|
IV Therapy/Nursing - Addl Admin Charge 90472
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1500422
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$77.44
|
|
|
IV Therapy/Nursing - Addl Admin Charge 90472
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1500422
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.98
|
| Rate for Payer: BCBS of TX PPO |
$30.09
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Multiplan Auto |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$57.20
|
| Rate for Payer: Multiplan Workers Comp |
$57.20
|
| Rate for Payer: Scott and White EPO/PPO |
$44.00
|
| Rate for Payer: Superior Health Plan EPO |
$11.97
|
|
|
IV Therapy/Nursing Addl Admin Charge 90472 BCE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1500422
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.98
|
| Rate for Payer: BCBS of TX PPO |
$30.09
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Multiplan Auto |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$57.20
|
| Rate for Payer: Multiplan Workers Comp |
$57.20
|
| Rate for Payer: Scott and White EPO/PPO |
$44.00
|
| Rate for Payer: Superior Health Plan EPO |
$11.97
|
|
|
IV Therapy/Nursing Flu Initial Admin Charge 90471/G0008 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500305
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing- Flu Vaccine Adm G0008
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
1500305
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| 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 Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$55.19
|
| 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 |
$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 |
$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 |
$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
|
|
|
IV Therapy/Nursing- Flu Vaccine Adm G0008
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
1500305
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing Hep B Initial Admin Charge 90471/G0010 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500421
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Hep B Vac Adm G0010
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
1500421
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Hep B Vac Adm G0010
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
1500421
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$90.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.95
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$120.41
|
| 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 |
$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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500305
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1510001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500305
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500421
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1510001
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500297
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500297
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Initial Admin Charge 90471
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500421
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing Initial Admin Charge 90471 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1510001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IV Therapy/Nursing - Pneum Vacc Adm G0009
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
1500297
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
IV Therapy/Nursing - Pneum Vacc Adm G0009
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
1500297
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$111.20 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$99.69
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$111.20
|
| 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 |
$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 |
$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 |
$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
|
|
|
IV Therapy/Nursing Pnuem Initial Admin Charge 90471/G0009 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1500297
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| 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 |
$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 |
$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
|
|
|
IVUS ADDITIONAL VESSEL
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
2302222
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$139.22 |
| Max. Negotiated Rate |
$1,675.70 |
| Rate for Payer: Aetna Commercial |
$1,417.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$232.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.42
|
| Rate for Payer: BCBS of TX PPO |
$185.62
|
| Rate for Payer: Cash Price |
$2,268.64
|
| Rate for Payer: Cash Price |
$2,268.64
|
| Rate for Payer: Multiplan Auto |
$1,675.70
|
| Rate for Payer: Multiplan Commercial |
$1,675.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,675.70
|
| Rate for Payer: Scott and White EPO/PPO |
$1,289.00
|
| Rate for Payer: Superior Health Plan EPO |
$350.61
|
|
|
IVUS ADDITIONAL VESSEL
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
2302222
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$2,268.64
|
|
|
IVUS NON CORON ADDL VESL
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
4617251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.35 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,098.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$343.35
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| 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 |
$1,907.50
|
| Rate for Payer: Superior Health Plan EPO |
$518.84
|
|
|
IVUS NON CORON ADDL VESL
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
4617251
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,357.20
|
|
