|
RT EKG 12 Lead Tracing BCE
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5503006
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$616.00
|
|
|
RT HEART CATH W O2 SATU & OUT PUT
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
2320520
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$6,594.72
|
|
|
RT HEART CATH W O2 SATU & OUT PUT
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
2320520
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$7,181.87 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,470.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$674.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Amerigroup Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$6,594.72
|
| Rate for Payer: Cash Price |
$6,594.72
|
| Rate for Payer: Cash Price |
$6,594.72
|
| Rate for Payer: Cigna Commercial |
$6,750.80
|
| Rate for Payer: Cigna Medicare |
$2,980.11
|
| Rate for Payer: Employer Direct Commercial |
$2,980.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,980.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Molina Medicare |
$2,980.11
|
| Rate for Payer: Multiplan Auto |
$4,871.10
|
| Rate for Payer: Multiplan Commercial |
$4,871.10
|
| Rate for Payer: Multiplan Workers Comp |
$4,871.10
|
| Rate for Payer: Scott and White EPO/PPO |
$53.30
|
| Rate for Payer: Scott and White Medicare |
$2,980.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,980.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,980.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Universal American Medicare |
$2,980.11
|
| Rate for Payer: Wellcare Medicare |
$2,980.11
|
| Rate for Payer: Wellmed Medicare |
$2,980.11
|
|
|
RT+LT HEART CATH+LT VENT GRAPHY INJ
|
Facility
|
IP
|
$13,446.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
2320522
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$11,832.48
|
|
|
RT+LT HEART CATH+LT VENT GRAPHY INJ
|
Facility
|
OP
|
$13,446.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
2320522
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$8,739.90 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,470.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,210.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Amerigroup Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,980.11
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$11,832.48
|
| Rate for Payer: Cash Price |
$11,832.48
|
| Rate for Payer: Cash Price |
$11,832.48
|
| Rate for Payer: Cigna Commercial |
$6,750.80
|
| Rate for Payer: Cigna Medicare |
$2,980.11
|
| Rate for Payer: Employer Direct Commercial |
$2,980.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,980.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Molina Medicare |
$2,980.11
|
| Rate for Payer: Multiplan Auto |
$8,739.90
|
| Rate for Payer: Multiplan Commercial |
$8,739.90
|
| Rate for Payer: Multiplan Workers Comp |
$8,739.90
|
| Rate for Payer: Scott and White EPO/PPO |
$53.30
|
| Rate for Payer: Scott and White Medicare |
$2,980.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,980.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,980.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,980.11
|
| Rate for Payer: Universal American Medicare |
$2,980.11
|
| Rate for Payer: Wellcare Medicare |
$2,980.11
|
| Rate for Payer: Wellmed Medicare |
$2,980.11
|
|
|
RT VENTRICULAR RECORDING
|
Facility
|
OP
|
$2,140.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
4613603
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$2,488.65 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,632.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$192.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,088.43
|
| Rate for Payer: Amerigroup Medicare |
$1,088.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,649.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,975.12
|
| Rate for Payer: BCBS of TX Medicare |
$1,088.43
|
| Rate for Payer: BCBS of TX PPO |
$2,488.65
|
| Rate for Payer: Cash Price |
$1,883.20
|
| Rate for Payer: Cash Price |
$1,883.20
|
| Rate for Payer: Cash Price |
$1,883.20
|
| Rate for Payer: Cigna Commercial |
$2,465.61
|
| Rate for Payer: Cigna Medicare |
$1,088.43
|
| Rate for Payer: Employer Direct Commercial |
$1,088.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,088.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,088.43
|
| Rate for Payer: Molina Medicare |
$1,088.43
|
| Rate for Payer: Multiplan Auto |
$1,391.00
|
| Rate for Payer: Multiplan Commercial |
$1,391.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,391.00
|
| Rate for Payer: Scott and White EPO/PPO |
$19.47
|
| Rate for Payer: Scott and White Medicare |
$1,088.43
|
| Rate for Payer: Superior Health Plan EPO |
$1,088.43
|
| Rate for Payer: Superior Health Plan Medicare |
$1,088.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,088.43
|
| Rate for Payer: Universal American Medicare |
$1,088.43
|
| Rate for Payer: Wellcare Medicare |
$1,088.43
|
| Rate for Payer: Wellmed Medicare |
$1,088.43
|
|
|
RT VENTRICULAR RECORDING
|
Facility
|
IP
|
$2,140.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
4613603
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,883.20
|
|
|
Rubella Antibodies, IgG SO
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
1605377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.49
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$31.80
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cigna Medicaid |
$14.39
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Parkland Medicaid |
$14.39
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.39
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Rubella Antibodies, IgM SO
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
1605377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.49
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$31.80
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cigna Medicaid |
$14.39
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Parkland Medicaid |
$14.39
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.39
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Rubella IgG Antibody
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
1605377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Amerigroup Medicare |
$14.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.49
|
| Rate for Payer: BCBS of TX Medicare |
$14.39
|
| Rate for Payer: BCBS of TX PPO |
$31.80
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cigna Medicaid |
$14.39
|
| Rate for Payer: Cigna Medicare |
$14.39
|
| Rate for Payer: Employer Direct Commercial |
$14.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Molina Medicare |
$14.39
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Parkland Medicaid |
$14.39
|
| Rate for Payer: Scott and White EPO/PPO |
$17.99
|
| Rate for Payer: Scott and White Medicare |
$14.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.39
|
| Rate for Payer: Superior Health Plan EPO |
$14.39
|
| Rate for Payer: Superior Health Plan Medicare |
$14.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.39
|
| Rate for Payer: Universal American Medicare |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: Wellmed Medicare |
$14.39
|
|
|
Rubella IgG Antibody
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
1605377
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$131.12
|
|
|
RubeoAb(IgG/IgM) SO
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$130.24
|
|
|
RubeoAb(IgG/IgM) SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1706704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cash Price |
$130.24
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$96.20
|
| Rate for Payer: Multiplan Workers Comp |
$96.20
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
Rupture of Membrane
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
1692010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna Commercial |
$103.02
|
| Rate for Payer: Aetna Medicare |
$147.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$98.11
|
| Rate for Payer: Amerigroup Medicare |
$98.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$161.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.26
|
| Rate for Payer: BCBS of TX Medicare |
$98.11
|
| Rate for Payer: BCBS of TX PPO |
$216.82
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Medicaid |
$98.11
|
| Rate for Payer: Cigna Medicare |
$98.11
|
| Rate for Payer: Employer Direct Commercial |
$98.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$98.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$98.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$98.11
|
| Rate for Payer: Molina Medicare |
$98.11
|
| Rate for Payer: Multiplan Auto |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Multiplan Workers Comp |
$351.00
|
| Rate for Payer: Parkland Medicaid |
$98.11
|
| Rate for Payer: Scott and White EPO/PPO |
$122.64
|
| Rate for Payer: Scott and White Medicare |
$98.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98.11
|
| Rate for Payer: Superior Health Plan EPO |
$98.11
|
| Rate for Payer: Superior Health Plan Medicare |
$98.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$98.11
|
| Rate for Payer: Universal American Medicare |
$98.11
|
| Rate for Payer: Wellcare Medicare |
$98.11
|
| Rate for Payer: Wellmed Medicare |
$98.11
|
|
|
Rupture of Membrane
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
1692010
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$475.20
|
|
|
RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1708353
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$14.37
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9.58
|
| Rate for Payer: Amerigroup Medicare |
$9.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.97
|
| Rate for Payer: BCBS of TX Medicare |
$9.58
|
| Rate for Payer: BCBS of TX PPO |
$21.17
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Medicaid |
$9.58
|
| Rate for Payer: Cigna Medicare |
$9.58
|
| Rate for Payer: Employer Direct Commercial |
$9.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$9.58
|
| Rate for Payer: Molina CHIP/Medicaid |
$9.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9.58
|
| Rate for Payer: Molina Medicare |
$9.58
|
| Rate for Payer: Multiplan Auto |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Multiplan Workers Comp |
$97.50
|
| Rate for Payer: Parkland Medicaid |
$9.58
|
| Rate for Payer: Scott and White EPO/PPO |
$11.98
|
| Rate for Payer: Scott and White Medicare |
$9.58
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9.58
|
| Rate for Payer: Superior Health Plan EPO |
$9.58
|
| Rate for Payer: Superior Health Plan Medicare |
$9.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9.58
|
| Rate for Payer: Universal American Medicare |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$9.58
|
| Rate for Payer: Wellmed Medicare |
$9.58
|
|
|
Saccharomyces cerevisiae Panel SO
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
1709757
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$74.80
|
|
|
Saccharomyces cerevisiae Panel SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
1709757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$12.86
|
| Rate for Payer: Aetna Medicare |
$18.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.25
|
| Rate for Payer: Amerigroup Medicare |
$12.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.26
|
| Rate for Payer: BCBS of TX Medicare |
$12.25
|
| Rate for Payer: BCBS of TX PPO |
$27.07
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cigna Medicaid |
$12.25
|
| Rate for Payer: Cigna Medicare |
$12.25
|
| Rate for Payer: Employer Direct Commercial |
$12.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.25
|
| Rate for Payer: Molina Medicare |
$12.25
|
| Rate for Payer: Multiplan Auto |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| Rate for Payer: Parkland Medicaid |
$12.25
|
| Rate for Payer: Scott and White EPO/PPO |
$15.31
|
| Rate for Payer: Scott and White Medicare |
$12.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.25
|
| Rate for Payer: Superior Health Plan EPO |
$12.25
|
| Rate for Payer: Superior Health Plan Medicare |
$12.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.25
|
| Rate for Payer: Universal American Medicare |
$12.25
|
| Rate for Payer: Wellcare Medicare |
$12.25
|
| Rate for Payer: Wellmed Medicare |
$12.25
|
|
|
sacubitril-valsartan Tab
|
Facility
|
IP
|
$32.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78349105
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$21.79
|
|
|
sacubitril-valsartan Tab
|
Facility
|
OP
|
$32.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78349105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.54
|
| Rate for Payer: BCBS of TX PPO |
$12.82
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Multiplan Auto |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$20.83
|
| Rate for Payer: Multiplan Workers Comp |
$20.83
|
| Rate for Payer: Scott and White EPO/PPO |
$16.02
|
| Rate for Payer: Superior Health Plan EPO |
$4.36
|
|
|
Salicylate Level
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$65.24
|
| Rate for Payer: Aetna Medicare |
$93.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Amerigroup Medicare |
$62.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$123.04
|
| Rate for Payer: BCBS of TX Medicare |
$62.14
|
| Rate for Payer: BCBS of TX PPO |
$137.33
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cigna Medicaid |
$62.14
|
| Rate for Payer: Cigna Medicare |
$62.14
|
| Rate for Payer: Employer Direct Commercial |
$62.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$62.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Molina Medicare |
$62.14
|
| Rate for Payer: Multiplan Auto |
$206.05
|
| Rate for Payer: Multiplan Commercial |
$206.05
|
| Rate for Payer: Multiplan Workers Comp |
$206.05
|
| Rate for Payer: Parkland Medicaid |
$62.14
|
| Rate for Payer: Scott and White EPO/PPO |
$77.68
|
| Rate for Payer: Scott and White Medicare |
$62.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.14
|
| Rate for Payer: Superior Health Plan EPO |
$62.14
|
| Rate for Payer: Superior Health Plan Medicare |
$62.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Universal American Medicare |
$62.14
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: Wellmed Medicare |
$62.14
|
|
|
Salicylate Level
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640123
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$278.96
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$22,566.30
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$8,833.06 |
| Max. Negotiated Rate |
$22,566.30 |
| Rate for Payer: Aetna Commercial |
$13,361.62
|
| Rate for Payer: Aetna Medicare |
$16,995.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,330.28
|
| Rate for Payer: Amerigroup Medicare |
$11,330.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,833.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,974.17
|
| Rate for Payer: BCBS of TX Medicare |
$11,330.28
|
| Rate for Payer: BCBS of TX PPO |
$13,305.15
|
| Rate for Payer: Cigna Commercial |
$15,297.58
|
| Rate for Payer: Cigna Medicare |
$11,330.28
|
| Rate for Payer: Employer Direct Commercial |
$11,330.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,330.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,330.28
|
| Rate for Payer: Molina Medicare |
$11,330.28
|
| Rate for Payer: Multiplan Auto |
$22,566.30
|
| Rate for Payer: Multiplan Commercial |
$22,566.30
|
| Rate for Payer: Multiplan Workers Comp |
$22,566.30
|
| Rate for Payer: Scott and White EPO/PPO |
$10,392.38
|
| Rate for Payer: Scott and White Medicare |
$11,330.28
|
| Rate for Payer: Superior Health Plan EPO |
$11,330.28
|
| Rate for Payer: Superior Health Plan Medicare |
$11,330.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,330.28
|
| Rate for Payer: Universal American Medicare |
$11,330.28
|
| Rate for Payer: Wellcare Medicare |
$11,330.28
|
| Rate for Payer: Wellmed Medicare |
$11,330.28
|
|
|
SARS Antigen
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
4100361
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$91.52
|
|
|
SARS Antigen
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
4100361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$53.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$74.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$89.56
|
| Rate for Payer: BCBS of TX Medicare |
$35.33
|
| Rate for Payer: BCBS of TX PPO |
$99.96
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cigna Medicaid |
$45.23
|
| Rate for Payer: Cigna Medicare |
$35.33
|
| Rate for Payer: Employer Direct Commercial |
$35.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.33
|
| Rate for Payer: Molina Medicare |
$35.33
|
| Rate for Payer: Multiplan Auto |
$67.60
|
| Rate for Payer: Multiplan Commercial |
$67.60
|
| Rate for Payer: Multiplan Workers Comp |
$67.60
|
| Rate for Payer: Parkland Medicaid |
$45.23
|
| Rate for Payer: Scott and White EPO/PPO |
$44.16
|
| Rate for Payer: Scott and White Medicare |
$35.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$45.23
|
| Rate for Payer: Superior Health Plan EPO |
$35.33
|
| Rate for Payer: Superior Health Plan Medicare |
$35.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.33
|
| Rate for Payer: Universal American Medicare |
$35.33
|
| Rate for Payer: Wellcare Medicare |
$35.33
|
| Rate for Payer: Wellmed Medicare |
$35.33
|
|
