|
REMOVE SINGL LEAD PACER ELECTRODE
|
Facility
|
IP
|
$10,014.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
2302487
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$8,812.32
|
|
|
REMOVE SINGL LEAD PACER ELECTRODE
|
Facility
|
OP
|
$10,014.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
2302487
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$8,135.63 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,387.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$901.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Amerigroup Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,983.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,968.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX PPO |
$7,519.71
|
| Rate for Payer: Cash Price |
$8,812.32
|
| Rate for Payer: Cash Price |
$8,812.32
|
| Rate for Payer: Cash Price |
$8,812.32
|
| Rate for Payer: Cigna Commercial |
$8,135.63
|
| Rate for Payer: Cigna Medicaid |
$1,906.80
|
| Rate for Payer: Cigna Medicare |
$3,591.43
|
| Rate for Payer: Employer Direct Commercial |
$3,591.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,591.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,906.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Molina Medicare |
$3,591.43
|
| Rate for Payer: Multiplan Auto |
$6,509.10
|
| Rate for Payer: Multiplan Commercial |
$6,509.10
|
| Rate for Payer: Multiplan Workers Comp |
$6,509.10
|
| Rate for Payer: Parkland Medicaid |
$1,906.80
|
| Rate for Payer: Scott and White EPO/PPO |
$64.23
|
| Rate for Payer: Scott and White Medicare |
$3,591.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,906.80
|
| Rate for Payer: Superior Health Plan EPO |
$3,591.43
|
| Rate for Payer: Superior Health Plan Medicare |
$3,591.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Universal American Medicare |
$3,591.43
|
| Rate for Payer: Wellcare Medicare |
$3,591.43
|
| Rate for Payer: Wellmed Medicare |
$3,591.43
|
|
|
Remove Spine Eltrd Plate
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63662
|
| Hospital Charge Code |
36063662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,667.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,499.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,111.77
|
| Rate for Payer: Amerigroup Medicare |
$3,111.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,258.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,111.77
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cigna Commercial |
$7,049.06
|
| Rate for Payer: Cigna Medicaid |
$1,499.71
|
| Rate for Payer: Cigna Medicare |
$3,111.77
|
| Rate for Payer: Employer Direct Commercial |
$3,111.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,111.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,499.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,111.77
|
| Rate for Payer: Molina Medicare |
$3,111.77
|
| 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 |
$1,499.71
|
| Rate for Payer: Scott and White EPO/PPO |
$68.64
|
| Rate for Payer: Scott and White Medicare |
$3,111.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,499.71
|
| Rate for Payer: Superior Health Plan EPO |
$3,111.77
|
| Rate for Payer: Superior Health Plan Medicare |
$3,111.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,111.77
|
| Rate for Payer: Universal American Medicare |
$3,111.77
|
| Rate for Payer: Wellcare Medicare |
$3,111.77
|
| Rate for Payer: Wellmed Medicare |
$3,111.77
|
|
|
REMOV & REPLAC PACEMAKER,DUAL LEAD
|
Facility
|
IP
|
$22,751.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
2320562
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$20,020.88
|
|
|
REMOV & REPLAC PACEMAKER,DUAL LEAD
|
Facility
|
OP
|
$22,751.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
2320562
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$25,834.89 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$14,648.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,047.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Amerigroup Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,120.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,503.88
|
| Rate for Payer: BCBS of TX Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX PPO |
$25,834.89
|
| Rate for Payer: Cash Price |
$20,020.88
|
| Rate for Payer: Cash Price |
$20,020.88
|
| Rate for Payer: Cash Price |
$20,020.88
|
| Rate for Payer: Cigna Commercial |
$22,122.29
|
| Rate for Payer: Cigna Medicaid |
$6,289.66
|
| Rate for Payer: Cigna Medicare |
$9,765.77
|
| Rate for Payer: Employer Direct Commercial |
$9,765.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,765.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,289.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Molina Medicare |
$9,765.77
|
| Rate for Payer: Multiplan Auto |
$14,788.15
|
| Rate for Payer: Multiplan Commercial |
$14,788.15
|
| Rate for Payer: Multiplan Workers Comp |
$14,788.15
|
| Rate for Payer: Parkland Medicaid |
$6,289.66
|
| Rate for Payer: Scott and White EPO/PPO |
$174.65
|
| Rate for Payer: Scott and White Medicare |
$9,765.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,289.66
|
| Rate for Payer: Superior Health Plan EPO |
$9,765.77
|
| Rate for Payer: Superior Health Plan Medicare |
$9,765.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Universal American Medicare |
$9,765.77
|
| Rate for Payer: Wellcare Medicare |
$9,765.77
|
| Rate for Payer: Wellmed Medicare |
$9,765.77
|
|
|
REMOV & REPLAC PACEMAKER,MULT LEAD
|
Facility
|
OP
|
$23,064.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
2320563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$318.69 |
| Max. Negotiated Rate |
$46,149.31 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$26,730.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,075.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,820.14
|
| Rate for Payer: Amerigroup Medicare |
$17,820.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30,583.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36,626.44
|
| Rate for Payer: BCBS of TX Medicare |
$17,820.14
|
| Rate for Payer: BCBS of TX PPO |
$46,149.31
|
| Rate for Payer: Cash Price |
$20,296.32
|
| Rate for Payer: Cash Price |
$20,296.32
|
| Rate for Payer: Cash Price |
$20,296.32
|
| Rate for Payer: Cigna Commercial |
$40,367.76
|
| Rate for Payer: Cigna Medicaid |
$9,828.12
|
| Rate for Payer: Cigna Medicare |
$17,820.14
|
| Rate for Payer: Employer Direct Commercial |
$17,820.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,820.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,828.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,820.14
|
| Rate for Payer: Molina Medicare |
$17,820.14
|
| Rate for Payer: Multiplan Auto |
$14,991.60
|
| Rate for Payer: Multiplan Commercial |
$14,991.60
|
| Rate for Payer: Multiplan Workers Comp |
$14,991.60
|
| Rate for Payer: Parkland Medicaid |
$9,828.12
|
| Rate for Payer: Scott and White EPO/PPO |
$318.69
|
| Rate for Payer: Scott and White Medicare |
$17,820.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,828.12
|
| Rate for Payer: Superior Health Plan EPO |
$17,820.14
|
| Rate for Payer: Superior Health Plan Medicare |
$17,820.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,820.14
|
| Rate for Payer: Universal American Medicare |
$17,820.14
|
| Rate for Payer: Wellcare Medicare |
$17,820.14
|
| Rate for Payer: Wellmed Medicare |
$17,820.14
|
|
|
REMOV & REPLAC PACEMAKER,MULT LEAD
|
Facility
|
IP
|
$23,064.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
2320563
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$20,296.32
|
|
|
REMOV & REPLAC PACEMAKER,SINGL LEAD
|
Facility
|
OP
|
$18,015.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
2320561
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$19,257.46 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$11,654.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,621.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Amerigroup Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,761.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,283.70
|
| Rate for Payer: BCBS of TX Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX PPO |
$19,257.46
|
| Rate for Payer: Cash Price |
$15,853.20
|
| Rate for Payer: Cash Price |
$15,853.20
|
| Rate for Payer: Cash Price |
$15,853.20
|
| Rate for Payer: Cigna Commercial |
$17,600.59
|
| Rate for Payer: Cigna Medicaid |
$5,259.03
|
| Rate for Payer: Cigna Medicare |
$7,769.69
|
| Rate for Payer: Employer Direct Commercial |
$7,769.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,769.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,259.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Molina Medicare |
$7,769.69
|
| Rate for Payer: Multiplan Auto |
$11,709.75
|
| Rate for Payer: Multiplan Commercial |
$11,709.75
|
| Rate for Payer: Multiplan Workers Comp |
$11,709.75
|
| Rate for Payer: Parkland Medicaid |
$5,259.03
|
| Rate for Payer: Scott and White EPO/PPO |
$138.95
|
| Rate for Payer: Scott and White Medicare |
$7,769.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,259.03
|
| Rate for Payer: Superior Health Plan EPO |
$7,769.69
|
| Rate for Payer: Superior Health Plan Medicare |
$7,769.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Universal American Medicare |
$7,769.69
|
| Rate for Payer: Wellcare Medicare |
$7,769.69
|
| Rate for Payer: Wellmed Medicare |
$7,769.69
|
|
|
REMOV & REPLAC PACEMAKER,SINGL LEAD
|
Facility
|
IP
|
$18,015.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
2320561
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$15,853.20
|
|
|
REMOV & REPLC DEFIBRI W DUAL LEAD
|
Facility
|
OP
|
$31,567.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
2320567
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$385.53 |
| Max. Negotiated Rate |
$57,236.48 |
| Rate for Payer: Aetna Commercial |
$17,361.85
|
| Rate for Payer: Aetna Medicare |
$32,335.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,841.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Amerigroup Medicare |
$21,557.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37,930.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45,425.78
|
| Rate for Payer: BCBS of TX Medicare |
$21,557.16
|
| Rate for Payer: BCBS of TX PPO |
$57,236.48
|
| Rate for Payer: Cash Price |
$27,778.96
|
| Rate for Payer: Cash Price |
$27,778.96
|
| Rate for Payer: Cash Price |
$27,778.96
|
| Rate for Payer: Cigna Commercial |
$48,833.21
|
| Rate for Payer: Cigna Medicaid |
$16,336.46
|
| Rate for Payer: Cigna Medicare |
$21,557.16
|
| Rate for Payer: Employer Direct Commercial |
$21,557.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,557.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,336.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Molina Medicare |
$21,557.16
|
| Rate for Payer: Multiplan Auto |
$20,518.55
|
| Rate for Payer: Multiplan Commercial |
$20,518.55
|
| Rate for Payer: Multiplan Workers Comp |
$20,518.55
|
| Rate for Payer: Parkland Medicaid |
$16,336.46
|
| Rate for Payer: Scott and White EPO/PPO |
$385.53
|
| Rate for Payer: Scott and White Medicare |
$21,557.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,336.46
|
| Rate for Payer: Superior Health Plan EPO |
$21,557.16
|
| Rate for Payer: Superior Health Plan Medicare |
$21,557.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Universal American Medicare |
$21,557.16
|
| Rate for Payer: Wellcare Medicare |
$21,557.16
|
| Rate for Payer: Wellmed Medicare |
$21,557.16
|
|
|
REMOV & REPLC DEFIBRI W DUAL LEAD
|
Facility
|
IP
|
$31,567.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
2320567
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$27,778.96
|
|
|
REMOV & REPLC DEFIBRI W MULTI LEAD
|
Facility
|
OP
|
$41,664.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
2320568
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$538.09 |
| Max. Negotiated Rate |
$81,352.25 |
| Rate for Payer: Aetna Commercial |
$22,915.20
|
| Rate for Payer: Aetna Medicare |
$45,131.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,749.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Amerigroup Medicare |
$30,087.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53,912.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64,565.28
|
| Rate for Payer: BCBS of TX Medicare |
$30,087.75
|
| Rate for Payer: BCBS of TX PPO |
$81,352.25
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cigna Commercial |
$68,157.46
|
| Rate for Payer: Cigna Medicaid |
$21,766.45
|
| Rate for Payer: Cigna Medicare |
$30,087.75
|
| Rate for Payer: Employer Direct Commercial |
$30,087.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,087.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$21,766.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Molina Medicare |
$30,087.75
|
| Rate for Payer: Multiplan Auto |
$27,081.60
|
| Rate for Payer: Multiplan Commercial |
$27,081.60
|
| Rate for Payer: Multiplan Workers Comp |
$27,081.60
|
| Rate for Payer: Parkland Medicaid |
$21,766.45
|
| Rate for Payer: Scott and White EPO/PPO |
$538.09
|
| Rate for Payer: Scott and White Medicare |
$30,087.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21,766.45
|
| Rate for Payer: Superior Health Plan EPO |
$30,087.75
|
| Rate for Payer: Superior Health Plan Medicare |
$30,087.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Universal American Medicare |
$30,087.75
|
| Rate for Payer: Wellcare Medicare |
$30,087.75
|
| Rate for Payer: Wellmed Medicare |
$30,087.75
|
|
|
REMOV & REPLC DEFIBRI W MULTI LEAD
|
Facility
|
IP
|
$41,664.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
2320568
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$36,664.32
|
|
|
REMOV & REPLC DEFIBRI W SINGLE LEAD
|
Facility
|
IP
|
$30,361.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
2320566
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$26,717.68
|
|
|
REMOV & REPLC DEFIBRI W SINGLE LEAD
|
Facility
|
OP
|
$30,361.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
2320566
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$385.53 |
| Max. Negotiated Rate |
$57,236.48 |
| Rate for Payer: Aetna Commercial |
$16,698.55
|
| Rate for Payer: Aetna Medicare |
$32,335.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,732.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Amerigroup Medicare |
$21,557.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37,930.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45,425.78
|
| Rate for Payer: BCBS of TX Medicare |
$21,557.16
|
| Rate for Payer: BCBS of TX PPO |
$57,236.48
|
| Rate for Payer: Cash Price |
$26,717.68
|
| Rate for Payer: Cash Price |
$26,717.68
|
| Rate for Payer: Cash Price |
$26,717.68
|
| Rate for Payer: Cigna Commercial |
$48,833.21
|
| Rate for Payer: Cigna Medicaid |
$16,178.06
|
| Rate for Payer: Cigna Medicare |
$21,557.16
|
| Rate for Payer: Employer Direct Commercial |
$21,557.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,557.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,178.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Molina Medicare |
$21,557.16
|
| Rate for Payer: Multiplan Auto |
$19,734.65
|
| Rate for Payer: Multiplan Commercial |
$19,734.65
|
| Rate for Payer: Multiplan Workers Comp |
$19,734.65
|
| Rate for Payer: Parkland Medicaid |
$16,178.06
|
| Rate for Payer: Scott and White EPO/PPO |
$385.53
|
| Rate for Payer: Scott and White Medicare |
$21,557.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,178.06
|
| Rate for Payer: Superior Health Plan EPO |
$21,557.16
|
| Rate for Payer: Superior Health Plan Medicare |
$21,557.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,557.16
|
| Rate for Payer: Universal American Medicare |
$21,557.16
|
| Rate for Payer: Wellcare Medicare |
$21,557.16
|
| Rate for Payer: Wellmed Medicare |
$21,557.16
|
|
|
REM&RPL ICD GEN/MULTI SYSTEM
|
Facility
|
OP
|
$41,664.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
2350079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$538.09 |
| Max. Negotiated Rate |
$81,352.25 |
| Rate for Payer: Aetna Commercial |
$22,915.20
|
| Rate for Payer: Aetna Medicare |
$45,131.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,749.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Amerigroup Medicare |
$30,087.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53,912.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64,565.28
|
| Rate for Payer: BCBS of TX Medicare |
$30,087.75
|
| Rate for Payer: BCBS of TX PPO |
$81,352.25
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cash Price |
$36,664.32
|
| Rate for Payer: Cigna Commercial |
$68,157.46
|
| Rate for Payer: Cigna Medicaid |
$21,766.45
|
| Rate for Payer: Cigna Medicare |
$30,087.75
|
| Rate for Payer: Employer Direct Commercial |
$30,087.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,087.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$21,766.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Molina Medicare |
$30,087.75
|
| Rate for Payer: Multiplan Auto |
$27,081.60
|
| Rate for Payer: Multiplan Commercial |
$27,081.60
|
| Rate for Payer: Multiplan Workers Comp |
$27,081.60
|
| Rate for Payer: Parkland Medicaid |
$21,766.45
|
| Rate for Payer: Scott and White EPO/PPO |
$538.09
|
| Rate for Payer: Scott and White Medicare |
$30,087.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21,766.45
|
| Rate for Payer: Superior Health Plan EPO |
$30,087.75
|
| Rate for Payer: Superior Health Plan Medicare |
$30,087.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,087.75
|
| Rate for Payer: Universal American Medicare |
$30,087.75
|
| Rate for Payer: Wellcare Medicare |
$30,087.75
|
| Rate for Payer: Wellmed Medicare |
$30,087.75
|
|
|
REM&RPL ICD GEN/MULTI SYSTEM
|
Facility
|
IP
|
$41,664.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
2350079
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$36,664.32
|
|
|
REMV TUNL CVC WO PMP/PRT
|
Facility
|
OP
|
$1,849.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
4616589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| 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 |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,627.12
|
| Rate for Payer: Cash Price |
$1,627.12
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
REMV TUNL CVC WO PMP/PRT
|
Facility
|
IP
|
$1,849.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
4616589
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,627.12
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$17,115.20
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$7,882.00 |
| Max. Negotiated Rate |
$17,115.20 |
| Rate for Payer: Aetna Commercial |
$10,134.00
|
| Rate for Payer: Aetna Medicare |
$13,924.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,282.93
|
| Rate for Payer: Amerigroup Medicare |
$9,282.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,904.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,483.16
|
| Rate for Payer: BCBS of TX Medicare |
$9,282.93
|
| Rate for Payer: BCBS of TX PPO |
$10,537.25
|
| Rate for Payer: Cigna Commercial |
$11,602.30
|
| Rate for Payer: Cigna Medicare |
$9,282.93
|
| Rate for Payer: Employer Direct Commercial |
$9,282.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,282.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,282.93
|
| Rate for Payer: Molina Medicare |
$9,282.93
|
| Rate for Payer: Multiplan Auto |
$17,115.20
|
| Rate for Payer: Multiplan Commercial |
$17,115.20
|
| Rate for Payer: Multiplan Workers Comp |
$17,115.20
|
| Rate for Payer: Scott and White EPO/PPO |
$7,882.00
|
| Rate for Payer: Scott and White Medicare |
$9,282.93
|
| Rate for Payer: Superior Health Plan EPO |
$9,282.93
|
| Rate for Payer: Superior Health Plan Medicare |
$9,282.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,282.93
|
| Rate for Payer: Universal American Medicare |
$9,282.93
|
| Rate for Payer: Wellcare Medicare |
$9,282.93
|
| Rate for Payer: Wellmed Medicare |
$9,282.93
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$28,515.20
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$12,890.54 |
| Max. Negotiated Rate |
$28,515.20 |
| Rate for Payer: Aetna Commercial |
$16,884.00
|
| Rate for Payer: Aetna Medicare |
$20,346.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,564.57
|
| Rate for Payer: Amerigroup Medicare |
$13,564.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,890.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,808.71
|
| Rate for Payer: BCBS of TX Medicare |
$13,564.57
|
| Rate for Payer: BCBS of TX PPO |
$17,565.91
|
| Rate for Payer: Cigna Commercial |
$19,330.30
|
| Rate for Payer: Cigna Medicare |
$13,564.57
|
| Rate for Payer: Employer Direct Commercial |
$13,564.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,564.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,564.57
|
| Rate for Payer: Molina Medicare |
$13,564.57
|
| Rate for Payer: Multiplan Auto |
$28,515.20
|
| Rate for Payer: Multiplan Commercial |
$28,515.20
|
| Rate for Payer: Multiplan Workers Comp |
$28,515.20
|
| Rate for Payer: Scott and White EPO/PPO |
$13,132.00
|
| Rate for Payer: Scott and White Medicare |
$13,564.57
|
| Rate for Payer: Superior Health Plan EPO |
$13,564.57
|
| Rate for Payer: Superior Health Plan Medicare |
$13,564.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,564.57
|
| Rate for Payer: Universal American Medicare |
$13,564.57
|
| Rate for Payer: Wellcare Medicare |
$13,564.57
|
| Rate for Payer: Wellmed Medicare |
$13,564.57
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,561.50
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$5,315.66 |
| Max. Negotiated Rate |
$11,561.50 |
| Rate for Payer: Aetna Commercial |
$6,845.62
|
| Rate for Payer: Aetna Medicare |
$10,795.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,197.06
|
| Rate for Payer: Amerigroup Medicare |
$7,197.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,315.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,395.72
|
| Rate for Payer: BCBS of TX Medicare |
$7,197.06
|
| Rate for Payer: BCBS of TX PPO |
$7,106.63
|
| Rate for Payer: Cigna Commercial |
$7,837.48
|
| Rate for Payer: Cigna Medicare |
$7,197.06
|
| Rate for Payer: Employer Direct Commercial |
$7,197.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,197.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,197.06
|
| Rate for Payer: Molina Medicare |
$7,197.06
|
| Rate for Payer: Multiplan Auto |
$11,561.50
|
| Rate for Payer: Multiplan Commercial |
$11,561.50
|
| Rate for Payer: Multiplan Workers Comp |
$11,561.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5,324.38
|
| Rate for Payer: Scott and White Medicare |
$7,197.06
|
| Rate for Payer: Superior Health Plan EPO |
$7,197.06
|
| Rate for Payer: Superior Health Plan Medicare |
$7,197.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,197.06
|
| Rate for Payer: Universal American Medicare |
$7,197.06
|
| Rate for Payer: Wellcare Medicare |
$7,197.06
|
| Rate for Payer: Wellmed Medicare |
$7,197.06
|
|
|
Renal Function Panel
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
1603539
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$425.92
|
|
|
Renal Function Panel
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
1603539
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$314.60 |
| Rate for Payer: Aetna Commercial |
$9.12
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.68
|
| Rate for Payer: Amerigroup Medicare |
$8.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.19
|
| Rate for Payer: BCBS of TX Medicare |
$8.68
|
| Rate for Payer: BCBS of TX PPO |
$19.18
|
| Rate for Payer: Cash Price |
$425.92
|
| Rate for Payer: Cash Price |
$425.92
|
| Rate for Payer: Cigna Medicaid |
$8.68
|
| Rate for Payer: Cigna Medicare |
$8.68
|
| Rate for Payer: Employer Direct Commercial |
$8.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.68
|
| Rate for Payer: Molina Medicare |
$8.68
|
| Rate for Payer: Multiplan Auto |
$314.60
|
| Rate for Payer: Multiplan Commercial |
$314.60
|
| Rate for Payer: Multiplan Workers Comp |
$314.60
|
| Rate for Payer: Parkland Medicaid |
$8.68
|
| Rate for Payer: Scott and White EPO/PPO |
$10.85
|
| Rate for Payer: Scott and White Medicare |
$8.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.68
|
| Rate for Payer: Superior Health Plan EPO |
$8.68
|
| Rate for Payer: Superior Health Plan Medicare |
$8.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.68
|
| Rate for Payer: Universal American Medicare |
$8.68
|
| Rate for Payer: Wellcare Medicare |
$8.68
|
| Rate for Payer: Wellmed Medicare |
$8.68
|
|
|
Renin Activity, Plasma SO
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
1701523
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$32.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21.99
|
| Rate for Payer: Amerigroup Medicare |
$21.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.54
|
| Rate for Payer: BCBS of TX Medicare |
$21.99
|
| Rate for Payer: BCBS of TX PPO |
$48.60
|
| Rate for Payer: Cash Price |
$412.72
|
| Rate for Payer: Cash Price |
$412.72
|
| Rate for Payer: Cigna Medicaid |
$21.99
|
| Rate for Payer: Cigna Medicare |
$21.99
|
| Rate for Payer: Employer Direct Commercial |
$21.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$21.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$21.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21.99
|
| Rate for Payer: Molina Medicare |
$21.99
|
| Rate for Payer: Multiplan Auto |
$304.85
|
| Rate for Payer: Multiplan Commercial |
$304.85
|
| Rate for Payer: Multiplan Workers Comp |
$304.85
|
| Rate for Payer: Parkland Medicaid |
$21.99
|
| Rate for Payer: Scott and White EPO/PPO |
$27.49
|
| Rate for Payer: Scott and White Medicare |
$21.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21.99
|
| Rate for Payer: Superior Health Plan EPO |
$21.99
|
| Rate for Payer: Superior Health Plan Medicare |
$21.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21.99
|
| Rate for Payer: Universal American Medicare |
$21.99
|
| Rate for Payer: Wellcare Medicare |
$21.99
|
| Rate for Payer: Wellmed Medicare |
$21.99
|
|
