|
EKG Charges - EKG -> Echo Trans ESO w/ Probe w/ Contrast 93312
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$2,311.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$963.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,155.60
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,284.00
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,311.20
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$2,311.20
|
| Rate for Payer: Scott and White EPO/PPO |
$1,605.00
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Echo Transthoracic LTD 93304
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$151.47 |
| Max. Negotiated Rate |
$1,211.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$504.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$605.88
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$673.20
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$1,211.76
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,211.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,093.95
|
| Rate for Payer: Multiplan Commercial |
$1,093.95
|
| Rate for Payer: Multiplan Workers Comp |
$1,093.95
|
| Rate for Payer: Parkland Medicaid |
$1,211.76
|
| Rate for Payer: Scott and White EPO/PPO |
$841.50
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,211.76
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Echo Transthoracic LTD 93304
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,144.44
|
|
|
EKG Charges - EKG -> Holter scanning analysis w/ report 12-48 hrs 93226
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
2800863
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$701.08
|
|
|
EKG Charges - EKG -> Holter scanning analysis w/ report 12-48 hrs 93226
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
2800863
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$742.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$309.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$371.16
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$412.40
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$742.32
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$742.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$670.15
|
| Rate for Payer: Multiplan Commercial |
$670.15
|
| Rate for Payer: Multiplan Workers Comp |
$670.15
|
| Rate for Payer: Parkland Medicaid |
$742.32
|
| Rate for Payer: Scott and White EPO/PPO |
$515.50
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$742.32
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
EKG Charges - EKG -> Pediatric Echo Complete 93303
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
2810001
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,664.64
|
|
|
EKG Charges - EKG -> Pediatric Echo Complete 93303
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
2810001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$1,762.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$220.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$734.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$881.28
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$979.20
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$1,762.56
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,762.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,591.20
|
| Rate for Payer: Multiplan Commercial |
$1,591.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,591.20
|
| Rate for Payer: Parkland Medicaid |
$1,762.56
|
| Rate for Payer: Scott and White EPO/PPO |
$1,224.00
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,762.56
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Routine ECG 12 lead/15 lead tracing only 93005
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$210.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$252.00
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$280.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$504.00
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$504.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| Rate for Payer: Parkland Medicaid |
$504.00
|
| Rate for Payer: Scott and White EPO/PPO |
$350.00
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$504.00
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
EKG Charges - EKG -> Routine ECG 12 lead/15 lead tracing only 93005
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$476.00
|
|
|
EKG Charges - EKG -> Stress Echo w/ Dobutamine 93350
|
Facility
|
OP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800555
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$250.38 |
| Max. Negotiated Rate |
$2,003.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$250.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$834.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,001.52
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,112.80
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,003.04
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,808.30
|
| Rate for Payer: Multiplan Commercial |
$1,808.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,808.30
|
| Rate for Payer: Parkland Medicaid |
$2,003.04
|
| Rate for Payer: Scott and White EPO/PPO |
$1,391.00
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Stress Echo w/ Dobutamine 93350
|
Facility
|
IP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800555
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,891.76
|
|
|
EKG Charges - EKG -> Stresss TTE Complete 93351
|
Facility
|
OP
|
$2,991.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
2810003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$269.19 |
| Max. Negotiated Rate |
$2,153.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$269.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$897.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,076.76
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,196.40
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,153.52
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,153.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,944.15
|
| Rate for Payer: Multiplan Commercial |
$1,944.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,944.15
|
| Rate for Payer: Parkland Medicaid |
$2,153.52
|
| Rate for Payer: Scott and White EPO/PPO |
$1,495.50
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,153.52
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Stresss TTE Complete 93351
|
Facility
|
IP
|
$2,991.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
2810003
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$2,033.88
|
|
|
EKG Charges - EKG -> TEE w/ Probe w/o Contrast 93312
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$2,311.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$963.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,155.60
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,284.00
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,311.20
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$2,311.20
|
| Rate for Payer: Scott and White EPO/PPO |
$1,605.00
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> TEE w/ Probe w/o Contrast 93312
|
Facility
|
IP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800498
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,182.80
|
|
|
ELCTRD BALL -- DHF
|
Facility
|
IP
|
$2,150.54
|
|
| Hospital Charge Code |
81812000
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,462.37
|
|
|
ELCTRD BALL -- DHF
|
Facility
|
OP
|
$2,150.54
|
|
| Hospital Charge Code |
81812000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$1,548.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$193.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$645.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$774.19
|
| Rate for Payer: BCBS of TX PPO |
$860.22
|
| Rate for Payer: Cash Price |
$1,462.37
|
| Rate for Payer: Cigna Medicaid |
$1,548.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,548.39
|
| Rate for Payer: Multiplan Auto |
$1,397.85
|
| Rate for Payer: Multiplan Commercial |
$1,397.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,397.85
|
| Rate for Payer: Parkland Medicaid |
$1,548.39
|
| Rate for Payer: Scott and White EPO/PPO |
$1,075.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,548.39
|
| Rate for Payer: Superior Health Plan EPO |
$292.47
|
|
|
ELCTRD EXPACE -- DHF
|
Facility
|
OP
|
$2,192.88
|
|
| Hospital Charge Code |
82030453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$197.36 |
| Max. Negotiated Rate |
$1,578.87 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$197.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$657.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$789.44
|
| Rate for Payer: BCBS of TX PPO |
$877.15
|
| Rate for Payer: Cash Price |
$1,491.16
|
| Rate for Payer: Cigna Medicaid |
$1,578.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,578.87
|
| Rate for Payer: Multiplan Auto |
$1,425.37
|
| Rate for Payer: Multiplan Commercial |
$1,425.37
|
| Rate for Payer: Multiplan Workers Comp |
$1,425.37
|
| Rate for Payer: Parkland Medicaid |
$1,578.87
|
| Rate for Payer: Scott and White EPO/PPO |
$1,096.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,578.87
|
| Rate for Payer: Superior Health Plan EPO |
$298.23
|
|
|
ELCTRD EXPACE -- DHF
|
Facility
|
IP
|
$2,192.88
|
|
| Hospital Charge Code |
82030453
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,491.16
|
|
|
ELCTRD FETAL -- DHF
|
Facility
|
OP
|
$293.75
|
|
| Hospital Charge Code |
82030503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$88.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$105.75
|
| Rate for Payer: BCBS of TX PPO |
$117.50
|
| Rate for Payer: Cash Price |
$199.75
|
| Rate for Payer: Cigna Medicaid |
$211.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$211.50
|
| Rate for Payer: Multiplan Auto |
$190.94
|
| Rate for Payer: Multiplan Commercial |
$190.94
|
| Rate for Payer: Multiplan Workers Comp |
$190.94
|
| Rate for Payer: Parkland Medicaid |
$211.50
|
| Rate for Payer: Scott and White EPO/PPO |
$146.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$211.50
|
| Rate for Payer: Superior Health Plan EPO |
$39.95
|
|
|
ELCTRD FETAL -- DHF
|
Facility
|
IP
|
$293.75
|
|
| Hospital Charge Code |
82030503
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$199.75
|
|
|
ELCTRD LOOP -- DHF
|
Facility
|
OP
|
$80.69
|
|
| Hospital Charge Code |
81823155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$58.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.05
|
| Rate for Payer: BCBS of TX PPO |
$32.28
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cigna Medicaid |
$58.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$58.10
|
| Rate for Payer: Multiplan Auto |
$52.45
|
| Rate for Payer: Multiplan Commercial |
$52.45
|
| Rate for Payer: Multiplan Workers Comp |
$52.45
|
| Rate for Payer: Parkland Medicaid |
$58.10
|
| Rate for Payer: Scott and White EPO/PPO |
$40.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$58.10
|
| Rate for Payer: Superior Health Plan EPO |
$10.97
|
|
|
ELCTRD LOOP -- DHF
|
Facility
|
IP
|
$80.69
|
|
| Hospital Charge Code |
81823155
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$54.87
|
|
|
ELCTRD MULTIFUNCTION -- DHF
|
Facility
|
IP
|
$93.29
|
|
| Hospital Charge Code |
82030578
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$63.44
|
|
|
ELCTRD MULTIFUNCTION -- DHF
|
Facility
|
OP
|
$93.29
|
|
| Hospital Charge Code |
82030578
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$67.17 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.58
|
| Rate for Payer: BCBS of TX PPO |
$37.32
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Cigna Medicaid |
$67.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.17
|
| Rate for Payer: Multiplan Auto |
$60.64
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: Multiplan Workers Comp |
$60.64
|
| Rate for Payer: Parkland Medicaid |
$67.17
|
| Rate for Payer: Scott and White EPO/PPO |
$46.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.17
|
| Rate for Payer: Superior Health Plan EPO |
$12.69
|
|
