|
Porphobilinogen, Qn, Random Ur SO
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
1704873
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$98.56
|
|
|
Porphyrins, Qn, Random U SO
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
1740109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: Aetna Medicare |
$22.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.71
|
| Rate for Payer: Amerigroup Medicare |
$14.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.13
|
| Rate for Payer: BCBS of TX Medicare |
$14.71
|
| Rate for Payer: BCBS of TX PPO |
$32.51
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna Medicaid |
$14.71
|
| Rate for Payer: Cigna Medicare |
$14.71
|
| Rate for Payer: Employer Direct Commercial |
$14.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.71
|
| Rate for Payer: Molina Medicare |
$14.71
|
| Rate for Payer: Multiplan Auto |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$109.20
|
| Rate for Payer: Multiplan Workers Comp |
$109.20
|
| Rate for Payer: Parkland Medicaid |
$14.71
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$14.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.71
|
| Rate for Payer: Superior Health Plan EPO |
$14.71
|
| Rate for Payer: Superior Health Plan Medicare |
$14.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.71
|
| Rate for Payer: Universal American Medicare |
$14.71
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
| Rate for Payer: Wellmed Medicare |
$14.71
|
|
|
Porphyrins, Qn, Random U SO
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
1740109
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$147.84
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$34,998.00
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$15,609.86 |
| Max. Negotiated Rate |
$34,998.00 |
| Rate for Payer: Aetna Commercial |
$20,722.50
|
| Rate for Payer: Aetna Medicare |
$23,999.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,999.40
|
| Rate for Payer: Amerigroup Medicare |
$15,999.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,609.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,860.04
|
| Rate for Payer: BCBS of TX Medicare |
$15,999.40
|
| Rate for Payer: BCBS of TX PPO |
$20,956.41
|
| Rate for Payer: Cigna Commercial |
$23,724.96
|
| Rate for Payer: Cigna Medicare |
$15,999.40
|
| Rate for Payer: Employer Direct Commercial |
$15,999.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,999.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,999.40
|
| Rate for Payer: Molina Medicare |
$15,999.40
|
| Rate for Payer: Multiplan Auto |
$34,998.00
|
| Rate for Payer: Multiplan Commercial |
$34,998.00
|
| Rate for Payer: Multiplan Workers Comp |
$34,998.00
|
| Rate for Payer: Scott and White EPO/PPO |
$16,117.50
|
| Rate for Payer: Scott and White Medicare |
$15,999.40
|
| Rate for Payer: Superior Health Plan EPO |
$15,999.40
|
| Rate for Payer: Superior Health Plan Medicare |
$15,999.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,999.40
|
| Rate for Payer: Universal American Medicare |
$15,999.40
|
| Rate for Payer: Wellcare Medicare |
$15,999.40
|
| Rate for Payer: Wellmed Medicare |
$15,999.40
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$19,104.50
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$8,516.58 |
| Max. Negotiated Rate |
$19,104.50 |
| Rate for Payer: Aetna Commercial |
$11,311.88
|
| Rate for Payer: Aetna Medicare |
$15,045.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,030.09
|
| Rate for Payer: Amerigroup Medicare |
$10,030.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,516.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,162.15
|
| Rate for Payer: BCBS of TX Medicare |
$10,030.09
|
| Rate for Payer: BCBS of TX PPO |
$11,291.72
|
| Rate for Payer: Cigna Commercial |
$12,950.84
|
| Rate for Payer: Cigna Medicare |
$10,030.09
|
| Rate for Payer: Employer Direct Commercial |
$10,030.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,030.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,030.09
|
| Rate for Payer: Molina Medicare |
$10,030.09
|
| Rate for Payer: Multiplan Auto |
$19,104.50
|
| Rate for Payer: Multiplan Commercial |
$19,104.50
|
| Rate for Payer: Multiplan Workers Comp |
$19,104.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8,798.12
|
| Rate for Payer: Scott and White Medicare |
$10,030.09
|
| Rate for Payer: Superior Health Plan EPO |
$10,030.09
|
| Rate for Payer: Superior Health Plan Medicare |
$10,030.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,030.09
|
| Rate for Payer: Universal American Medicare |
$10,030.09
|
| Rate for Payer: Wellcare Medicare |
$10,030.09
|
| Rate for Payer: Wellmed Medicare |
$10,030.09
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$40,578.30
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$17,875.96 |
| Max. Negotiated Rate |
$40,578.30 |
| Rate for Payer: Aetna Commercial |
$24,026.62
|
| Rate for Payer: Aetna Medicare |
$27,142.89
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,095.26
|
| Rate for Payer: Amerigroup Medicare |
$18,095.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,875.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,223.09
|
| Rate for Payer: BCBS of TX Medicare |
$18,095.26
|
| Rate for Payer: BCBS of TX PPO |
$23,582.12
|
| Rate for Payer: Cigna Commercial |
$27,507.82
|
| Rate for Payer: Cigna Medicare |
$18,095.26
|
| Rate for Payer: Employer Direct Commercial |
$18,095.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,095.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,095.26
|
| Rate for Payer: Molina Medicare |
$18,095.26
|
| Rate for Payer: Multiplan Auto |
$40,578.30
|
| Rate for Payer: Multiplan Commercial |
$40,578.30
|
| Rate for Payer: Multiplan Workers Comp |
$40,578.30
|
| Rate for Payer: Scott and White EPO/PPO |
$18,687.38
|
| Rate for Payer: Scott and White Medicare |
$18,095.26
|
| Rate for Payer: Superior Health Plan EPO |
$18,095.26
|
| Rate for Payer: Superior Health Plan Medicare |
$18,095.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,095.26
|
| Rate for Payer: Universal American Medicare |
$18,095.26
|
| Rate for Payer: Wellcare Medicare |
$18,095.26
|
| Rate for Payer: Wellmed Medicare |
$18,095.26
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$84,139.60
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$34,456.12 |
| Max. Negotiated Rate |
$84,139.60 |
| Rate for Payer: Aetna Commercial |
$49,819.50
|
| Rate for Payer: Aetna Medicare |
$51,684.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$34,456.12
|
| Rate for Payer: Amerigroup Medicare |
$34,456.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39,925.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46,314.77
|
| Rate for Payer: BCBS of TX Medicare |
$34,456.12
|
| Rate for Payer: BCBS of TX PPO |
$51,462.85
|
| Rate for Payer: Cigna Commercial |
$57,037.79
|
| Rate for Payer: Cigna Medicare |
$34,456.12
|
| Rate for Payer: Employer Direct Commercial |
$34,456.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$34,456.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$34,456.12
|
| Rate for Payer: Molina Medicare |
$34,456.12
|
| Rate for Payer: Multiplan Auto |
$84,139.60
|
| Rate for Payer: Multiplan Commercial |
$84,139.60
|
| Rate for Payer: Multiplan Workers Comp |
$84,139.60
|
| Rate for Payer: Scott and White EPO/PPO |
$38,748.50
|
| Rate for Payer: Scott and White Medicare |
$34,456.12
|
| Rate for Payer: Superior Health Plan EPO |
$34,456.12
|
| Rate for Payer: Superior Health Plan Medicare |
$34,456.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$34,456.12
|
| Rate for Payer: Universal American Medicare |
$34,456.12
|
| Rate for Payer: Wellcare Medicare |
$34,456.12
|
| Rate for Payer: Wellmed Medicare |
$34,456.12
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,384.60
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$11,229.75 |
| Max. Negotiated Rate |
$24,384.60 |
| Rate for Payer: Aetna Commercial |
$14,438.25
|
| Rate for Payer: Aetna Medicare |
$18,019.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,013.20
|
| Rate for Payer: Amerigroup Medicare |
$12,013.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,508.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,241.25
|
| Rate for Payer: BCBS of TX Medicare |
$12,013.20
|
| Rate for Payer: BCBS of TX PPO |
$15,824.23
|
| Rate for Payer: Cigna Commercial |
$16,530.19
|
| Rate for Payer: Cigna Medicare |
$12,013.20
|
| Rate for Payer: Employer Direct Commercial |
$12,013.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,013.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,013.20
|
| Rate for Payer: Molina Medicare |
$12,013.20
|
| Rate for Payer: Multiplan Auto |
$24,384.60
|
| Rate for Payer: Multiplan Commercial |
$24,384.60
|
| Rate for Payer: Multiplan Workers Comp |
$24,384.60
|
| Rate for Payer: Scott and White EPO/PPO |
$11,229.75
|
| Rate for Payer: Scott and White Medicare |
$12,013.20
|
| Rate for Payer: Superior Health Plan EPO |
$12,013.20
|
| Rate for Payer: Superior Health Plan Medicare |
$12,013.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,013.20
|
| Rate for Payer: Universal American Medicare |
$12,013.20
|
| Rate for Payer: Wellcare Medicare |
$12,013.20
|
| Rate for Payer: Wellmed Medicare |
$12,013.20
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$29,334.10
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$13,509.12 |
| Max. Negotiated Rate |
$29,334.10 |
| Rate for Payer: Aetna Commercial |
$17,368.88
|
| Rate for Payer: Aetna Medicare |
$20,808.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,872.13
|
| Rate for Payer: Amerigroup Medicare |
$13,872.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,695.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,044.07
|
| Rate for Payer: BCBS of TX Medicare |
$13,872.13
|
| Rate for Payer: BCBS of TX PPO |
$16,716.28
|
| Rate for Payer: Cigna Commercial |
$19,885.43
|
| Rate for Payer: Cigna Medicare |
$13,872.13
|
| Rate for Payer: Employer Direct Commercial |
$13,872.13
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,872.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,872.13
|
| Rate for Payer: Molina Medicare |
$13,872.13
|
| Rate for Payer: Multiplan Auto |
$29,334.10
|
| Rate for Payer: Multiplan Commercial |
$29,334.10
|
| Rate for Payer: Multiplan Workers Comp |
$29,334.10
|
| Rate for Payer: Scott and White EPO/PPO |
$13,509.12
|
| Rate for Payer: Scott and White Medicare |
$13,872.13
|
| Rate for Payer: Superior Health Plan EPO |
$13,872.13
|
| Rate for Payer: Superior Health Plan Medicare |
$13,872.13
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,872.13
|
| Rate for Payer: Universal American Medicare |
$13,872.13
|
| Rate for Payer: Wellcare Medicare |
$13,872.13
|
| Rate for Payer: Wellmed Medicare |
$13,872.13
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$13,617.30
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,085.36 |
| Max. Negotiated Rate |
$13,617.30 |
| Rate for Payer: Aetna Commercial |
$8,062.88
|
| Rate for Payer: Aetna Medicare |
$11,953.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,969.19
|
| Rate for Payer: Amerigroup Medicare |
$7,969.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,085.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,800.22
|
| Rate for Payer: BCBS of TX Medicare |
$7,969.19
|
| Rate for Payer: BCBS of TX PPO |
$7,556.09
|
| Rate for Payer: Cigna Commercial |
$9,231.10
|
| Rate for Payer: Cigna Medicare |
$7,969.19
|
| Rate for Payer: Employer Direct Commercial |
$7,969.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,969.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,969.19
|
| Rate for Payer: Molina Medicare |
$7,969.19
|
| Rate for Payer: Multiplan Auto |
$13,617.30
|
| Rate for Payer: Multiplan Commercial |
$13,617.30
|
| Rate for Payer: Multiplan Workers Comp |
$13,617.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,271.12
|
| Rate for Payer: Scott and White Medicare |
$7,969.19
|
| Rate for Payer: Superior Health Plan EPO |
$7,969.19
|
| Rate for Payer: Superior Health Plan Medicare |
$7,969.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,969.19
|
| Rate for Payer: Universal American Medicare |
$7,969.19
|
| Rate for Payer: Wellcare Medicare |
$7,969.19
|
| Rate for Payer: Wellmed Medicare |
$7,969.19
|
|
|
Postpartum High Risk Care 12 Hour
|
Facility
|
OP
|
$1,955.00
|
|
| Hospital Charge Code |
300665
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Aetna Commercial |
$1,075.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$586.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$703.80
|
| Rate for Payer: BCBS of TX PPO |
$782.00
|
| Rate for Payer: Cash Price |
$1,720.40
|
| Rate for Payer: Multiplan Auto |
$1,270.75
|
| Rate for Payer: Multiplan Commercial |
$1,270.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,270.75
|
| Rate for Payer: Scott and White EPO/PPO |
$977.50
|
| Rate for Payer: Superior Health Plan EPO |
$265.88
|
|
|
Postpartum High Risk Care 12 Hour
|
Facility
|
IP
|
$1,955.00
|
|
| Hospital Charge Code |
300665
|
|
Hospital Revenue Code
|
720
|
| Rate for Payer: Cash Price |
$1,720.40
|
|
|
.Post TR ABO/Rh
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2400406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$98.80
|
| Rate for Payer: Multiplan Commercial |
$98.80
|
| Rate for Payer: Multiplan Workers Comp |
$98.80
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
.Post TR ABO/Rh Echo
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2400406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$98.80
|
| Rate for Payer: Multiplan Commercial |
$98.80
|
| Rate for Payer: Multiplan Workers Comp |
$98.80
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
.Post TR Antibody Screen
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Amerigroup Medicare |
$49.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.95
|
| Rate for Payer: BCBS of TX Medicare |
$49.56
|
| Rate for Payer: BCBS of TX PPO |
$109.33
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$112.25
|
| Rate for Payer: Cigna Medicare |
$49.56
|
| Rate for Payer: Employer Direct Commercial |
$49.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Molina Medicare |
$49.56
|
| Rate for Payer: Multiplan Auto |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| Rate for Payer: Scott and White Medicare |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$49.56
|
| Rate for Payer: Superior Health Plan Medicare |
$49.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Universal American Medicare |
$49.56
|
| Rate for Payer: Wellcare Medicare |
$49.56
|
| Rate for Payer: Wellmed Medicare |
$49.56
|
|
|
.Post TR Antibody Screen Echo
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Amerigroup Medicare |
$49.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.95
|
| Rate for Payer: BCBS of TX Medicare |
$49.56
|
| Rate for Payer: BCBS of TX PPO |
$109.33
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$112.25
|
| Rate for Payer: Cigna Medicare |
$49.56
|
| Rate for Payer: Employer Direct Commercial |
$49.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Molina Medicare |
$49.56
|
| Rate for Payer: Multiplan Auto |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| Rate for Payer: Scott and White Medicare |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$49.56
|
| Rate for Payer: Superior Health Plan Medicare |
$49.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Universal American Medicare |
$49.56
|
| Rate for Payer: Wellcare Medicare |
$49.56
|
| Rate for Payer: Wellmed Medicare |
$49.56
|
|
|
.Post TR Antibody Screen Gel
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2403137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Amerigroup Medicare |
$49.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$81.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$97.95
|
| Rate for Payer: BCBS of TX Medicare |
$49.56
|
| Rate for Payer: BCBS of TX PPO |
$109.33
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$112.25
|
| Rate for Payer: Cigna Medicare |
$49.56
|
| Rate for Payer: Employer Direct Commercial |
$49.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Molina Medicare |
$49.56
|
| Rate for Payer: Multiplan Auto |
$164.45
|
| Rate for Payer: Multiplan Commercial |
$164.45
|
| Rate for Payer: Multiplan Workers Comp |
$164.45
|
| Rate for Payer: Scott and White EPO/PPO |
$12.21
|
| Rate for Payer: Scott and White Medicare |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$49.56
|
| Rate for Payer: Superior Health Plan Medicare |
$49.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$49.56
|
| Rate for Payer: Universal American Medicare |
$49.56
|
| Rate for Payer: Wellcare Medicare |
$49.56
|
| Rate for Payer: Wellmed Medicare |
$49.56
|
|
|
.Post TR Crossmatch
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2400158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2.79
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
.Post TR DAT C3
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| 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 CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| 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
|
|
|
.Post TR DAT IgG
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| 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 CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| 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
|
|
|
.Post TR DAT Poly
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| 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 CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| 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
|
|
|
potassium chloride 10 mEq/100 mL IV Soln 100 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
77767570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.12
|
| Rate for Payer: BCBS of TX PPO |
$0.14
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
potassium chloride 10 mEq/100 mL IV Soln 100 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
77767570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
potassium chloride 10 mEq ER Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77767519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
potassium chloride 10 mEq ER Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77767519
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
