|
ROOM/BED: Semi Private OB
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
16006
|
|
Hospital Revenue Code
|
122
|
| Rate for Payer: Cash Price |
$893.20
|
|
|
rOPINIRole 1 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77798348
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
rOPINIRole 1 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77798348
|
|
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
|
|
|
ropivacaine 0.2% Inj Soln 200 mL Epidural
|
Facility
|
IP
|
$150.59
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
77800099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cigna Commercial |
$37.65
|
| Rate for Payer: Scott and White EPO/PPO |
$75.30
|
|
|
ropivacaine 0.2% Inj Soln 200 mL Epidural
|
Facility
|
OP
|
$150.59
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
77800099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$97.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.05
|
| Rate for Payer: BCBS of TX PPO |
$0.06
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan Auto |
$97.88
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: Multiplan Workers Comp |
$97.88
|
| Rate for Payer: Scott and White EPO/PPO |
$75.30
|
| Rate for Payer: Superior Health Plan EPO |
$20.48
|
|
|
ropivacaine 0.5% Inj Soln 30 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
77801588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.05
|
| Rate for Payer: BCBS of TX PPO |
$0.06
|
| 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
|
|
|
ropivacaine 0.5% Inj Soln 30 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
77801588
|
|
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
|
|
|
Routine ECG 12 Lead
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
4603000
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| 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 |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| 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
|
|
|
Routine ECG 12 lead/15 lead tracing only 93005
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| 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 |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| 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
|
|
|
Routine ECG 12 lead/15 lead tracing only 93005 BCE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| 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 |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| 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
|
|
|
Routine ECG 15 Lead
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
4603000
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| 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 |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| 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
|
|
|
Routine ECG 15 Lead
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
4603000
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$616.00
|
|
|
.RPR Qn 006464 SO
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
1605468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Amerigroup Medicare |
$4.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.71
|
| Rate for Payer: BCBS of TX Medicare |
$4.40
|
| Rate for Payer: BCBS of TX PPO |
$9.72
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna Medicaid |
$4.40
|
| Rate for Payer: Cigna Medicare |
$4.40
|
| Rate for Payer: Employer Direct Commercial |
$4.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Molina Medicare |
$4.40
|
| Rate for Payer: Multiplan Auto |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$120.25
|
| Rate for Payer: Multiplan Workers Comp |
$120.25
|
| Rate for Payer: Parkland Medicaid |
$4.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5.50
|
| Rate for Payer: Scott and White Medicare |
$4.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.40
|
| Rate for Payer: Superior Health Plan EPO |
$4.40
|
| Rate for Payer: Superior Health Plan Medicare |
$4.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Universal American Medicare |
$4.40
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: Wellmed Medicare |
$4.40
|
|
|
.RPR Qn+TP Abs 012021 SO
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
1606045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
RPR, Rfx Qn RPR/Confirm TP SO
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
1605450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare |
$6.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Amerigroup Medicare |
$4.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.45
|
| Rate for Payer: BCBS of TX Medicare |
$4.27
|
| Rate for Payer: BCBS of TX PPO |
$9.44
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$4.27
|
| Rate for Payer: Cigna Medicare |
$4.27
|
| Rate for Payer: Employer Direct Commercial |
$4.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Molina Medicare |
$4.27
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Parkland Medicaid |
$4.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5.34
|
| Rate for Payer: Scott and White Medicare |
$4.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.27
|
| Rate for Payer: Superior Health Plan EPO |
$4.27
|
| Rate for Payer: Superior Health Plan Medicare |
$4.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Universal American Medicare |
$4.27
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: Wellmed Medicare |
$4.27
|
|
|
RT CHARGE Aerosol Demo/Eval BCE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4000048
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$36.96
|
|
|
RT CHARGE Aerosol Demo/Eval BCE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4000048
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$27.30
|
| Rate for Payer: Multiplan Workers Comp |
$27.30
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE Aerosol Demo/Eval:Yes
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4000048
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$27.30
|
| Rate for Payer: Multiplan Workers Comp |
$27.30
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE Aerosol Therapy:Initial
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4049144
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$110.50
|
| Rate for Payer: Multiplan Workers Comp |
$110.50
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE Aerosol Therapy Initial BCE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4049144
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$110.50
|
| Rate for Payer: Multiplan Workers Comp |
$110.50
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE Aerosol Therapy:Subsequent
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
4049144
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$110.50
|
| Rate for Payer: Multiplan Workers Comp |
$110.50
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE Aerosol Therapy Subsequent BCE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
4049144
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$149.60
|
|
|
RT CHARGE Aerosol Therapy Subsequent BCE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
4049144
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$110.50
|
| Rate for Payer: Multiplan Workers Comp |
$110.50
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE BiPAP:Initial
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5501857
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$454.35 |
| Rate for Payer: Aetna Commercial |
$384.45
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$454.35
|
| Rate for Payer: Multiplan Commercial |
$454.35
|
| Rate for Payer: Multiplan Workers Comp |
$454.35
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
RT CHARGE BIPAP Initial BCE
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5501857
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$454.35 |
| Rate for Payer: Aetna Commercial |
$384.45
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$454.35
|
| Rate for Payer: Multiplan Commercial |
$454.35
|
| Rate for Payer: Multiplan Workers Comp |
$454.35
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
