|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$34,760.50
|
|
|
Service Code
|
MSDRG 244
|
| Min. Negotiated Rate |
$15,910.20 |
| Max. Negotiated Rate |
$34,760.50 |
| Rate for Payer: Aetna Commercial |
$20,581.88
|
| Rate for Payer: Aetna Medicare |
$23,865.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,910.20
|
| Rate for Payer: Amerigroup Medicare |
$15,910.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18,397.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,781.35
|
| Rate for Payer: BCBS of TX Medicare |
$15,910.20
|
| Rate for Payer: BCBS of TX PPO |
$24,202.43
|
| Rate for Payer: Cigna Commercial |
$23,563.96
|
| Rate for Payer: Cigna Medicare |
$15,910.20
|
| Rate for Payer: Employer Direct Commercial |
$15,910.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,910.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,910.20
|
| Rate for Payer: Molina Medicare |
$15,910.20
|
| Rate for Payer: Multiplan Auto |
$34,760.50
|
| Rate for Payer: Multiplan Commercial |
$34,760.50
|
| Rate for Payer: Multiplan Workers Comp |
$34,760.50
|
| Rate for Payer: Scott and White EPO/PPO |
$16,008.12
|
| Rate for Payer: Scott and White Medicare |
$15,910.20
|
| Rate for Payer: Superior Health Plan EPO |
$15,910.20
|
| Rate for Payer: Superior Health Plan Medicare |
$15,910.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,910.20
|
| Rate for Payer: Universal American Medicare |
$15,910.20
|
| Rate for Payer: Wellcare Medicare |
$15,910.20
|
| Rate for Payer: Wellmed Medicare |
$15,910.20
|
|
|
PERQ DIA-CIRC THRO+PLST+IMG S&I
|
Facility
|
IP
|
$17,889.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
2351104
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,742.32
|
|
|
PERQ DIA-CIRC THRO+PLST+IMG S&I
|
Facility
|
OP
|
$17,889.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
2351104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,535.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$15,742.32
|
| Rate for Payer: Cash Price |
$15,742.32
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicaid |
$4,535.02
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,535.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| 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 |
$4,535.02
|
| Rate for Payer: Scott and White EPO/PPO |
$221.91
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,535.02
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
PERQ DIA-CIR THRO+IMG+S&I
|
Facility
|
IP
|
$8,559.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
2351103
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,531.92
|
|
|
PERQ DIA-CIR THRO+IMG+S&I
|
Facility
|
OP
|
$8,559.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
2351103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.30 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,840.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,362.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Amerigroup Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$7,531.92
|
| Rate for Payer: Cash Price |
$7,531.92
|
| Rate for Payer: Cigna Commercial |
$11,841.22
|
| Rate for Payer: Cigna Medicaid |
$2,362.78
|
| Rate for Payer: Cigna Medicare |
$5,227.24
|
| Rate for Payer: Employer Direct Commercial |
$5,227.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,227.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,362.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Molina Medicare |
$5,227.24
|
| 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 |
$2,362.78
|
| Rate for Payer: Scott and White EPO/PPO |
$115.30
|
| Rate for Payer: Scott and White Medicare |
$5,227.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,362.78
|
| Rate for Payer: Superior Health Plan EPO |
$5,227.24
|
| Rate for Payer: Superior Health Plan Medicare |
$5,227.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Universal American Medicare |
$5,227.24
|
| Rate for Payer: Wellcare Medicare |
$5,227.24
|
| Rate for Payer: Wellmed Medicare |
$5,227.24
|
|
|
PERQ DIA+CIR THRO+STN+IMG+S&I
|
Facility
|
OP
|
$40,051.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
2351105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$353.72 |
| Max. Negotiated Rate |
$40,168.72 |
| Rate for Payer: Aetna Commercial |
$13,390.00
|
| Rate for Payer: Aetna Medicare |
$24,055.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,719.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Amerigroup Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$35,244.88
|
| Rate for Payer: Cash Price |
$35,244.88
|
| Rate for Payer: Cigna Commercial |
$36,327.72
|
| Rate for Payer: Cigna Medicaid |
$8,719.70
|
| Rate for Payer: Cigna Medicare |
$16,036.68
|
| Rate for Payer: Employer Direct Commercial |
$16,036.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,036.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,719.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Molina Medicare |
$16,036.68
|
| 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 |
$8,719.70
|
| Rate for Payer: Scott and White EPO/PPO |
$353.72
|
| Rate for Payer: Scott and White Medicare |
$16,036.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,719.70
|
| Rate for Payer: Superior Health Plan EPO |
$16,036.68
|
| Rate for Payer: Superior Health Plan Medicare |
$16,036.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Universal American Medicare |
$16,036.68
|
| Rate for Payer: Wellcare Medicare |
$16,036.68
|
| Rate for Payer: Wellmed Medicare |
$16,036.68
|
|
|
PERQ DIA+CIR THRO+STN+IMG+S&I
|
Facility
|
IP
|
$40,051.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
2351105
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$35,244.88
|
|
|
PFT Body plethysmography (throacic gas volume) BCE
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
4049201
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$650.28 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$440.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$526.45
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$587.19
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$342.55
|
| Rate for Payer: Multiplan Commercial |
$342.55
|
| Rate for Payer: Multiplan Workers Comp |
$342.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
PFT Diffusion (DLCO) BCE
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4049204
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$270.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.45
|
| Rate for Payer: BCBS of TX PPO |
$108.69
|
| Rate for Payer: Cash Price |
$432.08
|
| Rate for Payer: Cash Price |
$432.08
|
| Rate for Payer: Multiplan Auto |
$319.15
|
| Rate for Payer: Multiplan Commercial |
$319.15
|
| Rate for Payer: Multiplan Workers Comp |
$319.15
|
| Rate for Payer: Scott and White EPO/PPO |
$245.50
|
| Rate for Payer: Superior Health Plan EPO |
$66.78
|
|
|
PFT Flow volume loop BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
4049086
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$650.28 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$440.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$526.45
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$587.19
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
PFT Indirect Cal Study 94690 BCE
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
4010013
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$480.48
|
|
|
PFT Indirect Cal Study 94690 BCE
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
4010013
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$354.90 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.53
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$77.56
|
| Rate for Payer: Cash Price |
$480.48
|
| Rate for Payer: Cash Price |
$480.48
|
| Rate for Payer: Cash Price |
$480.48
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$354.90
|
| Rate for Payer: Multiplan Workers Comp |
$354.90
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
PFT O2 Uptake CO2 Output 94681 BCE
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
5504681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$650.28 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$440.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$526.45
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$587.19
|
| Rate for Payer: Cash Price |
$741.84
|
| Rate for Payer: Cash Price |
$741.84
|
| Rate for Payer: Cash Price |
$741.84
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$547.95
|
| Rate for Payer: Multiplan Commercial |
$547.95
|
| Rate for Payer: Multiplan Workers Comp |
$547.95
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
PFT Spirometry BCE
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4000162
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$162.25
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$191.75
|
| Rate for Payer: Multiplan Commercial |
$191.75
|
| Rate for Payer: Multiplan Workers Comp |
$191.75
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
PFT Spirometry before & after BCE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4000170
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$650.28 |
| Rate for Payer: Aetna Commercial |
$381.70
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$98.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$109.53
|
| Rate for Payer: Cash Price |
$610.72
|
| Rate for Payer: Cash Price |
$610.72
|
| Rate for Payer: Cash Price |
$610.72
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$451.10
|
| Rate for Payer: Multiplan Commercial |
$451.10
|
| Rate for Payer: Multiplan Workers Comp |
$451.10
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
PFT Total vital capacity BCE
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4049052
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$152.90
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$180.70
|
| Rate for Payer: Multiplan Commercial |
$180.70
|
| Rate for Payer: Multiplan Workers Comp |
$180.70
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
pH Body Fluid
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
4186161
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$74.80
|
|
|
pH Body Fluid
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
4186161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Amerigroup Medicare |
$3.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.09
|
| Rate for Payer: BCBS of TX Medicare |
$3.58
|
| Rate for Payer: BCBS of TX PPO |
$7.91
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cigna Medicaid |
$3.58
|
| Rate for Payer: Cigna Medicare |
$3.58
|
| Rate for Payer: Employer Direct Commercial |
$3.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.58
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Molina Medicare |
$3.58
|
| Rate for Payer: Multiplan Auto |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| Rate for Payer: Parkland Medicaid |
$3.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.48
|
| Rate for Payer: Scott and White Medicare |
$3.58
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.58
|
| Rate for Payer: Superior Health Plan EPO |
$3.58
|
| Rate for Payer: Superior Health Plan Medicare |
$3.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Universal American Medicare |
$3.58
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: Wellmed Medicare |
$3.58
|
|
|
pH, Body Fluid SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
1605179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Amerigroup Medicare |
$3.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.09
|
| Rate for Payer: BCBS of TX Medicare |
$3.58
|
| Rate for Payer: BCBS of TX PPO |
$7.91
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cigna Medicaid |
$3.58
|
| Rate for Payer: Cigna Medicare |
$3.58
|
| Rate for Payer: Employer Direct Commercial |
$3.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.58
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Molina Medicare |
$3.58
|
| Rate for Payer: Multiplan Auto |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| Rate for Payer: Parkland Medicaid |
$3.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.48
|
| Rate for Payer: Scott and White Medicare |
$3.58
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.58
|
| Rate for Payer: Superior Health Plan EPO |
$3.58
|
| Rate for Payer: Superior Health Plan Medicare |
$3.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.58
|
| Rate for Payer: Universal American Medicare |
$3.58
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: Wellmed Medicare |
$3.58
|
|
|
pH, Body Fluid SO
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
1605179
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$74.80
|
|
|
phenAZOpyridine 100 mg tablet
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78404780
|
|
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
|
|
|
phenAZOpyridine 100 mg tablet
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78404780
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
PHENobarbital 32.4 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77755502
|
|
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
|
|
|
PHENobarbital 32.4 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77755502
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Phenobarbital Level
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
1602945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Medicare |
$15.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.29
|
| Rate for Payer: BCBS of TX Medicare |
$15.30
|
| Rate for Payer: BCBS of TX PPO |
$33.81
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cigna Medicaid |
$15.30
|
| Rate for Payer: Cigna Medicare |
$15.30
|
| Rate for Payer: Employer Direct Commercial |
$15.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.30
|
| Rate for Payer: Molina Medicare |
$15.30
|
| Rate for Payer: Multiplan Auto |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$318.50
|
| Rate for Payer: Multiplan Workers Comp |
$318.50
|
| Rate for Payer: Parkland Medicaid |
$15.30
|
| Rate for Payer: Scott and White EPO/PPO |
$19.12
|
| Rate for Payer: Scott and White Medicare |
$15.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.30
|
| Rate for Payer: Superior Health Plan EPO |
$15.30
|
| Rate for Payer: Superior Health Plan Medicare |
$15.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.30
|
| Rate for Payer: Universal American Medicare |
$15.30
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: Wellmed Medicare |
$15.30
|
|
