36
|
| Rate for Payer: Cigna Commercial |
$8,811.21
|
| Rate for Payer: Cigna Medicare |
$7,736.57
|
| Rate for Payer: Employer Direct Commercial |
$7,736.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,736.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,736.57
|
| Rate for Payer: Molina Medicare |
$7,736.57
|
| Rate for Payer: Multiplan Auto |
$12,997.90
|
| Rate for Payer: Multiplan Commercial |
$12,997.90
|
| Rate for Payer: Multiplan Workers Comp |
$12,997.90
|
| Rate for Payer: Scott and White EPO/PPO |
$5,985.88
|
| Rate for Payer: Scott and White Medicare |
$7,736.57
|
| Rate for Payer: Superior Health Plan EPO |
$7,736.57
|
| Rate for Payer: Superior Health Plan Medicare |
$7,736.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,736.57
|
| Rate for Payer: Universal American Medicare |
$7,736.57
|
| Rate for Payer: Wellcare Medicare |
$7,736.57
|
| Rate for Payer: Wellmed Medicare |
$7,736.57
|
|
|
INFL SYR W/GAUGE -- DHF
|
Facility
|
IP
|
$149.03
|
|
| Hospital Charge Code |
80325111
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$131.15
|
|
|
INFL SYR W/GAUGE -- DHF
|
Facility
|
OP
|
$149.03
|
|
| Hospital Charge Code |
80325111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$96.87 |
| Rate for Payer: Aetna Commercial |
$81.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$44.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53.65
|
| Rate for Payer: BCBS of TX PPO |
$59.61
|
| Rate for Payer: Cash Price |
$131.15
|
| Rate for Payer: Multiplan Auto |
$96.87
|
| Rate for Payer: Multiplan Commercial |
$96.87
|
| Rate for Payer: Multiplan Workers Comp |
$96.87
|
| Rate for Payer: Scott and White EPO/PPO |
$74.52
|
| Rate for Payer: Superior Health Plan EPO |
$20.27
|
|
|
Influenza A and B Antigens BCE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
1640072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Amerigroup Medicare |
$16.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.77
|
| Rate for Payer: BCBS of TX Medicare |
$16.55
|
| Rate for Payer: BCBS of TX PPO |
$36.58
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cigna Medicaid |
$16.55
|
| Rate for Payer: Cigna Medicare |
$16.55
|
| Rate for Payer: Employer Direct Commercial |
$16.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Molina Medicare |
$16.55
|
| Rate for Payer: Multiplan Auto |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$111.80
|
| Rate for Payer: Multiplan Workers Comp |
$111.80
|
| Rate for Payer: Parkland Medicaid |
$16.55
|
| Rate for Payer: Scott and White EPO/PPO |
$20.69
|
| Rate for Payer: Scott and White Medicare |
$16.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.55
|
| Rate for Payer: Superior Health Plan EPO |
$16.55
|
| Rate for Payer: Superior Health Plan Medicare |
$16.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Universal American Medicare |
$16.55
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: Wellmed Medicare |
$16.55
|
|
|
Influenza A and B by RNA
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
1630030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.36 |
| Max. Negotiated Rate |
$211.72 |
| Rate for Payer: Aetna Commercial |
$100.59
|
| Rate for Payer: Aetna Medicare |
$143.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$95.80
|
| Rate for Payer: Amerigroup Medicare |
$95.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$158.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$189.68
|
| Rate for Payer: BCBS of TX Medicare |
$95.80
|
| Rate for Payer: BCBS of TX PPO |
$211.72
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cigna Medicaid |
$95.80
|
| Rate for Payer: Cigna Medicare |
$95.80
|
| Rate for Payer: Employer Direct Commercial |
$95.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$95.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$95.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$95.80
|
| Rate for Payer: Molina Medicare |
$95.80
|
| Rate for Payer: Multiplan Auto |
$197.60
|
| Rate for Payer: Multiplan Commercial |
$197.60
|
| Rate for Payer: Multiplan Workers Comp |
$197.60
|
| Rate for Payer: Parkland Medicaid |
$95.80
|
| Rate for Payer: Scott and White EPO/PPO |
$119.75
|
| Rate for Payer: Scott and White Medicare |
$95.80
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$95.80
|
| Rate for Payer: Superior Health Plan EPO |
$95.80
|
| Rate for Payer: Superior Health Plan Medicare |
$95.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$95.80
|
| Rate for Payer: Universal American Medicare |
$95.80
|
| Rate for Payer: Wellcare Medicare |
$95.80
|
| Rate for Payer: Wellmed Medicare |
$95.80
|
|
|
Influenza A and B by RNA
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
1630030
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$267.52
|
|
|
Influenza A Antigen
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
1640072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Amerigroup Medicare |
$16.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.77
|
| Rate for Payer: BCBS of TX Medicare |
$16.55
|
| Rate for Payer: BCBS of TX PPO |
$36.58
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cigna Medicaid |
$16.55
|
| Rate for Payer: Cigna Medicare |
$16.55
|
| Rate for Payer: Employer Direct Commercial |
$16.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Molina Medicare |
$16.55
|
| Rate for Payer: Multiplan Auto |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$111.80
|
| Rate for Payer: Multiplan Workers Comp |
$111.80
|
| Rate for Payer: Parkland Medicaid |
$16.55
|
| Rate for Payer: Scott and White EPO/PPO |
$20.69
|
| Rate for Payer: Scott and White Medicare |
$16.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.55
|
| Rate for Payer: Superior Health Plan EPO |
$16.55
|
| Rate for Payer: Superior Health Plan Medicare |
$16.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Universal American Medicare |
$16.55
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: Wellmed Medicare |
$16.55
|
|
|
Influenza A/B Ab, Quant SO
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
1705953
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Amerigroup Medicare |
$13.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.83
|
| Rate for Payer: BCBS of TX Medicare |
$13.55
|
| Rate for Payer: BCBS of TX PPO |
$29.95
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Cigna Medicaid |
$13.55
|
| Rate for Payer: Cigna Medicare |
$13.55
|
| Rate for Payer: Employer Direct Commercial |
$13.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Molina Medicare |
$13.55
|
| Rate for Payer: Multiplan Auto |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Multiplan Workers Comp |
$114.40
|
| Rate for Payer: Parkland Medicaid |
$13.55
|
| Rate for Payer: Scott and White EPO/PPO |
$16.94
|
| Rate for Payer: Scott and White Medicare |
$13.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.55
|
| Rate for Payer: Superior Health Plan EPO |
$13.55
|
| Rate for Payer: Superior Health Plan Medicare |
$13.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.55
|
| Rate for Payer: Universal American Medicare |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: Wellmed Medicare |
$13.55
|
|
|
Influenza A/B Ab, Quant SO
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
1705953
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$154.88
|
|
|
Influenza B Antigen
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
1640072
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$151.36
|
|
|
Influenza B Antigen
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
1640072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Amerigroup Medicare |
$16.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.77
|
| Rate for Payer: BCBS of TX Medicare |
$16.55
|
| Rate for Payer: BCBS of TX PPO |
$36.58
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cigna Medicaid |
$16.55
|
| Rate for Payer: Cigna Medicare |
$16.55
|
| Rate for Payer: Employer Direct Commercial |
$16.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Molina Medicare |
$16.55
|
| Rate for Payer: Multiplan Auto |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$111.80
|
| Rate for Payer: Multiplan Workers Comp |
$111.80
|
| Rate for Payer: Parkland Medicaid |
$16.55
|
| Rate for Payer: Scott and White EPO/PPO |
$20.69
|
| Rate for Payer: Scott and White Medicare |
$16.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.55
|
| Rate for Payer: Superior Health Plan EPO |
$16.55
|
| Rate for Payer: Superior Health Plan Medicare |
$16.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.55
|
| Rate for Payer: Universal American Medicare |
$16.55
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: Wellmed Medicare |
$16.55
|
|
|
Inf Tx Chemo Inf 1 hr Single/Initial Drug 96413 BCE
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
1500271
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$488.40
|
|
|
Inf Tx Chemo Inf 1 hr Single/Initial Drug 96413 BCE
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
1500271
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$701.61 |
| Rate for Payer: Aetna Commercial |
$170.74
|
| Rate for Payer: Aetna Medicare |
$464.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Amerigroup Medicare |
$309.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$248.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$297.61
|
| Rate for Payer: BCBS of TX Medicare |
$309.73
|
| Rate for Payer: BCBS of TX PPO |
$331.95
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cigna Commercial |
$701.61
|
| Rate for Payer: Cigna Medicare |
$309.73
|
| Rate for Payer: Employer Direct Commercial |
$309.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$309.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Molina Medicare |
$309.73
|
| Rate for Payer: Multiplan Auto |
$360.75
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Multiplan Workers Comp |
$360.75
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Scott and White Medicare |
$309.73
|
| Rate for Payer: Superior Health Plan EPO |
$309.73
|
| Rate for Payer: Superior Health Plan Medicare |
$309.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Universal American Medicare |
$309.73
|
| Rate for Payer: Wellcare Medicare |
$309.73
|
| Rate for Payer: Wellmed Medicare |
$309.73
|
|
|
Inf Tx Chemo Infusion Each Additional Hr 96415 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
1500289
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64.46
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$71.90
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
Inf Tx Chemo Infusion Each Additional Hr 96415 BCE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
1500289
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
Inf Tx Proph Diag Ea Addl IVP Drug 96375 BCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6290775
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$290.40
|
|
