|
Inf Tx Proph Diag Ea Addl IVP Drug 96375 BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6290775
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$181.50
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.24
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$39.30
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| 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 |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| 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 Tx Proph Diag Injection SQ or IM 96372 BCE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
1500370
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$125.78
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$140.29
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicaid |
$11.23
|
| 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 CHIP/Medicaid |
$11.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$182.00
|
| Rate for Payer: Multiplan Workers Comp |
$182.00
|
| Rate for Payer: Parkland Medicaid |
$11.23
|
| 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 CHIP/Medicaid |
$11.23
|
| 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 Proph Diag Seq IVP Same Drug 96376 BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1500404
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$181.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.48
|
| Rate for Payer: BCBS of TX PPO |
$55.19
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Multiplan Auto |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| Rate for Payer: Scott and White EPO/PPO |
$165.00
|
| Rate for Payer: Superior Health Plan EPO |
$44.88
|
|
|
Inf Tx Proph Dx Each Addl Hr 96366 BCE
|
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 Tx Prophylactic Diag IVP Drug 96374 BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1500388
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$444.05 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$68.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$82.45
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$91.96
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| 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 |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| 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 Tx Prophylaxis Dx New Drug 96368 BCE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
1500362
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$81.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Scott and White EPO/PPO |
$74.50
|
| Rate for Payer: Superior Health Plan EPO |
$20.26
|
|
|
Inf Tx Prophylaxis Dx up to 1 Hour 96365 BCE
|
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
|
|
|
Infusion for Hydration Each Additional Hour 96361
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
7003593
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$138.05
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.48
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$31.76
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| 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 |
$163.15
|
| Rate for Payer: Multiplan Commercial |
$163.15
|
| Rate for Payer: Multiplan Workers Comp |
$163.15
|
| 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
|
|
|
Infusion for Hydration Each Additional Hour 96361
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
7003593
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$220.88
|
|
|
Infusion for Hydration Initial 31 to 60 Minutes 96360
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7003585
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$745.36
|
|
|
Infusion for Hydration Initial 31 to 60 Minutes 96360
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7003585
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$67.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$80.20
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$89.46
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| 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 |
$550.55
|
| Rate for Payer: Multiplan Commercial |
$550.55
|
| Rate for Payer: Multiplan Workers Comp |
$550.55
|
| 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
|
|
|
Infusion & Monitoring M0243
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
8686554
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$371.25
|
| Rate for Payer: Aetna Medicare |
$648.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$60.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$432.42
|
| Rate for Payer: Amerigroup Medicare |
$432.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$783.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$936.00
|
| Rate for Payer: BCBS of TX Medicare |
$432.42
|
| Rate for Payer: BCBS of TX PPO |
$1,044.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Medicaid |
$450.00
|
| Rate for Payer: Cigna Medicare |
$432.42
|
| Rate for Payer: Employer Direct Commercial |
$432.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$432.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$450.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$432.42
|
| Rate for Payer: Molina Medicare |
$432.42
|
| Rate for Payer: Multiplan Auto |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Multiplan Workers Comp |
$438.75
|
| Rate for Payer: Parkland Medicaid |
$450.00
|
| Rate for Payer: Scott and White EPO/PPO |
$337.50
|
| Rate for Payer: Scott and White Medicare |
$432.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$450.00
|
| Rate for Payer: Superior Health Plan EPO |
$432.42
|
| Rate for Payer: Superior Health Plan Medicare |
$432.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$432.42
|
| Rate for Payer: Universal American Medicare |
$432.42
|
| Rate for Payer: Wellcare Medicare |
$432.42
|
| Rate for Payer: Wellmed Medicare |
$432.42
|
|
|
Infusion & Monitoring M0243
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
8686554
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$594.00
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$27,656.40
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$12,043.44 |
| Max. Negotiated Rate |
$27,656.40 |
| Rate for Payer: Aetna Commercial |
$16,375.50
|
| Rate for Payer: Aetna Medicare |
$19,863.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,242.03
|
| Rate for Payer: Amerigroup Medicare |
$13,242.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,043.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,479.53
|
| Rate for Payer: BCBS of TX Medicare |
$13,242.03
|
| Rate for Payer: BCBS of TX PPO |
$17,200.15
|
| Rate for Payer: Cigna Commercial |
$18,748.13
|
| Rate for Payer: Cigna Medicare |
$13,242.03
|
| Rate for Payer: Employer Direct Commercial |
$13,242.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,242.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,242.03
|
| Rate for Payer: Molina Medicare |
$13,242.03
|
| Rate for Payer: Multiplan Auto |
$27,656.40
|
| Rate for Payer: Multiplan Commercial |
$27,656.40
|
| Rate for Payer: Multiplan Workers Comp |
$27,656.40
|
| Rate for Payer: Scott and White EPO/PPO |
$12,736.50
|
| Rate for Payer: Scott and White Medicare |
$13,242.03
|
| Rate for Payer: Superior Health Plan EPO |
$13,242.03
|
| Rate for Payer: Superior Health Plan Medicare |
$13,242.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,242.03
|
| Rate for Payer: Universal American Medicare |
$13,242.03
|
| Rate for Payer: Wellcare Medicare |
$13,242.03
|
| Rate for Payer: Wellmed Medicare |
$13,242.03
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,600.00
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$19,981.32 |
| Max. Negotiated Rate |
$45,600.00 |
| Rate for Payer: Aetna Commercial |
$27,000.00
|
| Rate for Payer: Aetna Medicare |
$29,971.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,981.32
|
| Rate for Payer: Amerigroup Medicare |
$19,981.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,867.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25,245.43
|
| Rate for Payer: BCBS of TX Medicare |
$19,981.32
|
| Rate for Payer: BCBS of TX PPO |
$28,051.57
|
| Rate for Payer: Cigna Commercial |
$30,912.00
|
| Rate for Payer: Cigna Medicare |
$19,981.32
|
| Rate for Payer: Employer Direct Commercial |
$19,981.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,981.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,981.32
|
| Rate for Payer: Molina Medicare |
$19,981.32
|
| Rate for Payer: Multiplan Auto |
$45,600.00
|
| Rate for Payer: Multiplan Commercial |
$45,600.00
|
| Rate for Payer: Multiplan Workers Comp |
$45,600.00
|
| Rate for Payer: Scott and White EPO/PPO |
$21,000.00
|
| Rate for Payer: Scott and White Medicare |
$19,981.32
|
| Rate for Payer: Superior Health Plan EPO |
$19,981.32
|
| Rate for Payer: Superior Health Plan Medicare |
$19,981.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,981.32
|
| Rate for Payer: Universal American Medicare |
$19,981.32
|
| Rate for Payer: Wellcare Medicare |
$19,981.32
|
| Rate for Payer: Wellmed Medicare |
$19,981.32
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,071.00
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$8,612.90 |
| Max. Negotiated Rate |
$21,071.00 |
| Rate for Payer: Aetna Commercial |
$12,476.25
|
| Rate for Payer: Aetna Medicare |
$16,153.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,768.67
|
| Rate for Payer: Amerigroup Medicare |
$10,768.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,612.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,871.07
|
| Rate for Payer: BCBS of TX Medicare |
$10,768.67
|
| Rate for Payer: BCBS of TX PPO |
$12,079.43
|
| Rate for Payer: Cigna Commercial |
$14,283.92
|
| Rate for Payer: Cigna Medicare |
$10,768.67
|
| Rate for Payer: Employer Direct Commercial |
$10,768.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,768.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,768.67
|
| Rate for Payer: Molina Medicare |
$10,768.67
|
| Rate for Payer: Multiplan Auto |
$21,071.00
|
| Rate for Payer: Multiplan Commercial |
$21,071.00
|
| Rate for Payer: Multiplan Workers Comp |
$21,071.00
|
| Rate for Payer: Scott and White EPO/PPO |
$9,703.75
|
| Rate for Payer: Scott and White Medicare |
$10,768.67
|
| Rate for Payer: Superior Health Plan EPO |
$10,768.67
|
| Rate for Payer: Superior Health Plan Medicare |
$10,768.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,768.67
|
| Rate for Payer: Universal American Medicare |
$10,768.67
|
| Rate for Payer: Wellcare Medicare |
$10,768.67
|
| Rate for Payer: Wellmed Medicare |
$10,768.67
|
|
|
Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure)
|
Facility
|
OP
|
$13,509.82
|
|
|
Service Code
|
CPT 38760
|
| Hospital Charge Code |
36038760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$13,509.82 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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
|
|
|
Inhibin A, Ultrasensitive SO
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
1708908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Medicare |
$23.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.59
|
| Rate for Payer: Amerigroup Medicare |
$15.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.87
|
| Rate for Payer: BCBS of TX Medicare |
$15.59
|
| Rate for Payer: BCBS of TX PPO |
$34.45
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Medicaid |
$15.59
|
| Rate for Payer: Cigna Medicare |
$15.59
|
| Rate for Payer: Employer Direct Commercial |
$15.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.59
|
| Rate for Payer: Molina Medicare |
$15.59
|
| Rate for Payer: Multiplan Auto |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Workers Comp |
$58.50
|
| Rate for Payer: Parkland Medicaid |
$15.59
|
| Rate for Payer: Scott and White EPO/PPO |
$19.49
|
| Rate for Payer: Scott and White Medicare |
$15.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.59
|
| Rate for Payer: Superior Health Plan EPO |
$15.59
|
| Rate for Payer: Superior Health Plan Medicare |
$15.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.59
|
| Rate for Payer: Universal American Medicare |
$15.59
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: Wellmed Medicare |
$15.59
|
|
|
Inhibin A, Ultrasensitive SO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
1708908
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$79.20
|
|
|
Inhibin B SO
|
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
|
|
|
Initial Setup 99453
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
6019906
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare |
$181.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Amerigroup Medicare |
$120.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$201.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$241.13
|
| Rate for Payer: BCBS of TX Medicare |
$120.89
|
| Rate for Payer: BCBS of TX PPO |
$268.96
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$273.87
|
| Rate for Payer: Cigna Medicare |
$120.89
|
| Rate for Payer: Employer Direct Commercial |
$120.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Molina Medicare |
$120.89
|
| Rate for Payer: Multiplan Auto |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
| Rate for Payer: Multiplan Workers Comp |
$370.50
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.89
|
| Rate for Payer: Superior Health Plan EPO |
$120.89
|
| Rate for Payer: Superior Health Plan Medicare |
$120.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Universal American Medicare |
$120.89
|
| Rate for Payer: Wellcare Medicare |
$120.89
|
| Rate for Payer: Wellmed Medicare |
$120.89
|
|
|
INJ CM EVAL JTUBE
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
4619467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$471.35
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$77.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$389.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$466.08
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$587.26
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| 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: Scott and White EPO/PPO |
$4.94
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
INJ CM EVAL JTUBE
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
4619467
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$754.16
|
|
|
INJECT CONGEN CARD CATH
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
4613563
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$2,383.04
|
|
|
INJECT CONGEN CARD CATH
|
Facility
|
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
4613563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$243.72 |
| Max. Negotiated Rate |
$7,287.00 |
| Rate for Payer: Aetna Commercial |
$7,287.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$243.72
|
| Rate for Payer: Cash Price |
$2,383.04
|
| Rate for Payer: Cash Price |
$2,383.04
|
| Rate for Payer: Multiplan Auto |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$1,760.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,760.20
|
| Rate for Payer: Scott and White EPO/PPO |
$1,354.00
|
| Rate for Payer: Superior Health Plan EPO |
$368.29
|
|
