|
SWITCHING STICK
|
Facility
|
OP
|
$774.43
|
|
| Hospital Charge Code |
8414480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$503.38 |
| Rate for Payer: Aetna Commercial |
$425.94
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$232.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$278.79
|
| Rate for Payer: BCBS of TX PPO |
$309.77
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Multiplan Auto |
$503.38
|
| Rate for Payer: Multiplan Commercial |
$503.38
|
| Rate for Payer: Multiplan Workers Comp |
$503.38
|
| Rate for Payer: Scott and White EPO/PPO |
$387.22
|
| Rate for Payer: Superior Health Plan EPO |
$105.32
|
|
|
Sympathectomy; digital arteries, each digit
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64820
|
| Hospital Charge Code |
36064820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
Sympathectomy; ulnar artery
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64822
|
| Hospital Charge Code |
36064822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
SYMPHION FLUID MANAGMENT KIT FG-0202
|
Facility
|
OP
|
$1,811.46
|
|
| Hospital Charge Code |
145145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.03 |
| Max. Negotiated Rate |
$1,177.45 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$163.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$543.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$652.13
|
| Rate for Payer: BCBS of TX PPO |
$724.58
|
| Rate for Payer: Cash Price |
$1,594.08
|
| Rate for Payer: Multiplan Auto |
$1,177.45
|
| Rate for Payer: Multiplan Commercial |
$1,177.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,177.45
|
| Rate for Payer: Scott and White EPO/PPO |
$905.73
|
| Rate for Payer: Superior Health Plan EPO |
$246.36
|
|
|
SYMPHION FLUID MANAGMENT KIT FG-0202
|
Facility
|
IP
|
$1,811.46
|
|
| Hospital Charge Code |
145145
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,594.08
|
|
|
SYMPHION RESECTING DEVICE FG-0201
|
Facility
|
IP
|
$4,535.46
|
|
| Hospital Charge Code |
145144
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$3,991.20
|
|
|
SYMPHION RESECTING DEVICE FG-0201
|
Facility
|
OP
|
$4,535.46
|
|
| Hospital Charge Code |
145144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$2,948.05 |
| Rate for Payer: Aetna Commercial |
$2,494.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$408.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,360.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,632.77
|
| Rate for Payer: BCBS of TX PPO |
$1,814.18
|
| Rate for Payer: Cash Price |
$3,991.20
|
| Rate for Payer: Multiplan Auto |
$2,948.05
|
| Rate for Payer: Multiplan Commercial |
$2,948.05
|
| Rate for Payer: Multiplan Workers Comp |
$2,948.05
|
| Rate for Payer: Scott and White EPO/PPO |
$2,267.73
|
| Rate for Payer: Superior Health Plan EPO |
$616.82
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$16,406.50
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$6,646.94 |
| Max. Negotiated Rate |
$16,406.50 |
| Rate for Payer: Aetna Commercial |
$9,714.38
|
| Rate for Payer: Aetna Medicare |
$13,525.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,016.77
|
| Rate for Payer: Amerigroup Medicare |
$9,016.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,646.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,270.68
|
| Rate for Payer: BCBS of TX Medicare |
$9,016.77
|
| Rate for Payer: BCBS of TX PPO |
$9,190.00
|
| Rate for Payer: Cigna Commercial |
$11,121.88
|
| Rate for Payer: Cigna Medicare |
$9,016.77
|
| Rate for Payer: Employer Direct Commercial |
$9,016.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,016.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,016.77
|
| Rate for Payer: Molina Medicare |
$9,016.77
|
| Rate for Payer: Multiplan Auto |
$16,406.50
|
| Rate for Payer: Multiplan Commercial |
$16,406.50
|
| Rate for Payer: Multiplan Workers Comp |
$16,406.50
|
| Rate for Payer: Scott and White EPO/PPO |
$7,555.62
|
| Rate for Payer: Scott and White Medicare |
$9,016.77
|
| Rate for Payer: Superior Health Plan EPO |
$9,016.77
|
| Rate for Payer: Superior Health Plan Medicare |
$9,016.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,016.77
|
| Rate for Payer: Universal American Medicare |
$9,016.77
|
| Rate for Payer: Wellcare Medicare |
$9,016.77
|
| Rate for Payer: Wellmed Medicare |
$9,016.77
|
|
|
Syndactylization, toes (eg, webbing or Kelikian type procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
36028280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Synovectomy, extensor tendon sheath, wrist, single compartment
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25118
|
| Hospital Charge Code |
36025118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26135
|
| Hospital Charge Code |
36026135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Synovectomy, tendon sheath, foot; flexor
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28086
|
| Hospital Charge Code |
36028086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendo
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26145
|
| Hospital Charge Code |
36026145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
SYPHILIS TEST QUALITATIVE
|
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
|
|
|
SYPHILIS TEST QUANTITATIVE
|
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
|
|
|
SYRINGE ALLIANCE II DIL/INFL M00550600
|
Facility
|
IP
|
$132.57
|
|
| Hospital Charge Code |
115780
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$116.66
|
|
|
SYRINGE ALLIANCE II DIL/INFL M00550600
|
Facility
|
OP
|
$132.57
|
|
| Hospital Charge Code |
115780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$86.17 |
| Rate for Payer: Aetna Commercial |
$72.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$47.73
|
| Rate for Payer: BCBS of TX PPO |
$53.03
|
| Rate for Payer: Cash Price |
$116.66
|
| Rate for Payer: Multiplan Auto |
$86.17
|
| Rate for Payer: Multiplan Commercial |
$86.17
|
| Rate for Payer: Multiplan Workers Comp |
$86.17
|
| Rate for Payer: Scott and White EPO/PPO |
$66.28
|
| Rate for Payer: Superior Health Plan EPO |
$18.03
|
|
|
SYRINGE MEDRAD -- DHF
|
Facility
|
OP
|
$39.41
|
|
| Hospital Charge Code |
80345465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$25.62 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.19
|
| Rate for Payer: BCBS of TX PPO |
$15.76
|
| Rate for Payer: Cash Price |
$34.68
|
| Rate for Payer: Multiplan Auto |
$25.62
|
| Rate for Payer: Multiplan Commercial |
$25.62
|
| Rate for Payer: Multiplan Workers Comp |
$25.62
|
| Rate for Payer: Scott and White EPO/PPO |
$19.70
|
| Rate for Payer: Superior Health Plan EPO |
$5.36
|
|
|
SYRINGE MEDRAD -- DHF
|
Facility
|
IP
|
$39.41
|
|
| Hospital Charge Code |
80345465
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$34.68
|
|
|
SYS BICEP DSTL REPR IMPL -- DHF
|
Facility
|
OP
|
$8,139.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40180614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.59 |
| Max. Negotiated Rate |
$4,069.96 |
| Rate for Payer: Aetna Commercial |
$2,441.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$732.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,441.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,930.37
|
| Rate for Payer: BCBS of TX PPO |
$3,255.96
|
| Rate for Payer: Cash Price |
$7,163.12
|
| Rate for Payer: Multiplan Auto |
$4,069.96
|
| Rate for Payer: Multiplan Commercial |
$4,069.96
|
| Rate for Payer: Multiplan Workers Comp |
$4,069.96
|
| Rate for Payer: Scott and White EPO/PPO |
$4,069.96
|
| Rate for Payer: Superior Health Plan EPO |
$1,107.03
|
|
|
SYS BICEP DSTL REPR IMPL -- DHF
|
Facility
|
IP
|
$8,139.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40180614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.98 |
| Max. Negotiated Rate |
$4,069.96 |
| Rate for Payer: Aetna Commercial |
$2,441.97
|
| Rate for Payer: Cash Price |
$7,163.12
|
| Rate for Payer: Cigna Commercial |
$2,034.98
|
| Rate for Payer: Multiplan Auto |
$4,069.96
|
| Rate for Payer: Multiplan Commercial |
$4,069.96
|
| Rate for Payer: Multiplan Workers Comp |
$4,069.96
|
| Rate for Payer: Scott and White EPO/PPO |
$4,069.96
|
|
|
SYS CALIB SLV GASTRECTMY -- DHF
|
Facility
|
OP
|
$886.66
|
|
| Hospital Charge Code |
80849417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$576.33 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$266.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$319.20
|
| Rate for Payer: BCBS of TX PPO |
$354.66
|
| Rate for Payer: Cash Price |
$780.26
|
| Rate for Payer: Multiplan Auto |
$576.33
|
| Rate for Payer: Multiplan Commercial |
$576.33
|
| Rate for Payer: Multiplan Workers Comp |
$576.33
|
| Rate for Payer: Scott and White EPO/PPO |
$443.33
|
| Rate for Payer: Superior Health Plan EPO |
$120.59
|
|
|
SYS CALIB SLV GASTRECTMY -- DHF
|
Facility
|
IP
|
$886.66
|
|
| Hospital Charge Code |
80849417
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$780.26
|
|
|
SYS CAST TOTAL CONTACT -- DHF
|
Facility
|
OP
|
$516.06
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
81020430
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$335.44 |
| Rate for Payer: Aetna Commercial |
$283.83
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$154.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$185.78
|
| Rate for Payer: BCBS of TX PPO |
$206.42
|
| Rate for Payer: Cash Price |
$454.13
|
| Rate for Payer: Multiplan Auto |
$335.44
|
| Rate for Payer: Multiplan Commercial |
$335.44
|
| Rate for Payer: Multiplan Workers Comp |
$335.44
|
| Rate for Payer: Scott and White EPO/PPO |
$258.03
|
| Rate for Payer: Superior Health Plan EPO |
$70.18
|
|
|
SYS CAST TOTAL CONTACT -- DHF
|
Facility
|
IP
|
$516.06
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
81020430
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$454.13
|
|
