|
Injection(s) single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia)
|
Facility
|
IP
|
$1,175.27
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
9900170
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$799.18
|
|
|
Injection(s) single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia)
|
Facility
|
OP
|
$1,175.27
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
9900170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$846.19
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$846.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$846.19
|
| Rate for Payer: Scott and White EPO/PPO |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$846.19
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Injection(s) single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36020550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
36020526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.00
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$104.58
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
IP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
9900169
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,065.57
|
|
|
Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
OP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
9900169
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.00
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$104.58
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,128.25
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$1,128.25
|
| Rate for Payer: Scott and White EPO/PPO |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
INJECTOR, UTERINE MANIPULATOR BLLN TIPPD 13'L DISP -- DHF
|
Facility
|
OP
|
$165.36
|
|
| Hospital Charge Code |
81778250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$119.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.53
|
| Rate for Payer: BCBS of TX PPO |
$66.14
|
| Rate for Payer: Cash Price |
$112.44
|
| Rate for Payer: Cigna Medicaid |
$119.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$119.06
|
| Rate for Payer: Multiplan Auto |
$107.48
|
| Rate for Payer: Multiplan Commercial |
$107.48
|
| Rate for Payer: Multiplan Workers Comp |
$107.48
|
| Rate for Payer: Parkland Medicaid |
$119.06
|
| Rate for Payer: Scott and White EPO/PPO |
$82.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$119.06
|
| Rate for Payer: Superior Health Plan EPO |
$22.49
|
|
|
INJECTOR, UTERINE MANIPULATOR BLLN TIPPD 13'L DISP -- DHF
|
Facility
|
IP
|
$165.36
|
|
| Hospital Charge Code |
81778250
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$112.44
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
4613571
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,516.40
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
4613571
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$1,605.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$200.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$669.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$802.80
|
| Rate for Payer: BCBS of TX PPO |
$892.00
|
| Rate for Payer: Cash Price |
$1,516.40
|
| Rate for Payer: Cigna Medicaid |
$1,605.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,605.60
|
| Rate for Payer: Multiplan Auto |
$1,449.50
|
| Rate for Payer: Multiplan Commercial |
$1,449.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,449.50
|
| Rate for Payer: Parkland Medicaid |
$1,605.60
|
| Rate for Payer: Scott and White EPO/PPO |
$1,115.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,605.60
|
| Rate for Payer: Superior Health Plan EPO |
$303.28
|
|
|
INJ EPID BLD PATCH
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
4610101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$964.08
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$964.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$964.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$964.08
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
INJ EPID BLD PATCH
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
4610101
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$910.52
|
|
|
INJ NEPHROGRM EXIS ACC
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
4617665
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,098.88
|
|
|
INJ NEPHROGRM EXIS ACC
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
4617665
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$145.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Amerigroup Medicare |
$700.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$929.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,113.06
|
| Rate for Payer: BCBS of TX Medicare |
$700.47
|
| Rate for Payer: BCBS of TX PPO |
$1,402.46
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,480.67
|
| Rate for Payer: Cigna Medicaid |
$1,163.52
|
| Rate for Payer: Cigna Medicare |
$700.47
|
| Rate for Payer: Employer Direct Commercial |
$700.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$700.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,163.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Molina Medicare |
$700.47
|
| 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 |
$1,163.52
|
| Rate for Payer: Scott and White EPO/PPO |
$1,295.87
|
| Rate for Payer: Scott and White Medicare |
$700.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,163.52
|
| Rate for Payer: Superior Health Plan EPO |
$700.47
|
| Rate for Payer: Superior Health Plan Medicare |
$700.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Universal American Medicare |
$700.47
|
| Rate for Payer: Wellcare Medicare |
$700.47
|
| Rate for Payer: Wellmed Medicare |
$700.47
|
|
|
INJ PERC TX OF EXT PSEUDOANERYSM BCE
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2117968
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,351.16
|
|
|
INJ PERC TX OF EXT PSEUDOANERYSM BCE
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2117968
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,430.64
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,430.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| 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 |
$1,430.64
|
| Rate for Payer: Scott and White EPO/PPO |
$1,165.80
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,430.64
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
|
INJ RT VENTR/ATRIAL ANGIO
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
2350069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$193.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$645.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$774.00
|
| Rate for Payer: BCBS of TX PPO |
$860.00
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cigna Medicaid |
$1,548.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,548.00
|
| Rate for Payer: Multiplan Auto |
$1,397.50
|
| Rate for Payer: Multiplan Commercial |
$1,397.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,397.50
|
| Rate for Payer: Parkland Medicaid |
$1,548.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,075.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,548.00
|
| Rate for Payer: Superior Health Plan EPO |
$292.40
|
|
|
INJ RT VENTR/ATRIAL ANGIO
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
2350069
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,462.00
|
|
|
Inkjet Printable DVD+R Discs, 4.7GB, 16x, Spindle, White
|
Facility
|
OP
|
$1.36
|
|
| Hospital Charge Code |
993238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.49
|
| Rate for Payer: BCBS of TX PPO |
$0.54
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna Medicaid |
$0.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$0.98
|
| Rate for Payer: Multiplan Auto |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Multiplan Workers Comp |
$0.88
|
| Rate for Payer: Parkland Medicaid |
$0.98
|
| Rate for Payer: Scott and White EPO/PPO |
$0.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$0.98
|
| Rate for Payer: Superior Health Plan EPO |
$0.18
|
|
|
Inkjet Printable DVD+R Discs, 4.7GB, 16x, Spindle, White
|
Facility
|
IP
|
$1.36
|
|
| Hospital Charge Code |
993238
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$0.92
|
|
|
INNOVA 6 X 150 X 130
|
Facility
|
OP
|
$21,506.02
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
991298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,935.54 |
| Max. Negotiated Rate |
$15,484.33 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,935.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,451.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,742.17
|
| Rate for Payer: BCBS of TX PPO |
$8,602.41
|
| Rate for Payer: Cash Price |
$14,624.09
|
| Rate for Payer: Cigna Medicaid |
$15,484.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,484.33
|
| Rate for Payer: Multiplan Auto |
$10,753.01
|
| Rate for Payer: Multiplan Commercial |
$10,753.01
|
| Rate for Payer: Multiplan Workers Comp |
$10,753.01
|
| Rate for Payer: Parkland Medicaid |
$15,484.33
|
| Rate for Payer: Scott and White EPO/PPO |
$10,753.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,484.33
|
| Rate for Payer: Superior Health Plan EPO |
$2,924.82
|
|
|
INNOVA 6 X 150 X 130
|
Facility
|
OP
|
$15,638.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
991279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.47 |
| Max. Negotiated Rate |
$11,259.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,407.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,691.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,629.88
|
| Rate for Payer: BCBS of TX PPO |
$6,255.42
|
| Rate for Payer: Cash Price |
$10,634.21
|
| Rate for Payer: Cigna Medicaid |
$11,259.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$11,259.76
|
| Rate for Payer: Multiplan Auto |
$7,819.27
|
| Rate for Payer: Multiplan Commercial |
$7,819.27
|
| Rate for Payer: Multiplan Workers Comp |
$7,819.27
|
| Rate for Payer: Parkland Medicaid |
$11,259.76
|
| Rate for Payer: Scott and White EPO/PPO |
$7,819.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,259.76
|
| Rate for Payer: Superior Health Plan EPO |
$2,126.84
|
|
|
INNOVA 6 X 150 X 130
|
Facility
|
IP
|
$15,638.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
991279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,909.64 |
| Max. Negotiated Rate |
$7,819.27 |
| Rate for Payer: Cash Price |
$10,634.21
|
| Rate for Payer: Cigna Commercial |
$3,909.64
|
| Rate for Payer: Multiplan Auto |
$7,819.27
|
| Rate for Payer: Multiplan Commercial |
$7,819.27
|
| Rate for Payer: Multiplan Workers Comp |
$7,819.27
|
| Rate for Payer: Scott and White EPO/PPO |
$7,819.27
|
|
|
INNOVA 6 X 150 X 130
|
Facility
|
IP
|
$21,506.02
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
991298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,376.51 |
| Max. Negotiated Rate |
$10,753.01 |
| Rate for Payer: Cash Price |
$14,624.09
|
| Rate for Payer: Cigna Commercial |
$5,376.51
|
| Rate for Payer: Multiplan Auto |
$10,753.01
|
| Rate for Payer: Multiplan Commercial |
$10,753.01
|
| Rate for Payer: Multiplan Workers Comp |
$10,753.01
|
| Rate for Payer: Scott and White EPO/PPO |
$10,753.01
|
|
|
innovance d-dimer
|
Facility
|
OP
|
$2,860.15
|
|
| Hospital Charge Code |
993842
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.41 |
| Max. Negotiated Rate |
$2,059.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$858.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,029.65
|
| Rate for Payer: BCBS of TX PPO |
$1,144.06
|
| Rate for Payer: Cash Price |
$1,944.90
|
| Rate for Payer: Cigna Medicaid |
$2,059.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,059.31
|
| Rate for Payer: Multiplan Auto |
$1,859.10
|
| Rate for Payer: Multiplan Commercial |
$1,859.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,859.10
|
| Rate for Payer: Parkland Medicaid |
$2,059.31
|
| Rate for Payer: Scott and White EPO/PPO |
$1,430.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,059.31
|
| Rate for Payer: Superior Health Plan EPO |
$388.98
|
|
