|
MI Fusion, Sacroiliac Joint
|
Facility
|
OP
|
$40,184.12
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
36027279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.93 |
| Max. Negotiated Rate |
$40,184.12 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$25,565.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Amerigroup Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| Rate for Payer: Cigna Commercial |
$38,608.57
|
| Rate for Payer: Cigna Medicare |
$17,043.54
|
| Rate for Payer: Employer Direct Commercial |
$17,043.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,043.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Molina Medicare |
$17,043.54
|
| 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 |
$375.93
|
| Rate for Payer: Scott and White Medicare |
$17,043.54
|
| Rate for Payer: Superior Health Plan EPO |
$17,043.54
|
| Rate for Payer: Superior Health Plan Medicare |
$17,043.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Universal American Medicare |
$17,043.54
|
| Rate for Payer: Wellcare Medicare |
$17,043.54
|
| Rate for Payer: Wellmed Medicare |
$17,043.54
|
|
|
MILD Percutaneous laminotomy/laminectomy
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 0275T
|
| Hospital Charge Code |
3600275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.01 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$117.01
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
mineral oil Oral Liquid 30 mL
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77706917
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
mineral oil Oral Liquid 30 mL
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77706917
|
|
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
|
|
|
Minimum Inhibitory Concentration
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4157186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Amerigroup Medicare |
$8.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.13
|
| Rate for Payer: BCBS of TX Medicare |
$8.65
|
| Rate for Payer: BCBS of TX PPO |
$19.12
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cigna Medicaid |
$8.65
|
| Rate for Payer: Cigna Medicare |
$8.65
|
| Rate for Payer: Employer Direct Commercial |
$8.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Molina Medicare |
$8.65
|
| 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: Parkland Medicaid |
$8.65
|
| Rate for Payer: Scott and White EPO/PPO |
$10.81
|
| Rate for Payer: Scott and White Medicare |
$8.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.65
|
| Rate for Payer: Superior Health Plan EPO |
$8.65
|
| Rate for Payer: Superior Health Plan Medicare |
$8.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Universal American Medicare |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: Wellmed Medicare |
$8.65
|
|
|
Minimum Inhibitory Concentration
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4157186
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$220.88
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$27,721.00
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$12,766.25 |
| Max. Negotiated Rate |
$27,721.00 |
| Rate for Payer: Aetna Commercial |
$16,413.75
|
| Rate for Payer: Aetna Medicare |
$19,899.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,266.28
|
| Rate for Payer: Amerigroup Medicare |
$13,266.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,953.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,926.26
|
| Rate for Payer: BCBS of TX Medicare |
$13,266.28
|
| Rate for Payer: BCBS of TX PPO |
$18,807.68
|
| Rate for Payer: Cigna Commercial |
$18,791.92
|
| Rate for Payer: Cigna Medicare |
$13,266.28
|
| Rate for Payer: Employer Direct Commercial |
$13,266.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,266.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,266.28
|
| Rate for Payer: Molina Medicare |
$13,266.28
|
| Rate for Payer: Multiplan Auto |
$27,721.00
|
| Rate for Payer: Multiplan Commercial |
$27,721.00
|
| Rate for Payer: Multiplan Workers Comp |
$27,721.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,766.25
|
| Rate for Payer: Scott and White Medicare |
$13,266.28
|
| Rate for Payer: Superior Health Plan EPO |
$13,266.28
|
| Rate for Payer: Superior Health Plan Medicare |
$13,266.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,266.28
|
| Rate for Payer: Universal American Medicare |
$13,266.28
|
| Rate for Payer: Wellcare Medicare |
$13,266.28
|
| Rate for Payer: Wellmed Medicare |
$13,266.28
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$56,937.30
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$24,239.41 |
| Max. Negotiated Rate |
$56,937.30 |
| Rate for Payer: Aetna Commercial |
$33,712.88
|
| Rate for Payer: Aetna Medicare |
$36,359.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,239.41
|
| Rate for Payer: Amerigroup Medicare |
$24,239.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24,881.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32,801.01
|
| Rate for Payer: BCBS of TX Medicare |
$24,239.41
|
| Rate for Payer: BCBS of TX PPO |
$36,446.97
|
| Rate for Payer: Cigna Commercial |
$38,597.50
|
| Rate for Payer: Cigna Medicare |
$24,239.41
|
| Rate for Payer: Employer Direct Commercial |
$24,239.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,239.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,239.41
|
| Rate for Payer: Molina Medicare |
$24,239.41
|
| Rate for Payer: Multiplan Auto |
$56,937.30
|
| Rate for Payer: Multiplan Commercial |
$56,937.30
|
| Rate for Payer: Multiplan Workers Comp |
$56,937.30
|
| Rate for Payer: Scott and White EPO/PPO |
$26,221.12
|
| Rate for Payer: Scott and White Medicare |
$24,239.41
|
| Rate for Payer: Superior Health Plan EPO |
$24,239.41
|
| Rate for Payer: Superior Health Plan Medicare |
$24,239.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,239.41
|
| Rate for Payer: Universal American Medicare |
$24,239.41
|
| Rate for Payer: Wellcare Medicare |
$24,239.41
|
| Rate for Payer: Wellmed Medicare |
$24,239.41
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,170.40
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$9,289.00 |
| Max. Negotiated Rate |
$20,170.40 |
| Rate for Payer: Aetna Commercial |
$11,943.00
|
| Rate for Payer: Aetna Medicare |
$15,645.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,430.43
|
| Rate for Payer: Amerigroup Medicare |
$10,430.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,445.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,235.24
|
| Rate for Payer: BCBS of TX Medicare |
$10,430.43
|
| Rate for Payer: BCBS of TX PPO |
$13,595.24
|
| Rate for Payer: Cigna Commercial |
$13,673.41
|
| Rate for Payer: Cigna Medicare |
$10,430.43
|
| Rate for Payer: Employer Direct Commercial |
$10,430.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,430.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,430.43
|
| Rate for Payer: Molina Medicare |
$10,430.43
|
| Rate for Payer: Multiplan Auto |
$20,170.40
|
| Rate for Payer: Multiplan Commercial |
$20,170.40
|
| Rate for Payer: Multiplan Workers Comp |
$20,170.40
|
| Rate for Payer: Scott and White EPO/PPO |
$9,289.00
|
| Rate for Payer: Scott and White Medicare |
$10,430.43
|
| Rate for Payer: Superior Health Plan EPO |
$10,430.43
|
| Rate for Payer: Superior Health Plan Medicare |
$10,430.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,430.43
|
| Rate for Payer: Universal American Medicare |
$10,430.43
|
| Rate for Payer: Wellcare Medicare |
$10,430.43
|
| Rate for Payer: Wellmed Medicare |
$10,430.43
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$30,130.20
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$12,093.32 |
| Max. Negotiated Rate |
$30,130.20 |
| Rate for Payer: Aetna Commercial |
$17,840.25
|
| Rate for Payer: Aetna Medicare |
$21,256.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,171.15
|
| Rate for Payer: Amerigroup Medicare |
$14,171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,093.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,248.48
|
| Rate for Payer: BCBS of TX Medicare |
$14,171.15
|
| Rate for Payer: BCBS of TX PPO |
$15,832.25
|
| Rate for Payer: Cigna Commercial |
$20,425.10
|
| Rate for Payer: Cigna Medicare |
$14,171.15
|
| Rate for Payer: Employer Direct Commercial |
$14,171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,171.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,171.15
|
| Rate for Payer: Molina Medicare |
$14,171.15
|
| Rate for Payer: Multiplan Auto |
$30,130.20
|
| Rate for Payer: Multiplan Commercial |
$30,130.20
|
| Rate for Payer: Multiplan Workers Comp |
$30,130.20
|
| Rate for Payer: Scott and White EPO/PPO |
$13,875.75
|
| Rate for Payer: Scott and White Medicare |
$14,171.15
|
| Rate for Payer: Superior Health Plan EPO |
$14,171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$14,171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,171.15
|
| Rate for Payer: Universal American Medicare |
$14,171.15
|
| Rate for Payer: Wellcare Medicare |
$14,171.15
|
| Rate for Payer: Wellmed Medicare |
$14,171.15
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$16,976.50
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$6,638.34 |
| Max. Negotiated Rate |
$16,976.50 |
| Rate for Payer: Aetna Commercial |
$10,051.88
|
| Rate for Payer: Aetna Medicare |
$13,846.29
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,230.86
|
| Rate for Payer: Amerigroup Medicare |
$9,230.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,638.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,265.52
|
| Rate for Payer: BCBS of TX Medicare |
$9,230.86
|
| Rate for Payer: BCBS of TX PPO |
$9,184.27
|
| Rate for Payer: Cigna Commercial |
$11,508.28
|
| Rate for Payer: Cigna Medicare |
$9,230.86
|
| Rate for Payer: Employer Direct Commercial |
$9,230.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,230.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,230.86
|
| Rate for Payer: Molina Medicare |
$9,230.86
|
| Rate for Payer: Multiplan Auto |
$16,976.50
|
| Rate for Payer: Multiplan Commercial |
$16,976.50
|
| Rate for Payer: Multiplan Workers Comp |
$16,976.50
|
| Rate for Payer: Scott and White EPO/PPO |
$7,818.12
|
| Rate for Payer: Scott and White Medicare |
$9,230.86
|
| Rate for Payer: Superior Health Plan EPO |
$9,230.86
|
| Rate for Payer: Superior Health Plan Medicare |
$9,230.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,230.86
|
| Rate for Payer: Universal American Medicare |
$9,230.86
|
| Rate for Payer: Wellcare Medicare |
$9,230.86
|
| Rate for Payer: Wellmed Medicare |
$9,230.86
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$29,271.40
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$13,480.25 |
| Max. Negotiated Rate |
$29,271.40 |
| Rate for Payer: Aetna Commercial |
$17,331.75
|
| Rate for Payer: Aetna Medicare |
$20,772.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,848.60
|
| Rate for Payer: Amerigroup Medicare |
$13,848.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,267.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,898.39
|
| Rate for Payer: BCBS of TX Medicare |
$13,848.60
|
| Rate for Payer: BCBS of TX PPO |
$18,776.72
|
| Rate for Payer: Cigna Commercial |
$19,842.93
|
| Rate for Payer: Cigna Medicare |
$13,848.60
|
| Rate for Payer: Employer Direct Commercial |
$13,848.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,848.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,848.60
|
| Rate for Payer: Molina Medicare |
$13,848.60
|
| Rate for Payer: Multiplan Auto |
$29,271.40
|
| Rate for Payer: Multiplan Commercial |
$29,271.40
|
| Rate for Payer: Multiplan Workers Comp |
$29,271.40
|
| Rate for Payer: Scott and White EPO/PPO |
$13,480.25
|
| Rate for Payer: Scott and White Medicare |
$13,848.60
|
| Rate for Payer: Superior Health Plan EPO |
$13,848.60
|
| Rate for Payer: Superior Health Plan Medicare |
$13,848.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,848.60
|
| Rate for Payer: Universal American Medicare |
$13,848.60
|
| Rate for Payer: Wellcare Medicare |
$13,848.60
|
| Rate for Payer: Wellmed Medicare |
$13,848.60
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$52,067.60
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$22,410.44 |
| Max. Negotiated Rate |
$52,067.60 |
| Rate for Payer: Aetna Commercial |
$30,829.50
|
| Rate for Payer: Aetna Medicare |
$33,615.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,410.44
|
| Rate for Payer: Amerigroup Medicare |
$22,410.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,198.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,824.92
|
| Rate for Payer: BCBS of TX Medicare |
$22,410.44
|
| Rate for Payer: BCBS of TX PPO |
$34,251.24
|
| Rate for Payer: Cigna Commercial |
$35,296.35
|
| Rate for Payer: Cigna Medicare |
$22,410.44
|
| Rate for Payer: Employer Direct Commercial |
$22,410.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,410.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,410.44
|
| Rate for Payer: Molina Medicare |
$22,410.44
|
| Rate for Payer: Multiplan Auto |
$52,067.60
|
| Rate for Payer: Multiplan Commercial |
$52,067.60
|
| Rate for Payer: Multiplan Workers Comp |
$52,067.60
|
| Rate for Payer: Scott and White EPO/PPO |
$23,978.50
|
| Rate for Payer: Scott and White Medicare |
$22,410.44
|
| Rate for Payer: Superior Health Plan EPO |
$22,410.44
|
| Rate for Payer: Superior Health Plan Medicare |
$22,410.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,410.44
|
| Rate for Payer: Universal American Medicare |
$22,410.44
|
| Rate for Payer: Wellcare Medicare |
$22,410.44
|
| Rate for Payer: Wellmed Medicare |
$22,410.44
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,468.20
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$10,580.58 |
| Max. Negotiated Rate |
$24,468.20 |
| Rate for Payer: Aetna Commercial |
$14,487.75
|
| Rate for Payer: Aetna Medicare |
$18,066.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,044.61
|
| Rate for Payer: Amerigroup Medicare |
$12,044.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,580.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,760.48
|
| Rate for Payer: BCBS of TX Medicare |
$12,044.61
|
| Rate for Payer: BCBS of TX PPO |
$14,178.86
|
| Rate for Payer: Cigna Commercial |
$16,586.86
|
| Rate for Payer: Cigna Medicare |
$12,044.61
|
| Rate for Payer: Employer Direct Commercial |
$12,044.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,044.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,044.61
|
| Rate for Payer: Molina Medicare |
$12,044.61
|
| Rate for Payer: Multiplan Auto |
$24,468.20
|
| Rate for Payer: Multiplan Commercial |
$24,468.20
|
| Rate for Payer: Multiplan Workers Comp |
$24,468.20
|
| Rate for Payer: Scott and White EPO/PPO |
$11,268.25
|
| Rate for Payer: Scott and White Medicare |
$12,044.61
|
| Rate for Payer: Superior Health Plan EPO |
$12,044.61
|
| Rate for Payer: Superior Health Plan Medicare |
$12,044.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,044.61
|
| Rate for Payer: Universal American Medicare |
$12,044.61
|
| Rate for Payer: Wellcare Medicare |
$12,044.61
|
| Rate for Payer: Wellmed Medicare |
$12,044.61
|
|
|
mirtazapine 15 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77708620
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
mirtazapine 15 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77708620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$24,988.80
|
|
|
Service Code
|
MSDRG 640
|
| Min. Negotiated Rate |
$9,832.38 |
| Max. Negotiated Rate |
$24,988.80 |
| Rate for Payer: Aetna Commercial |
$14,796.00
|
| Rate for Payer: Aetna Medicare |
$18,360.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,240.12
|
| Rate for Payer: Amerigroup Medicare |
$12,240.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,832.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,281.67
|
| Rate for Payer: BCBS of TX Medicare |
$12,240.12
|
| Rate for Payer: BCBS of TX PPO |
$13,646.83
|
| Rate for Payer: Cigna Commercial |
$16,939.78
|
| Rate for Payer: Cigna Medicare |
$12,240.12
|
| Rate for Payer: Employer Direct Commercial |
$12,240.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,240.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,240.12
|
| Rate for Payer: Molina Medicare |
$12,240.12
|
| Rate for Payer: Multiplan Auto |
$24,988.80
|
| Rate for Payer: Multiplan Commercial |
$24,988.80
|
| Rate for Payer: Multiplan Workers Comp |
$24,988.80
|
| Rate for Payer: Scott and White EPO/PPO |
$11,508.00
|
| Rate for Payer: Scott and White Medicare |
$12,240.12
|
| Rate for Payer: Superior Health Plan EPO |
$12,240.12
|
| Rate for Payer: Superior Health Plan Medicare |
$12,240.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,240.12
|
| Rate for Payer: Universal American Medicare |
$12,240.12
|
| Rate for Payer: Wellcare Medicare |
$12,240.12
|
| Rate for Payer: Wellmed Medicare |
$12,240.12
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$14,846.60
|
|
|
Service Code
|
MSDRG 641
|
| Min. Negotiated Rate |
$6,175.66 |
| Max. Negotiated Rate |
$14,846.60 |
| Rate for Payer: Aetna Commercial |
$8,790.75
|
| Rate for Payer: Aetna Medicare |
$12,646.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,430.90
|
| Rate for Payer: Amerigroup Medicare |
$8,430.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,175.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,758.86
|
| Rate for Payer: BCBS of TX Medicare |
$8,430.90
|
| Rate for Payer: BCBS of TX PPO |
$8,621.29
|
| Rate for Payer: Cigna Commercial |
$10,064.43
|
| Rate for Payer: Cigna Medicare |
$8,430.90
|
| Rate for Payer: Employer Direct Commercial |
$8,430.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,430.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,430.90
|
| Rate for Payer: Molina Medicare |
$8,430.90
|
| Rate for Payer: Multiplan Auto |
$14,846.60
|
| Rate for Payer: Multiplan Commercial |
$14,846.60
|
| Rate for Payer: Multiplan Workers Comp |
$14,846.60
|
| Rate for Payer: Scott and White EPO/PPO |
$6,837.25
|
| Rate for Payer: Scott and White Medicare |
$8,430.90
|
| Rate for Payer: Superior Health Plan EPO |
$8,430.90
|
| Rate for Payer: Superior Health Plan Medicare |
$8,430.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,430.90
|
| Rate for Payer: Universal American Medicare |
$8,430.90
|
| Rate for Payer: Wellcare Medicare |
$8,430.90
|
| Rate for Payer: Wellmed Medicare |
$8,430.90
|
|
|
Mitochondrial (M2) Antibody SO
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$26.72
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.39
|
| Rate for Payer: BCBS of TX Medicare |
$25.45
|
| Rate for Payer: BCBS of TX PPO |
$56.24
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Medicaid |
$25.45
|
| Rate for Payer: Cigna Medicare |
$25.45
|
| Rate for Payer: Employer Direct Commercial |
$25.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Molina Medicare |
$25.45
|
| Rate for Payer: Multiplan Auto |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Multiplan Workers Comp |
$126.75
|
| Rate for Payer: Parkland Medicaid |
$25.45
|
| Rate for Payer: Scott and White EPO/PPO |
$31.81
|
| Rate for Payer: Scott and White Medicare |
$25.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.45
|
| Rate for Payer: Superior Health Plan EPO |
$25.45
|
| Rate for Payer: Superior Health Plan Medicare |
$25.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Universal American Medicare |
$25.45
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: Wellmed Medicare |
$25.45
|
|
|
Mitochondrial (M2) Antibody SO
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$171.60
|
|
|
.M. marinum Susceptibility 182842 SO
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Amerigroup Medicare |
$8.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.13
|
| Rate for Payer: BCBS of TX Medicare |
$8.65
|
| Rate for Payer: BCBS of TX PPO |
$19.12
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cigna Medicaid |
$8.65
|
| Rate for Payer: Cigna Medicare |
$8.65
|
| Rate for Payer: Employer Direct Commercial |
$8.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Molina Medicare |
$8.65
|
| 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: Parkland Medicaid |
$8.65
|
| Rate for Payer: Scott and White EPO/PPO |
$10.81
|
| Rate for Payer: Scott and White Medicare |
$8.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.65
|
| Rate for Payer: Superior Health Plan EPO |
$8.65
|
| Rate for Payer: Superior Health Plan Medicare |
$8.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Universal American Medicare |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: Wellmed Medicare |
$8.65
|
|
|
modafinil 100 mg Tab
|
Facility
|
IP
|
$37.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77709492
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$25.64
|
|
|
modafinil 100 mg Tab
|
Facility
|
OP
|
$37.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77709492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.57
|
| Rate for Payer: BCBS of TX PPO |
$15.08
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Multiplan Auto |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$24.50
|
| Rate for Payer: Multiplan Workers Comp |
$24.50
|
| Rate for Payer: Scott and White EPO/PPO |
$18.85
|
| Rate for Payer: Superior Health Plan EPO |
$5.13
|
|
|
Modified Hodge Test SO
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
1630041
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.75
|
| Rate for Payer: Amerigroup Medicare |
$4.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.40
|
| Rate for Payer: BCBS of TX Medicare |
$4.75
|
| Rate for Payer: BCBS of TX PPO |
$10.50
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cigna Medicaid |
$4.75
|
| Rate for Payer: Cigna Medicare |
$4.75
|
| Rate for Payer: Employer Direct Commercial |
$4.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.75
|
| Rate for Payer: Molina Medicare |
$4.75
|
| Rate for Payer: Multiplan Auto |
$74.10
|
| Rate for Payer: Multiplan Commercial |
$74.10
|
| Rate for Payer: Multiplan Workers Comp |
$74.10
|
| Rate for Payer: Parkland Medicaid |
$4.75
|
| Rate for Payer: Scott and White EPO/PPO |
$5.94
|
| Rate for Payer: Scott and White Medicare |
$4.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.75
|
| Rate for Payer: Superior Health Plan EPO |
$4.75
|
| Rate for Payer: Superior Health Plan Medicare |
$4.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.75
|
| Rate for Payer: Universal American Medicare |
$4.75
|
| Rate for Payer: Wellcare Medicare |
$4.75
|
| Rate for Payer: Wellmed Medicare |
$4.75
|
|
|
Modified Hodge Test SO
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
1630041
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$100.32
|
|
