|
Mumps Antibodies, IgM 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
|
|
|
Mumps Antibodies, IgM SO
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
1705557
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$144.32
|
|
|
Mumps Antibody IgG
|
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
|
|
|
mupirocin topical 2% Ointment
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78432468
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$78.88
|
|
|
mupirocin topical 2% Ointment
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78432468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.76
|
| Rate for Payer: BCBS of TX PPO |
$46.40
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Multiplan Auto |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$75.40
|
| Rate for Payer: Multiplan Workers Comp |
$75.40
|
| Rate for Payer: Scott and White EPO/PPO |
$58.00
|
| Rate for Payer: Superior Health Plan EPO |
$15.78
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap head and neck with named vascular pedicle (ie, buccin
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15733
|
| Hospital Charge Code |
36015733
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,921.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Amerigroup Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cigna Commercial |
$7,432.53
|
| Rate for Payer: Cigna Medicaid |
$1,457.62
|
| Rate for Payer: Cigna Medicare |
$3,281.05
|
| Rate for Payer: Employer Direct Commercial |
$3,281.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,281.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Molina Medicare |
$3,281.05
|
| 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 |
$1,457.62
|
| Rate for Payer: Scott and White EPO/PPO |
$72.37
|
| Rate for Payer: Scott and White Medicare |
$3,281.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Superior Health Plan EPO |
$3,281.05
|
| Rate for Payer: Superior Health Plan Medicare |
$3,281.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Universal American Medicare |
$3,281.05
|
| Rate for Payer: Wellcare Medicare |
$3,281.05
|
| Rate for Payer: Wellmed Medicare |
$3,281.05
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; trunk
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
36015734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,921.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Amerigroup Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cigna Commercial |
$7,432.53
|
| Rate for Payer: Cigna Medicaid |
$1,457.62
|
| Rate for Payer: Cigna Medicare |
$3,281.05
|
| Rate for Payer: Employer Direct Commercial |
$3,281.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,281.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Molina Medicare |
$3,281.05
|
| 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 |
$1,457.62
|
| Rate for Payer: Scott and White EPO/PPO |
$72.37
|
| Rate for Payer: Scott and White Medicare |
$3,281.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Superior Health Plan EPO |
$3,281.05
|
| Rate for Payer: Superior Health Plan Medicare |
$3,281.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Universal American Medicare |
$3,281.05
|
| Rate for Payer: Wellcare Medicare |
$3,281.05
|
| Rate for Payer: Wellmed Medicare |
$3,281.05
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap upper extremity
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15736
|
| Hospital Charge Code |
36015736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| 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 |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$36.79
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
Muscle transfer, any type, shoulder or upper arm single
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 23395
|
| Hospital Charge Code |
36023395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| 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 Medicaid |
$2,398.52
|
| 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 CHIP/Medicaid |
$2,398.52
|
| 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: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| 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
|
|
|
MuSK Antibodies SO
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1703461
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$271.92
|
|
|
MuSK Antibodies SO
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1703461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Amerigroup Medicare |
$18.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36.43
|
| Rate for Payer: BCBS of TX Medicare |
$18.40
|
| Rate for Payer: BCBS of TX PPO |
$40.66
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cigna Medicaid |
$18.40
|
| Rate for Payer: Cigna Medicare |
$18.40
|
| Rate for Payer: Employer Direct Commercial |
$18.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Molina Medicare |
$18.40
|
| Rate for Payer: Multiplan Auto |
$200.85
|
| Rate for Payer: Multiplan Commercial |
$200.85
|
| Rate for Payer: Multiplan Workers Comp |
$200.85
|
| Rate for Payer: Parkland Medicaid |
$18.40
|
| Rate for Payer: Scott and White EPO/PPO |
$23.00
|
| Rate for Payer: Scott and White Medicare |
$18.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.40
|
| Rate for Payer: Superior Health Plan EPO |
$18.40
|
| Rate for Payer: Superior Health Plan Medicare |
$18.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.40
|
| Rate for Payer: Universal American Medicare |
$18.40
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: Wellmed Medicare |
$18.40
|
|
|
Myasthenia Gravis Full Panel SO
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
1707074
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$327.36
|
|
|
Myasthenia Gravis Full Panel SO
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
1707074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$241.80 |
| Rate for Payer: Aetna Commercial |
$12.65
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.86
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$26.63
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: Multiplan Workers Comp |
$241.80
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
Mycoplasma pneu. IgG/IgM Abs SO
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
1701200
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$299.20
|
|
|
Mycoplasma pneu. IgG/IgM Abs SO
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
1701200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Multiplan Workers Comp |
$221.00
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
Mycoplasma pneumoniae, IgG Ab SO
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
1701200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Multiplan Workers Comp |
$221.00
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
Mycoplasma pneumoniae, IgM Ab SO
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
1701200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Multiplan Workers Comp |
$221.00
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
Myelin Basic Protein, CSF SO
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
1703073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$25.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.20
|
| Rate for Payer: Amerigroup Medicare |
$17.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.06
|
| Rate for Payer: BCBS of TX Medicare |
$17.20
|
| Rate for Payer: BCBS of TX PPO |
$38.01
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Medicaid |
$17.20
|
| Rate for Payer: Cigna Medicare |
$17.20
|
| Rate for Payer: Employer Direct Commercial |
$17.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.20
|
| Rate for Payer: Molina Medicare |
$17.20
|
| Rate for Payer: Multiplan Auto |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$105.30
|
| Rate for Payer: Multiplan Workers Comp |
$105.30
|
| Rate for Payer: Parkland Medicaid |
$17.20
|
| Rate for Payer: Scott and White EPO/PPO |
$21.50
|
| Rate for Payer: Scott and White Medicare |
$17.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.20
|
| Rate for Payer: Superior Health Plan EPO |
$17.20
|
| Rate for Payer: Superior Health Plan Medicare |
$17.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.20
|
| Rate for Payer: Universal American Medicare |
$17.20
|
| Rate for Payer: Wellcare Medicare |
$17.20
|
| Rate for Payer: Wellmed Medicare |
$17.20
|
|
|
Myelin Basic Protein, CSF SO
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
1703073
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$142.56
|
|
|
Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more r
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36062305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,136.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,361.64
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,715.67
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| 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 |
$16.15
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$44,026.80
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$19,390.45 |
| Max. Negotiated Rate |
$44,026.80 |
| Rate for Payer: Aetna Commercial |
$26,068.50
|
| Rate for Payer: Aetna Medicare |
$29,085.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,390.45
|
| Rate for Payer: Amerigroup Medicare |
$19,390.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,196.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,235.29
|
| Rate for Payer: BCBS of TX Medicare |
$19,390.45
|
| Rate for Payer: BCBS of TX PPO |
$25,817.99
|
| Rate for Payer: Cigna Commercial |
$29,845.54
|
| Rate for Payer: Cigna Medicare |
$19,390.45
|
| Rate for Payer: Employer Direct Commercial |
$19,390.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,390.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,390.45
|
| Rate for Payer: Molina Medicare |
$19,390.45
|
| Rate for Payer: Multiplan Auto |
$44,026.80
|
| Rate for Payer: Multiplan Commercial |
$44,026.80
|
| Rate for Payer: Multiplan Workers Comp |
$44,026.80
|
| Rate for Payer: Scott and White EPO/PPO |
$20,275.50
|
| Rate for Payer: Scott and White Medicare |
$19,390.45
|
| Rate for Payer: Superior Health Plan EPO |
$19,390.45
|
| Rate for Payer: Superior Health Plan Medicare |
$19,390.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,390.45
|
| Rate for Payer: Universal American Medicare |
$19,390.45
|
| Rate for Payer: Wellcare Medicare |
$19,390.45
|
| Rate for Payer: Wellmed Medicare |
$19,390.45
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$83,387.20
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$35,878.33 |
| Max. Negotiated Rate |
$83,387.20 |
| Rate for Payer: Aetna Commercial |
$49,374.00
|
| Rate for Payer: Aetna Medicare |
$53,817.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35,878.33
|
| Rate for Payer: Amerigroup Medicare |
$35,878.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41,869.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51,057.38
|
| Rate for Payer: BCBS of TX Medicare |
$35,878.33
|
| Rate for Payer: BCBS of TX PPO |
$56,732.62
|
| Rate for Payer: Cigna Commercial |
$56,527.74
|
| Rate for Payer: Cigna Medicare |
$35,878.33
|
| Rate for Payer: Employer Direct Commercial |
$35,878.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$35,878.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35,878.33
|
| Rate for Payer: Molina Medicare |
$35,878.33
|
| Rate for Payer: Multiplan Auto |
$83,387.20
|
| Rate for Payer: Multiplan Commercial |
$83,387.20
|
| Rate for Payer: Multiplan Workers Comp |
$83,387.20
|
| Rate for Payer: Scott and White EPO/PPO |
$38,402.00
|
| Rate for Payer: Scott and White Medicare |
$35,878.33
|
| Rate for Payer: Superior Health Plan EPO |
$35,878.33
|
| Rate for Payer: Superior Health Plan Medicare |
$35,878.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35,878.33
|
| Rate for Payer: Universal American Medicare |
$35,878.33
|
| Rate for Payer: Wellcare Medicare |
$35,878.33
|
| Rate for Payer: Wellmed Medicare |
$35,878.33
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,167.60
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$12,675.54 |
| Max. Negotiated Rate |
$31,167.60 |
| Rate for Payer: Aetna Commercial |
$18,454.50
|
| Rate for Payer: Aetna Medicare |
$21,841.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,560.78
|
| Rate for Payer: Amerigroup Medicare |
$14,560.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,675.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,875.69
|
| Rate for Payer: BCBS of TX Medicare |
$14,560.78
|
| Rate for Payer: BCBS of TX PPO |
$18,751.50
|
| Rate for Payer: Cigna Commercial |
$21,128.35
|
| Rate for Payer: Cigna Medicare |
$14,560.78
|
| Rate for Payer: Employer Direct Commercial |
$14,560.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,560.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,560.78
|
| Rate for Payer: Molina Medicare |
$14,560.78
|
| Rate for Payer: Multiplan Auto |
$31,167.60
|
| Rate for Payer: Multiplan Commercial |
$31,167.60
|
| Rate for Payer: Multiplan Workers Comp |
$31,167.60
|
| Rate for Payer: Scott and White EPO/PPO |
$14,353.50
|
| Rate for Payer: Scott and White Medicare |
$14,560.78
|
| Rate for Payer: Superior Health Plan EPO |
$14,560.78
|
| Rate for Payer: Superior Health Plan Medicare |
$14,560.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,560.78
|
| Rate for Payer: Universal American Medicare |
$14,560.78
|
| Rate for Payer: Wellcare Medicare |
$14,560.78
|
| Rate for Payer: Wellmed Medicare |
$14,560.78
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$59,922.20
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$25,360.50 |
| Max. Negotiated Rate |
$59,922.20 |
| Rate for Payer: Aetna Commercial |
$35,480.25
|
| Rate for Payer: Aetna Medicare |
$38,040.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25,360.50
|
| Rate for Payer: Amerigroup Medicare |
$25,360.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28,854.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32,088.99
|
| Rate for Payer: BCBS of TX Medicare |
$25,360.50
|
| Rate for Payer: BCBS of TX PPO |
$35,655.82
|
| Rate for Payer: Cigna Commercial |
$40,620.94
|
| Rate for Payer: Cigna Medicare |
$25,360.50
|
| Rate for Payer: Employer Direct Commercial |
$25,360.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$25,360.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25,360.50
|
| Rate for Payer: Molina Medicare |
$25,360.50
|
| Rate for Payer: Multiplan Auto |
$59,922.20
|
| Rate for Payer: Multiplan Commercial |
$59,922.20
|
| Rate for Payer: Multiplan Workers Comp |
$59,922.20
|
| Rate for Payer: Scott and White EPO/PPO |
$27,595.75
|
| Rate for Payer: Scott and White Medicare |
$25,360.50
|
| Rate for Payer: Superior Health Plan EPO |
$25,360.50
|
| Rate for Payer: Superior Health Plan Medicare |
$25,360.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25,360.50
|
| Rate for Payer: Universal American Medicare |
$25,360.50
|
| Rate for Payer: Wellcare Medicare |
$25,360.50
|
| Rate for Payer: Wellmed Medicare |
$25,360.50
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,042.80
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$12,939.56 |
| Max. Negotiated Rate |
$30,042.80 |
| Rate for Payer: Aetna Commercial |
$17,788.50
|
| Rate for Payer: Aetna Medicare |
$21,207.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,138.32
|
| Rate for Payer: Amerigroup Medicare |
$14,138.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,939.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,640.60
|
| Rate for Payer: BCBS of TX Medicare |
$14,138.32
|
| Rate for Payer: BCBS of TX PPO |
$16,267.96
|
| Rate for Payer: Cigna Commercial |
$20,365.86
|
| Rate for Payer: Cigna Medicare |
$14,138.32
|
| Rate for Payer: Employer Direct Commercial |
$14,138.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,138.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,138.32
|
| Rate for Payer: Molina Medicare |
$14,138.32
|
| Rate for Payer: Multiplan Auto |
$30,042.80
|
| Rate for Payer: Multiplan Commercial |
$30,042.80
|
| Rate for Payer: Multiplan Workers Comp |
$30,042.80
|
| Rate for Payer: Scott and White EPO/PPO |
$13,835.50
|
| Rate for Payer: Scott and White Medicare |
$14,138.32
|
| Rate for Payer: Superior Health Plan EPO |
$14,138.32
|
| Rate for Payer: Superior Health Plan Medicare |
$14,138.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,138.32
|
| Rate for Payer: Universal American Medicare |
$14,138.32
|
| Rate for Payer: Wellcare Medicare |
$14,138.32
|
| Rate for Payer: Wellmed Medicare |
$14,138.32
|
|
