|
BLOOD ADMIN SET KENTEC 039600F
|
Facility
|
IP
|
$65.96
|
|
| Hospital Charge Code |
8568497
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$58.04
|
|
|
Blood Collection Capillary BCE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
300673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Multiplan Auto |
$26.65
|
| Rate for Payer: Multiplan Commercial |
$26.65
|
| Rate for Payer: Multiplan Workers Comp |
$26.65
|
| Rate for Payer: Scott and White EPO/PPO |
$20.50
|
| Rate for Payer: Superior Health Plan EPO |
$5.58
|
|
|
Blood Collection Venous Draw BCE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
1605526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$25.85
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.83
|
| Rate for Payer: Amerigroup Medicare |
$8.83
|
| Rate for Payer: BCBS of TX Medicare |
$8.83
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Medicare |
$8.83
|
| Rate for Payer: Employer Direct Commercial |
$8.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.83
|
| Rate for Payer: Molina Medicare |
$8.83
|
| Rate for Payer: Multiplan Auto |
$30.55
|
| Rate for Payer: Multiplan Commercial |
$30.55
|
| Rate for Payer: Multiplan Workers Comp |
$30.55
|
| Rate for Payer: Scott and White EPO/PPO |
$11.04
|
| Rate for Payer: Scott and White Medicare |
$8.83
|
| Rate for Payer: Superior Health Plan EPO |
$8.83
|
| Rate for Payer: Superior Health Plan Medicare |
$8.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.83
|
| Rate for Payer: Universal American Medicare |
$8.83
|
| Rate for Payer: Wellcare Medicare |
$8.83
|
| Rate for Payer: Wellmed Medicare |
$8.83
|
|
|
BLOOD COUNT RED BLOOD CELL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
1605799
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$13.20
|
|
|
BLOOD COUNT RED BLOOD CELL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
1605799
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.02
|
| Rate for Payer: Amerigroup Medicare |
$3.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5.98
|
| Rate for Payer: BCBS of TX Medicare |
$3.02
|
| Rate for Payer: BCBS of TX PPO |
$6.67
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Medicaid |
$3.02
|
| Rate for Payer: Cigna Medicare |
$3.02
|
| Rate for Payer: Employer Direct Commercial |
$3.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.02
|
| Rate for Payer: Molina Medicare |
$3.02
|
| Rate for Payer: Multiplan Auto |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Multiplan Workers Comp |
$9.75
|
| Rate for Payer: Parkland Medicaid |
$3.02
|
| Rate for Payer: Scott and White EPO/PPO |
$3.78
|
| Rate for Payer: Scott and White Medicare |
$3.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.02
|
| Rate for Payer: Superior Health Plan EPO |
$3.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.02
|
| Rate for Payer: Universal American Medicare |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$3.02
|
| Rate for Payer: Wellmed Medicare |
$3.02
|
|
|
Blood Culture
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
4107040
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$344.08
|
|
|
Blood Culture
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
4107040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Aetna Commercial |
$10.83
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.32
|
| Rate for Payer: Amerigroup Medicare |
$10.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.43
|
| Rate for Payer: BCBS of TX Medicare |
$10.32
|
| Rate for Payer: BCBS of TX PPO |
$22.81
|
| Rate for Payer: Cash Price |
$344.08
|
| Rate for Payer: Cash Price |
$344.08
|
| Rate for Payer: Cigna Medicaid |
$10.32
|
| Rate for Payer: Cigna Medicare |
$10.32
|
| Rate for Payer: Employer Direct Commercial |
$10.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.32
|
| Rate for Payer: Molina Medicare |
$10.32
|
| Rate for Payer: Multiplan Auto |
$254.15
|
| Rate for Payer: Multiplan Commercial |
$254.15
|
| Rate for Payer: Multiplan Workers Comp |
$254.15
|
| Rate for Payer: Parkland Medicaid |
$10.32
|
| Rate for Payer: Scott and White EPO/PPO |
$12.90
|
| Rate for Payer: Scott and White Medicare |
$10.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.32
|
| Rate for Payer: Superior Health Plan EPO |
$10.32
|
| Rate for Payer: Superior Health Plan Medicare |
$10.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.32
|
| Rate for Payer: Universal American Medicare |
$10.32
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: Wellmed Medicare |
$10.32
|
|
|
Blood Gas Draw Type:Arterial
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| 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 |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| 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
|
|
|
Blood Gas Draw Type Arterial BCE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$134.64
|
|
|
Blood Gas Draw Type Arterial BCE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| 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 |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| 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
|
|
|
Blood Gas RT O2 Sat Calc BCE
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
4000493
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$326.48
|
|
|
Blood Gas RT O2 Sat Calc BCE
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
4000493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$241.15 |
| Rate for Payer: Aetna Commercial |
$27.37
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Amerigroup Medicare |
$26.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.62
|
| Rate for Payer: BCBS of TX Medicare |
$26.07
|
| Rate for Payer: BCBS of TX PPO |
$57.61
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cigna Medicaid |
$26.07
|
| Rate for Payer: Cigna Medicare |
$26.07
|
| Rate for Payer: Employer Direct Commercial |
$26.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$26.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Molina Medicare |
$26.07
|
| Rate for Payer: Multiplan Auto |
$241.15
|
| Rate for Payer: Multiplan Commercial |
$241.15
|
| Rate for Payer: Multiplan Workers Comp |
$241.15
|
| Rate for Payer: Parkland Medicaid |
$26.07
|
| Rate for Payer: Scott and White EPO/PPO |
$32.59
|
| Rate for Payer: Scott and White Medicare |
$26.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$26.07
|
| Rate for Payer: Superior Health Plan EPO |
$26.07
|
| Rate for Payer: Superior Health Plan Medicare |
$26.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Universal American Medicare |
$26.07
|
| Rate for Payer: Wellcare Medicare |
$26.07
|
| Rate for Payer: Wellmed Medicare |
$26.07
|
|
|
Blood Gas RT O2 Sat Meas BCE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4000519
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$829.84
|
|
|
Blood Gas RT O2 Sat Meas BCE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4000519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$612.95 |
| Rate for Payer: Aetna Commercial |
$82.70
|
| Rate for Payer: Aetna Medicare |
$118.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$78.77
|
| Rate for Payer: Amerigroup Medicare |
$78.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$129.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$155.96
|
| Rate for Payer: BCBS of TX Medicare |
$78.77
|
| Rate for Payer: BCBS of TX PPO |
$174.08
|
| Rate for Payer: Cash Price |
$829.84
|
| Rate for Payer: Cash Price |
$829.84
|
| Rate for Payer: Cigna Medicaid |
$78.77
|
| Rate for Payer: Cigna Medicare |
$78.77
|
| Rate for Payer: Employer Direct Commercial |
$78.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$78.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$78.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$78.77
|
| Rate for Payer: Molina Medicare |
$78.77
|
| Rate for Payer: Multiplan Auto |
$612.95
|
| Rate for Payer: Multiplan Commercial |
$612.95
|
| Rate for Payer: Multiplan Workers Comp |
$612.95
|
| Rate for Payer: Parkland Medicaid |
$78.77
|
| Rate for Payer: Scott and White EPO/PPO |
$98.46
|
| Rate for Payer: Scott and White Medicare |
$78.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$78.77
|
| Rate for Payer: Superior Health Plan EPO |
$78.77
|
| Rate for Payer: Superior Health Plan Medicare |
$78.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$78.77
|
| Rate for Payer: Universal American Medicare |
$78.77
|
| Rate for Payer: Wellcare Medicare |
$78.77
|
| Rate for Payer: Wellmed Medicare |
$78.77
|
|
|
BLOOD INFU ST -- DHF
|
Facility
|
IP
|
$53.29
|
|
| Hospital Charge Code |
80313356
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$46.90
|
|
|
BLOOD INFU ST -- DHF
|
Facility
|
OP
|
$53.29
|
|
| Hospital Charge Code |
80313356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.18
|
| Rate for Payer: BCBS of TX PPO |
$21.32
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Multiplan Auto |
$34.64
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Multiplan Workers Comp |
$34.64
|
| Rate for Payer: Scott and White EPO/PPO |
$26.64
|
| Rate for Payer: Superior Health Plan EPO |
$7.25
|
|
|
BLOOD TYPING RH (D)
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2400414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$83.09 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Amerigroup Medicare |
$36.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$36.68
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cigna Commercial |
$83.09
|
| Rate for Payer: Cigna Medicaid |
$2.99
|
| Rate for Payer: Cigna Medicare |
$36.68
|
| Rate for Payer: Employer Direct Commercial |
$36.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$36.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare |
$36.68
|
| Rate for Payer: Multiplan Auto |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$73.45
|
| Rate for Payer: Multiplan Workers Comp |
$73.45
|
| Rate for Payer: Parkland Medicaid |
$2.99
|
| Rate for Payer: Scott and White EPO/PPO |
$3.74
|
| Rate for Payer: Scott and White Medicare |
$36.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.99
|
| Rate for Payer: Superior Health Plan EPO |
$36.68
|
| Rate for Payer: Superior Health Plan Medicare |
$36.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Universal American Medicare |
$36.68
|
| Rate for Payer: Wellcare Medicare |
$36.68
|
| Rate for Payer: Wellmed Medicare |
$36.68
|
|
|
Blood Urea Nitrogen
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
1602358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.95
|
| Rate for Payer: Amerigroup Medicare |
$3.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.82
|
| Rate for Payer: BCBS of TX Medicare |
$3.95
|
| Rate for Payer: BCBS of TX PPO |
$8.73
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$3.95
|
| Rate for Payer: Cigna Medicare |
$3.95
|
| Rate for Payer: Employer Direct Commercial |
$3.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.95
|
| Rate for Payer: Molina Medicare |
$3.95
|
| 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 |
$3.95
|
| Rate for Payer: Scott and White EPO/PPO |
$4.94
|
| Rate for Payer: Scott and White Medicare |
$3.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.95
|
| Rate for Payer: Superior Health Plan EPO |
$3.95
|
| Rate for Payer: Superior Health Plan Medicare |
$3.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.95
|
| Rate for Payer: Universal American Medicare |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: Wellmed Medicare |
$3.95
|
|
|
Blood Urea Nitrogen
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
1602358
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$144.32
|
|
|
BLT HL -- DHF
|
Facility
|
IP
|
$211.71
|
|
| Hospital Charge Code |
81140105
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$186.30
|
|
|
BLT HL -- DHF
|
Facility
|
OP
|
$211.71
|
|
| Hospital Charge Code |
81140105
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$137.61 |
| Rate for Payer: Aetna Commercial |
$116.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$63.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$76.22
|
| Rate for Payer: BCBS of TX PPO |
$84.68
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Multiplan Auto |
$137.61
|
| Rate for Payer: Multiplan Commercial |
$137.61
|
| Rate for Payer: Multiplan Workers Comp |
$137.61
|
| Rate for Payer: Scott and White EPO/PPO |
$105.86
|
| Rate for Payer: Superior Health Plan EPO |
$28.79
|
|
|
BLT LG -- DHF
|
Facility
|
OP
|
$507.22
|
|
| Hospital Charge Code |
80313430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$329.69 |
| Rate for Payer: Aetna Commercial |
$278.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$45.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$152.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$182.60
|
| Rate for Payer: BCBS of TX PPO |
$202.89
|
| Rate for Payer: Cash Price |
$446.35
|
| Rate for Payer: Multiplan Auto |
$329.69
|
| Rate for Payer: Multiplan Commercial |
$329.69
|
| Rate for Payer: Multiplan Workers Comp |
$329.69
|
| Rate for Payer: Scott and White EPO/PPO |
$253.61
|
| Rate for Payer: Superior Health Plan EPO |
$68.98
|
|
|
BLT LG -- DHF
|
Facility
|
IP
|
$507.22
|
|
| Hospital Charge Code |
80313430
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$446.35
|
|
|
BLT SAFETY -- DHF
|
Facility
|
IP
|
$18.02
|
|
| Hospital Charge Code |
80313554
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$15.86
|
|
|
BLT SAFETY -- DHF
|
Facility
|
OP
|
$18.02
|
|
| Hospital Charge Code |
80313554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna Commercial |
$9.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.49
|
| Rate for Payer: BCBS of TX PPO |
$7.21
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Multiplan Auto |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
| Rate for Payer: Multiplan Workers Comp |
$11.71
|
| Rate for Payer: Scott and White EPO/PPO |
$9.01
|
| Rate for Payer: Superior Health Plan EPO |
$2.45
|
|
