|
MSK AMBU INFANT -- DHF
|
Facility
|
OP
|
$67.43
|
|
| Hospital Charge Code |
82055658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$37.09
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.27
|
| Rate for Payer: BCBS of TX PPO |
$26.97
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Multiplan Auto |
$43.83
|
| Rate for Payer: Multiplan Commercial |
$43.83
|
| Rate for Payer: Multiplan Workers Comp |
$43.83
|
| Rate for Payer: Scott and White EPO/PPO |
$33.72
|
| Rate for Payer: Superior Health Plan EPO |
$9.17
|
|
|
MSK NASAL CPAP -- DHF
|
Facility
|
OP
|
$75.16
|
|
| Hospital Charge Code |
82056979
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27.06
|
| Rate for Payer: BCBS of TX PPO |
$30.06
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Multiplan Auto |
$48.85
|
| Rate for Payer: Multiplan Commercial |
$48.85
|
| Rate for Payer: Multiplan Workers Comp |
$48.85
|
| Rate for Payer: Scott and White EPO/PPO |
$37.58
|
| Rate for Payer: Superior Health Plan EPO |
$10.22
|
|
|
MSK NASAL CPAP -- DHF
|
Facility
|
IP
|
$75.16
|
|
| Hospital Charge Code |
82056979
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$66.14
|
|
|
.Mtb AST Confirm 182691 SO
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 87190
|
| Hospital Charge Code |
1700035
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$129.36
|
|
|
.Mtb AST Confirm 182691 SO
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 87190
|
| Hospital Charge Code |
1700035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Amerigroup Medicare |
$7.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.47
|
| Rate for Payer: BCBS of TX Medicare |
$7.31
|
| Rate for Payer: BCBS of TX PPO |
$16.16
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cigna Medicaid |
$7.31
|
| Rate for Payer: Cigna Medicare |
$7.31
|
| Rate for Payer: Employer Direct Commercial |
$7.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Molina Medicare |
$7.31
|
| Rate for Payer: Multiplan Auto |
$95.55
|
| Rate for Payer: Multiplan Commercial |
$95.55
|
| Rate for Payer: Multiplan Workers Comp |
$95.55
|
| Rate for Payer: Parkland Medicaid |
$7.31
|
| Rate for Payer: Scott and White EPO/PPO |
$9.14
|
| Rate for Payer: Scott and White Medicare |
$7.31
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.31
|
| Rate for Payer: Superior Health Plan EPO |
$7.31
|
| Rate for Payer: Superior Health Plan Medicare |
$7.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Universal American Medicare |
$7.31
|
| Rate for Payer: Wellcare Medicare |
$7.31
|
| Rate for Payer: Wellmed Medicare |
$7.31
|
|
|
.Mtb AST Confirm 183792 SO
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 87190
|
| Hospital Charge Code |
1700035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Amerigroup Medicare |
$7.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.47
|
| Rate for Payer: BCBS of TX Medicare |
$7.31
|
| Rate for Payer: BCBS of TX PPO |
$16.16
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cash Price |
$129.36
|
| Rate for Payer: Cigna Medicaid |
$7.31
|
| Rate for Payer: Cigna Medicare |
$7.31
|
| Rate for Payer: Employer Direct Commercial |
$7.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Molina Medicare |
$7.31
|
| Rate for Payer: Multiplan Auto |
$95.55
|
| Rate for Payer: Multiplan Commercial |
$95.55
|
| Rate for Payer: Multiplan Workers Comp |
$95.55
|
| Rate for Payer: Parkland Medicaid |
$7.31
|
| Rate for Payer: Scott and White EPO/PPO |
$9.14
|
| Rate for Payer: Scott and White Medicare |
$7.31
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.31
|
| Rate for Payer: Superior Health Plan EPO |
$7.31
|
| Rate for Payer: Superior Health Plan Medicare |
$7.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.31
|
| Rate for Payer: Universal American Medicare |
$7.31
|
| Rate for Payer: Wellcare Medicare |
$7.31
|
| Rate for Payer: Wellmed Medicare |
$7.31
|
|
|
.Mtb Suscept Broth 183798 SO
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
1700034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Medicare |
$6.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.15
|
| Rate for Payer: BCBS of TX Medicare |
$6.64
|
| Rate for Payer: BCBS of TX PPO |
$14.67
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cigna Medicaid |
$6.64
|
| Rate for Payer: Cigna Medicare |
$6.64
|
| Rate for Payer: Employer Direct Commercial |
$6.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Molina Medicare |
$6.64
|
| Rate for Payer: Multiplan Auto |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$118.30
|
| Rate for Payer: Multiplan Workers Comp |
$118.30
|
| Rate for Payer: Parkland Medicaid |
$6.64
|
| Rate for Payer: Scott and White EPO/PPO |
$8.30
|
| Rate for Payer: Scott and White Medicare |
$6.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.64
|
| Rate for Payer: Superior Health Plan EPO |
$6.64
|
| Rate for Payer: Superior Health Plan Medicare |
$6.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Universal American Medicare |
$6.64
|
| Rate for Payer: Wellcare Medicare |
$6.64
|
| Rate for Payer: Wellmed Medicare |
$6.64
|
|
|
MTB SUSCEPTIBILITY BROTH
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
1700034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Medicare |
$6.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.15
|
| Rate for Payer: BCBS of TX Medicare |
$6.64
|
| Rate for Payer: BCBS of TX PPO |
$14.67
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cigna Medicaid |
$6.64
|
| Rate for Payer: Cigna Medicare |
$6.64
|
| Rate for Payer: Employer Direct Commercial |
$6.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Molina Medicare |
$6.64
|
| Rate for Payer: Multiplan Auto |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$118.30
|
| Rate for Payer: Multiplan Workers Comp |
$118.30
|
| Rate for Payer: Parkland Medicaid |
$6.64
|
| Rate for Payer: Scott and White EPO/PPO |
$8.30
|
| Rate for Payer: Scott and White Medicare |
$6.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.64
|
| Rate for Payer: Superior Health Plan EPO |
$6.64
|
| Rate for Payer: Superior Health Plan Medicare |
$6.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Universal American Medicare |
$6.64
|
| Rate for Payer: Wellcare Medicare |
$6.64
|
| Rate for Payer: Wellmed Medicare |
$6.64
|
|
|
.Mtb Susceptibility Broth 182579 SO
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
1700034
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$160.16
|
|
|
.Mtb Susceptibility Broth 182579 SO
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
1700034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Medicare |
$6.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13.15
|
| Rate for Payer: BCBS of TX Medicare |
$6.64
|
| Rate for Payer: BCBS of TX PPO |
$14.67
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cigna Medicaid |
$6.64
|
| Rate for Payer: Cigna Medicare |
$6.64
|
| Rate for Payer: Employer Direct Commercial |
$6.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Molina Medicare |
$6.64
|
| Rate for Payer: Multiplan Auto |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$118.30
|
| Rate for Payer: Multiplan Workers Comp |
$118.30
|
| Rate for Payer: Parkland Medicaid |
$6.64
|
| Rate for Payer: Scott and White EPO/PPO |
$8.30
|
| Rate for Payer: Scott and White Medicare |
$6.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.64
|
| Rate for Payer: Superior Health Plan EPO |
$6.64
|
| Rate for Payer: Superior Health Plan Medicare |
$6.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.64
|
| Rate for Payer: Universal American Medicare |
$6.64
|
| Rate for Payer: Wellcare Medicare |
$6.64
|
| Rate for Payer: Wellmed Medicare |
$6.64
|
|
|
MUE 1 - Percutaneous implantation of neurostimulator electrode array; cranial nerve
|
Facility
|
OP
|
$28,220.93
|
|
|
Service Code
|
CPT 64553
|
| Hospital Charge Code |
36064553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$274.78 |
| Max. Negotiated Rate |
$28,220.93 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$18,686.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7,950.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Amerigroup Medicare |
$12,457.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$12,457.97
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$28,220.93
|
| Rate for Payer: Cigna Medicaid |
$7,950.18
|
| Rate for Payer: Cigna Medicare |
$12,457.97
|
| Rate for Payer: Employer Direct Commercial |
$12,457.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,457.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,950.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Molina Medicare |
$12,457.97
|
| 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 |
$7,950.18
|
| Rate for Payer: Scott and White EPO/PPO |
$274.78
|
| Rate for Payer: Scott and White Medicare |
$12,457.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,950.18
|
| Rate for Payer: Superior Health Plan EPO |
$12,457.97
|
| Rate for Payer: Superior Health Plan Medicare |
$12,457.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Universal American Medicare |
$12,457.97
|
| Rate for Payer: Wellcare Medicare |
$12,457.97
|
| Rate for Payer: Wellmed Medicare |
$12,457.97
|
|
|
MUE 2 - The incision for implantation of neurostimulator electrode array peripheral nerve (excludes
|
Facility
|
OP
|
$48,584.14
|
|
|
Service Code
|
CPT 64575
|
| Hospital Charge Code |
36064575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$274.78 |
| Max. Negotiated Rate |
$48,584.14 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$18,686.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,186.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Amerigroup Medicare |
$12,457.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$32,196.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38,558.84
|
| Rate for Payer: BCBS of TX Medicare |
$12,457.97
|
| Rate for Payer: BCBS of TX PPO |
$48,584.14
|
| Rate for Payer: Cigna Commercial |
$28,220.93
|
| Rate for Payer: Cigna Medicaid |
$8,186.92
|
| Rate for Payer: Cigna Medicare |
$12,457.97
|
| Rate for Payer: Employer Direct Commercial |
$12,457.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,457.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,186.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Molina Medicare |
$12,457.97
|
| 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 |
$8,186.92
|
| Rate for Payer: Scott and White EPO/PPO |
$274.78
|
| Rate for Payer: Scott and White Medicare |
$12,457.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,186.92
|
| Rate for Payer: Superior Health Plan EPO |
$12,457.97
|
| Rate for Payer: Superior Health Plan Medicare |
$12,457.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,457.97
|
| Rate for Payer: Universal American Medicare |
$12,457.97
|
| Rate for Payer: Wellcare Medicare |
$12,457.97
|
| Rate for Payer: Wellmed Medicare |
$12,457.97
|
|
|
Multilayer Compression Wrap:Below the Knee Bilateral
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 29581 50
|
| Hospital Charge Code |
7150774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$274.95
|
| Rate for Payer: Multiplan Workers Comp |
$274.95
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$56.48
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
Multilayer Compression Wrap:Below the Knee Left
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 29581 LT
|
| Hospital Charge Code |
7150830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$155.10
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$183.30
|
| Rate for Payer: Multiplan Commercial |
$183.30
|
| Rate for Payer: Multiplan Workers Comp |
$183.30
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$56.48
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
Multilayer Compression Wrap:Below the Knee Right
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 29581 RT
|
| Hospital Charge Code |
7150829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$155.10
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$183.30
|
| Rate for Payer: Multiplan Commercial |
$183.30
|
| Rate for Payer: Multiplan Workers Comp |
$183.30
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$56.48
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$22,556.80
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$9,033.44 |
| Max. Negotiated Rate |
$22,556.80 |
| Rate for Payer: Aetna Commercial |
$13,356.00
|
| Rate for Payer: Aetna Medicare |
$16,990.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,326.71
|
| Rate for Payer: Amerigroup Medicare |
$11,326.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,033.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,343.68
|
| Rate for Payer: BCBS of TX Medicare |
$11,326.71
|
| Rate for Payer: BCBS of TX PPO |
$12,604.57
|
| Rate for Payer: Cigna Commercial |
$15,291.14
|
| Rate for Payer: Cigna Medicare |
$11,326.71
|
| Rate for Payer: Employer Direct Commercial |
$11,326.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,326.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,326.71
|
| Rate for Payer: Molina Medicare |
$11,326.71
|
| Rate for Payer: Multiplan Auto |
$22,556.80
|
| Rate for Payer: Multiplan Commercial |
$22,556.80
|
| Rate for Payer: Multiplan Workers Comp |
$22,556.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10,388.00
|
| Rate for Payer: Scott and White Medicare |
$11,326.71
|
| Rate for Payer: Superior Health Plan EPO |
$11,326.71
|
| Rate for Payer: Superior Health Plan Medicare |
$11,326.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,326.71
|
| Rate for Payer: Universal American Medicare |
$11,326.71
|
| Rate for Payer: Wellcare Medicare |
$11,326.71
|
| Rate for Payer: Wellmed Medicare |
$11,326.71
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$32,830.10
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$14,496.16 |
| Max. Negotiated Rate |
$32,830.10 |
| Rate for Payer: Aetna Commercial |
$19,438.88
|
| Rate for Payer: Aetna Medicare |
$22,777.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,185.18
|
| Rate for Payer: Amerigroup Medicare |
$15,185.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,496.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,157.31
|
| Rate for Payer: BCBS of TX Medicare |
$15,185.18
|
| Rate for Payer: BCBS of TX PPO |
$20,175.57
|
| Rate for Payer: Cigna Commercial |
$22,255.35
|
| Rate for Payer: Cigna Medicare |
$15,185.18
|
| Rate for Payer: Employer Direct Commercial |
$15,185.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,185.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,185.18
|
| Rate for Payer: Molina Medicare |
$15,185.18
|
| Rate for Payer: Multiplan Auto |
$32,830.10
|
| Rate for Payer: Multiplan Commercial |
$32,830.10
|
| Rate for Payer: Multiplan Workers Comp |
$32,830.10
|
| Rate for Payer: Scott and White EPO/PPO |
$15,119.12
|
| Rate for Payer: Scott and White Medicare |
$15,185.18
|
| Rate for Payer: Superior Health Plan EPO |
$15,185.18
|
| Rate for Payer: Superior Health Plan Medicare |
$15,185.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,185.18
|
| Rate for Payer: Universal American Medicare |
$15,185.18
|
| Rate for Payer: Wellcare Medicare |
$15,185.18
|
| Rate for Payer: Wellmed Medicare |
$15,185.18
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$17,050.60
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$7,003.84 |
| Max. Negotiated Rate |
$17,050.60 |
| Rate for Payer: Aetna Commercial |
$10,095.75
|
| Rate for Payer: Aetna Medicare |
$13,888.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,258.68
|
| Rate for Payer: Amerigroup Medicare |
$9,258.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,003.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,592.63
|
| Rate for Payer: BCBS of TX Medicare |
$9,258.68
|
| Rate for Payer: BCBS of TX PPO |
$9,547.74
|
| Rate for Payer: Cigna Commercial |
$11,558.51
|
| Rate for Payer: Cigna Medicare |
$9,258.68
|
| Rate for Payer: Employer Direct Commercial |
$9,258.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,258.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,258.68
|
| Rate for Payer: Molina Medicare |
$9,258.68
|
| Rate for Payer: Multiplan Auto |
$17,050.60
|
| Rate for Payer: Multiplan Commercial |
$17,050.60
|
| Rate for Payer: Multiplan Workers Comp |
$17,050.60
|
| Rate for Payer: Scott and White EPO/PPO |
$7,852.25
|
| Rate for Payer: Scott and White Medicare |
$9,258.68
|
| Rate for Payer: Superior Health Plan EPO |
$9,258.68
|
| Rate for Payer: Superior Health Plan Medicare |
$9,258.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,258.68
|
| Rate for Payer: Universal American Medicare |
$9,258.68
|
| Rate for Payer: Wellcare Medicare |
$9,258.68
|
| Rate for Payer: Wellmed Medicare |
$9,258.68
|
|
|
Multiple Vitamins IV Soln 10 mL
|
Facility
|
IP
|
$630.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77715887
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$429.07
|
|
|
Multiple Vitamins IV Soln 10 mL
|
Facility
|
OP
|
$630.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77715887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.79 |
| Max. Negotiated Rate |
$410.14 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$227.16
|
| Rate for Payer: BCBS of TX PPO |
$252.40
|
| Rate for Payer: Cash Price |
$429.07
|
| Rate for Payer: Multiplan Auto |
$410.14
|
| Rate for Payer: Multiplan Commercial |
$410.14
|
| Rate for Payer: Multiplan Workers Comp |
$410.14
|
| Rate for Payer: Scott and White EPO/PPO |
$315.50
|
| Rate for Payer: Superior Health Plan EPO |
$85.81
|
|
|
Multi Sleep Latency Test 95805
|
Facility
|
OP
|
$3,115.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
6912115
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,024.75 |
| Rate for Payer: Aetna Commercial |
$621.76
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$639.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$763.86
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$852.00
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,024.75
|
| Rate for Payer: Multiplan Commercial |
$2,024.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,024.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
Multi Sleep Latency Test 95805
|
Facility
|
OP
|
$3,115.00
|
|
|
Service Code
|
CPT 95805 52
|
| Hospital Charge Code |
6912115
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,024.75 |
| Rate for Payer: Aetna Commercial |
$621.76
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$639.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$763.86
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$852.00
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,024.75
|
| Rate for Payer: Multiplan Commercial |
$2,024.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,024.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
Multi Sleep Latency Test 95805 BCE
|
Facility
|
OP
|
$3,115.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
6912115
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$2,024.75 |
| Rate for Payer: Aetna Commercial |
$621.76
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$639.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$763.86
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$852.00
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$2,024.75
|
| Rate for Payer: Multiplan Commercial |
$2,024.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,024.75
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
|
Multi Sleep Latency Test 95805 BCE
|
Facility
|
IP
|
$3,115.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
6912115
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$2,741.20
|
|
|
Mumps Antibodies, IgG SO
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
1705557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$13.70
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.84
|
| Rate for Payer: BCBS of TX Medicare |
$13.05
|
| Rate for Payer: BCBS of TX PPO |
$28.84
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$13.05
|
| Rate for Payer: Cigna Medicare |
$13.05
|
| Rate for Payer: Employer Direct Commercial |
$13.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Molina Medicare |
$13.05
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Parkland Medicaid |
$13.05
|
| Rate for Payer: Scott and White EPO/PPO |
$16.31
|
| Rate for Payer: Scott and White Medicare |
$13.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.05
|
| Rate for Payer: Superior Health Plan EPO |
$13.05
|
| Rate for Payer: Superior Health Plan Medicare |
$13.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Universal American Medicare |
$13.05
|
| Rate for Payer: Wellcare Medicare |
$13.05
|
| Rate for Payer: Wellmed Medicare |
$13.05
|
|
