|
RT CHARGE BIPAP Initial BCE
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5501857
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$615.12
|
|
|
RT CHARGE BiPAP:Subsequent
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5504662
|
|
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 Subsequent BCE
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5504662
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$615.12
|
|
|
RT CHARGE BIPAP Subsequent BCE
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
5504662
|
|
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 Chest Physiotherapy:Manipulate chest PT initial
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$123.75
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$20.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| 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 Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Multiplan Workers Comp |
$146.25
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| 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
|
|
|
RT CHARGE Chest Physiotherapy:Manipulate chest PT initial
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000055
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
RT CHARGE Chest Physiotherapy:Manipulate chest PT subsequent
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4000337
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| 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 Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Workers Comp |
$87.75
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| 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
|
|
|
RT CHARGE Chest Physiotherapy Manipulate Subsequent BCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4000337
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$118.80
|
|
|
RT CHARGE Chest Physiotherapy Manipulate Subsequent BCE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4000337
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| 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 Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Workers Comp |
$87.75
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| 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
|
|
|
RT CHARGE Continuous Ea Additional Hr
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4000568
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$400.40
|
|
|
RT CHARGE Continuous Ea Additional Hr
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4000568
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$40.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.24
|
| Rate for Payer: BCBS of TX PPO |
$39.30
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Multiplan Auto |
$295.75
|
| Rate for Payer: Multiplan Commercial |
$295.75
|
| Rate for Payer: Multiplan Workers Comp |
$295.75
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$61.88
|
|
|
RT CHARGE Continuous First Hour BCE
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4000550
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$310.70 |
| Rate for Payer: Aetna Commercial |
$262.90
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| 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 Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$310.70
|
| Rate for Payer: Multiplan Commercial |
$310.70
|
| Rate for Payer: Multiplan Workers Comp |
$310.70
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| 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
|
|
|
RT CHARGE Continuous First Hour BCE
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4000550
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$420.64
|
|
|
RT CHARGE Continuous First Hour:Yes
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4000550
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$310.70 |
| Rate for Payer: Aetna Commercial |
$262.90
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cash Price |
$420.64
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| 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 Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$310.70
|
| Rate for Payer: Multiplan Commercial |
$310.70
|
| Rate for Payer: Multiplan Workers Comp |
$310.70
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| 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
|
|
|
RT CHARGE CPAP:Initial
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000105
|
|
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 CPAP Initial BCE
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000105
|
|
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 CPAP:Subsequent
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000105
|
|
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 CPAP Subsequent BCE
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000105
|
|
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 CPAP Subsequent BCE
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000105
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$615.12
|
|
|
RT CHARGE CPR BCE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,012.00
|
|
|
RT CHARGE CPR BCE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$632.50
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
RT CHARGE CPR:Yes
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$632.50
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
RT CHARGE Intubation or Assist::RT Intubation
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$576.95
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| 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 |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.93
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
RT CHARGE Intubation or Assist RT Intubation BCE
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$923.12
|
|
|
RT CHARGE Intubation or Assist RT Intubation BCE
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$576.95
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| 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 |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.93
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
