|
MARKER ENDOSCOPIC ENDOLINK
|
Facility
|
OP
|
$111.37
|
|
| Hospital Charge Code |
145333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$72.39 |
| Rate for Payer: Aetna Commercial |
$61.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40.09
|
| Rate for Payer: BCBS of TX PPO |
$44.55
|
| Rate for Payer: Cash Price |
$98.01
|
| Rate for Payer: Multiplan Auto |
$72.39
|
| Rate for Payer: Multiplan Commercial |
$72.39
|
| Rate for Payer: Multiplan Workers Comp |
$72.39
|
| Rate for Payer: Scott and White EPO/PPO |
$55.68
|
| Rate for Payer: Superior Health Plan EPO |
$15.15
|
|
|
MARKER, SKIN & SURG W/FLEX RULER & LABELS VIOLET -- DHF
|
Facility
|
OP
|
$78.04
|
|
| Hospital Charge Code |
80334857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.09
|
| Rate for Payer: BCBS of TX PPO |
$31.22
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Multiplan Auto |
$50.73
|
| Rate for Payer: Multiplan Commercial |
$50.73
|
| Rate for Payer: Multiplan Workers Comp |
$50.73
|
| Rate for Payer: Scott and White EPO/PPO |
$39.02
|
| Rate for Payer: Superior Health Plan EPO |
$10.61
|
|
|
MARKER, SKIN W/RULER ON CAP DUAL TIP REG & X-FINE -- DHF
|
Facility
|
OP
|
$78.04
|
|
| Hospital Charge Code |
80334857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.09
|
| Rate for Payer: BCBS of TX PPO |
$31.22
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Multiplan Auto |
$50.73
|
| Rate for Payer: Multiplan Commercial |
$50.73
|
| Rate for Payer: Multiplan Workers Comp |
$50.73
|
| Rate for Payer: Scott and White EPO/PPO |
$39.02
|
| Rate for Payer: Superior Health Plan EPO |
$10.61
|
|
|
MARKER, SKIN W/RULER VIOLET STERILE -- DHF
|
Facility
|
IP
|
$78.04
|
|
| Hospital Charge Code |
80334857
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$68.68
|
|
|
MARKER, SKIN W/RULER VIOLET STERILE -- DHF
|
Facility
|
OP
|
$78.04
|
|
| Hospital Charge Code |
80334857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.09
|
| Rate for Payer: BCBS of TX PPO |
$31.22
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Multiplan Auto |
$50.73
|
| Rate for Payer: Multiplan Commercial |
$50.73
|
| Rate for Payer: Multiplan Workers Comp |
$50.73
|
| Rate for Payer: Scott and White EPO/PPO |
$39.02
|
| Rate for Payer: Superior Health Plan EPO |
$10.61
|
|
|
MASK, OXYGEN ETCO2 LL CAPF CO2 SMPL LN RBGP 7FT-10 -- DHF
|
Facility
|
OP
|
$43.13
|
|
| Hospital Charge Code |
82057050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.53
|
| Rate for Payer: BCBS of TX PPO |
$17.25
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Multiplan Auto |
$28.03
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: Multiplan Workers Comp |
$28.03
|
| Rate for Payer: Scott and White EPO/PPO |
$21.56
|
| Rate for Payer: Superior Health Plan EPO |
$5.87
|
|
|
MASK, OXYGEN ETCO2 LL CAPF CO2 SMPL LN RBGP 7FT-10 -- DHF
|
Facility
|
IP
|
$43.13
|
|
| Hospital Charge Code |
82057050
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$37.95
|
|
|
Mastectomy for gynecomastia
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
36019300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| 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 |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$76.89
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$31,674.90
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$12,896.56 |
| Max. Negotiated Rate |
$31,674.90 |
| Rate for Payer: Aetna Commercial |
$18,754.88
|
| Rate for Payer: Aetna Medicare |
$22,921.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,280.80
|
| Rate for Payer: Amerigroup Medicare |
$15,280.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,896.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,195.67
|
| Rate for Payer: BCBS of TX Medicare |
$15,280.80
|
| Rate for Payer: BCBS of TX PPO |
$17,995.89
|
| Rate for Payer: Cigna Commercial |
$21,472.25
|
| Rate for Payer: Cigna Medicare |
$15,280.80
|
| Rate for Payer: Employer Direct Commercial |
$15,280.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,280.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,280.80
|
| Rate for Payer: Molina Medicare |
$15,280.80
|
| Rate for Payer: Multiplan Auto |
$31,674.90
|
| Rate for Payer: Multiplan Commercial |
$31,674.90
|
| Rate for Payer: Multiplan Workers Comp |
$31,674.90
|
| Rate for Payer: Scott and White EPO/PPO |
$14,587.12
|
| Rate for Payer: Scott and White Medicare |
$15,280.80
|
| Rate for Payer: Superior Health Plan EPO |
$15,280.80
|
| Rate for Payer: Superior Health Plan Medicare |
$15,280.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,280.80
|
| Rate for Payer: Universal American Medicare |
$15,280.80
|
| Rate for Payer: Wellcare Medicare |
$15,280.80
|
| Rate for Payer: Wellmed Medicare |
$15,280.80
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$28,916.10
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$11,318.46 |
| Max. Negotiated Rate |
$28,916.10 |
| Rate for Payer: Aetna Commercial |
$17,121.38
|
| Rate for Payer: Aetna Medicare |
$20,572.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,715.15
|
| Rate for Payer: Amerigroup Medicare |
$13,715.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,318.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,220.61
|
| Rate for Payer: BCBS of TX Medicare |
$13,715.15
|
| Rate for Payer: BCBS of TX PPO |
$15,801.29
|
| Rate for Payer: Cigna Commercial |
$19,602.07
|
| Rate for Payer: Cigna Medicare |
$13,715.15
|
| Rate for Payer: Employer Direct Commercial |
$13,715.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,715.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,715.15
|
| Rate for Payer: Molina Medicare |
$13,715.15
|
| Rate for Payer: Multiplan Auto |
$28,916.10
|
| Rate for Payer: Multiplan Commercial |
$28,916.10
|
| Rate for Payer: Multiplan Workers Comp |
$28,916.10
|
| Rate for Payer: Scott and White EPO/PPO |
$13,316.62
|
| Rate for Payer: Scott and White Medicare |
$13,715.15
|
| Rate for Payer: Superior Health Plan EPO |
$13,715.15
|
| Rate for Payer: Superior Health Plan Medicare |
$13,715.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,715.15
|
| Rate for Payer: Universal American Medicare |
$13,715.15
|
| Rate for Payer: Wellcare Medicare |
$13,715.15
|
| Rate for Payer: Wellmed Medicare |
$13,715.15
|
|
|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
36019301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| 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 |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$76.89
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
Mastopexy
|
Facility
|
OP
|
$13,509.82
|
|
|
Service Code
|
CPT 19316
|
| Hospital Charge Code |
36019316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$13,509.82 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| 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
|
|
|
Mastotomy with exploration or drainage of abscess, deep
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36019020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
MCATH DIREXION PL FATHOM -- DHF
|
Facility
|
IP
|
$2,861.45
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
40330524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.36 |
| Max. Negotiated Rate |
$1,430.72 |
| Rate for Payer: Aetna Commercial |
$858.44
|
| Rate for Payer: Cash Price |
$2,518.08
|
| Rate for Payer: Cigna Commercial |
$715.36
|
| Rate for Payer: Multiplan Auto |
$1,430.72
|
| Rate for Payer: Multiplan Commercial |
$1,430.72
|
| Rate for Payer: Multiplan Workers Comp |
$1,430.72
|
| Rate for Payer: Scott and White EPO/PPO |
$1,430.72
|
|
|
MCATH DIREXION PL FATHOM -- DHF
|
Facility
|
OP
|
$2,861.45
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
40330524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.53 |
| Max. Negotiated Rate |
$1,430.72 |
| Rate for Payer: Aetna Commercial |
$858.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$858.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,030.12
|
| Rate for Payer: BCBS of TX PPO |
$1,144.58
|
| Rate for Payer: Cash Price |
$2,518.08
|
| Rate for Payer: Multiplan Auto |
$1,430.72
|
| Rate for Payer: Multiplan Commercial |
$1,430.72
|
| Rate for Payer: Multiplan Workers Comp |
$1,430.72
|
| Rate for Payer: Scott and White EPO/PPO |
$1,430.72
|
| Rate for Payer: Superior Health Plan EPO |
$389.16
|
|
|
Measles Antibodies, IgG SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
Measles Antibodies, IgM SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
Measles IgG Antibody
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
meclizine 12.5 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77680581
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
meclizine 12.5 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77680581
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
meclizine 25 mg Chew Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77680634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
meclizine 25 mg Chew Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77680634
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
Meconium 5 Panel SO
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640102
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$278.96
|
|
|
Meconium 5 Panel SO
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$65.24
|
| Rate for Payer: Aetna Medicare |
$93.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Amerigroup Medicare |
$62.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$123.04
|
| Rate for Payer: BCBS of TX Medicare |
$62.14
|
| Rate for Payer: BCBS of TX PPO |
$137.33
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cigna Medicaid |
$62.14
|
| Rate for Payer: Cigna Medicare |
$62.14
|
| Rate for Payer: Employer Direct Commercial |
$62.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$62.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Molina Medicare |
$62.14
|
| Rate for Payer: Multiplan Auto |
$206.05
|
| Rate for Payer: Multiplan Commercial |
$206.05
|
| Rate for Payer: Multiplan Workers Comp |
$206.05
|
| Rate for Payer: Parkland Medicaid |
$62.14
|
| Rate for Payer: Scott and White EPO/PPO |
$77.68
|
| Rate for Payer: Scott and White Medicare |
$62.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.14
|
| Rate for Payer: Superior Health Plan EPO |
$62.14
|
| Rate for Payer: Superior Health Plan Medicare |
$62.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Universal American Medicare |
$62.14
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: Wellmed Medicare |
$62.14
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$32,336.10
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$13,427.18 |
| Max. Negotiated Rate |
$32,336.10 |
| Rate for Payer: Aetna Commercial |
$19,146.38
|
| Rate for Payer: Aetna Medicare |
$22,499.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,999.64
|
| Rate for Payer: Amerigroup Medicare |
$14,999.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,427.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,423.72
|
| Rate for Payer: BCBS of TX Medicare |
$14,999.64
|
| Rate for Payer: BCBS of TX PPO |
$18,249.29
|
| Rate for Payer: Cigna Commercial |
$21,920.47
|
| Rate for Payer: Cigna Medicare |
$14,999.64
|
| Rate for Payer: Employer Direct Commercial |
$14,999.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,999.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,999.64
|
| Rate for Payer: Molina Medicare |
$14,999.64
|
| Rate for Payer: Multiplan Auto |
$32,336.10
|
| Rate for Payer: Multiplan Commercial |
$32,336.10
|
| Rate for Payer: Multiplan Workers Comp |
$32,336.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14,891.62
|
| Rate for Payer: Scott and White Medicare |
$14,999.64
|
| Rate for Payer: Superior Health Plan EPO |
$14,999.64
|
| Rate for Payer: Superior Health Plan Medicare |
$14,999.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,999.64
|
| Rate for Payer: Universal American Medicare |
$14,999.64
|
| Rate for Payer: Wellcare Medicare |
$14,999.64
|
| Rate for Payer: Wellmed Medicare |
$14,999.64
|
|
