|
Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27606
|
| Hospital Charge Code |
36027606
|
|
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
|
|
|
Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27306
|
| Hospital Charge Code |
36027306
|
|
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
|
|
|
Tenotomy, shoulder area single tendon
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 23405
|
| Hospital Charge Code |
36023405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
terbutaline 1 mg/mL Inj Soln 1 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
9301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.80
|
| Rate for Payer: BCBS of TX PPO |
$5.33
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
terbutaline 1 mg/mL Inj Soln 1 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
9301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$40,335.10
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$18,003.92 |
| Max. Negotiated Rate |
$40,335.10 |
| Rate for Payer: Aetna Commercial |
$23,882.62
|
| Rate for Payer: Aetna Medicare |
$27,005.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,003.92
|
| Rate for Payer: Amerigroup Medicare |
$18,003.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18,241.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,499.64
|
| Rate for Payer: BCBS of TX Medicare |
$18,003.92
|
| Rate for Payer: BCBS of TX PPO |
$23,889.41
|
| Rate for Payer: Cigna Commercial |
$27,342.95
|
| Rate for Payer: Cigna Medicare |
$18,003.92
|
| Rate for Payer: Employer Direct Commercial |
$18,003.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,003.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,003.92
|
| Rate for Payer: Molina Medicare |
$18,003.92
|
| Rate for Payer: Multiplan Auto |
$40,335.10
|
| Rate for Payer: Multiplan Commercial |
$40,335.10
|
| Rate for Payer: Multiplan Workers Comp |
$40,335.10
|
| Rate for Payer: Scott and White EPO/PPO |
$18,575.38
|
| Rate for Payer: Scott and White Medicare |
$18,003.92
|
| Rate for Payer: Superior Health Plan EPO |
$18,003.92
|
| Rate for Payer: Superior Health Plan Medicare |
$18,003.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,003.92
|
| Rate for Payer: Universal American Medicare |
$18,003.92
|
| Rate for Payer: Wellcare Medicare |
$18,003.92
|
| Rate for Payer: Wellmed Medicare |
$18,003.92
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,579.60
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$9,214.04 |
| Max. Negotiated Rate |
$22,579.60 |
| Rate for Payer: Aetna Commercial |
$13,369.50
|
| Rate for Payer: Aetna Medicare |
$17,002.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,335.28
|
| Rate for Payer: Amerigroup Medicare |
$11,335.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,214.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,111.50
|
| Rate for Payer: BCBS of TX Medicare |
$11,335.28
|
| Rate for Payer: BCBS of TX PPO |
$12,346.59
|
| Rate for Payer: Cigna Commercial |
$15,306.59
|
| Rate for Payer: Cigna Medicare |
$11,335.28
|
| Rate for Payer: Employer Direct Commercial |
$11,335.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,335.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,335.28
|
| Rate for Payer: Molina Medicare |
$11,335.28
|
| Rate for Payer: Multiplan Auto |
$22,579.60
|
| Rate for Payer: Multiplan Commercial |
$22,579.60
|
| Rate for Payer: Multiplan Workers Comp |
$22,579.60
|
| Rate for Payer: Scott and White EPO/PPO |
$10,398.50
|
| Rate for Payer: Scott and White Medicare |
$11,335.28
|
| Rate for Payer: Superior Health Plan EPO |
$11,335.28
|
| Rate for Payer: Superior Health Plan Medicare |
$11,335.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,335.28
|
| Rate for Payer: Universal American Medicare |
$11,335.28
|
| Rate for Payer: Wellcare Medicare |
$11,335.28
|
| Rate for Payer: Wellmed Medicare |
$11,335.28
|
|
|
Testosterone,Free and Total SO
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1706175
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$368.72
|
|
|
Testosterone,Free and Total SO
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1706175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$272.35 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Aetna Medicare |
$38.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.47
|
| Rate for Payer: Amerigroup Medicare |
$25.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.43
|
| Rate for Payer: BCBS of TX Medicare |
$25.47
|
| Rate for Payer: BCBS of TX PPO |
$56.29
|
| Rate for Payer: Cash Price |
$368.72
|
| Rate for Payer: Cash Price |
$368.72
|
| Rate for Payer: Cigna Medicaid |
$25.47
|
| Rate for Payer: Cigna Medicare |
$25.47
|
| Rate for Payer: Employer Direct Commercial |
$25.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.47
|
| Rate for Payer: Molina Medicare |
$25.47
|
| Rate for Payer: Multiplan Auto |
$272.35
|
| Rate for Payer: Multiplan Commercial |
$272.35
|
| Rate for Payer: Multiplan Workers Comp |
$272.35
|
| Rate for Payer: Parkland Medicaid |
$25.47
|
| Rate for Payer: Scott and White EPO/PPO |
$31.84
|
| Rate for Payer: Scott and White Medicare |
$25.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.47
|
| Rate for Payer: Superior Health Plan EPO |
$25.47
|
| Rate for Payer: Superior Health Plan Medicare |
$25.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.47
|
| Rate for Payer: Universal American Medicare |
$25.47
|
| Rate for Payer: Wellcare Medicare |
$25.47
|
| Rate for Payer: Wellmed Medicare |
$25.47
|
|
|
Testosterone Level Total (Male)
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1701556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Aetna Commercial |
$27.11
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Amerigroup Medicare |
$25.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.10
|
| Rate for Payer: BCBS of TX Medicare |
$25.81
|
| Rate for Payer: BCBS of TX PPO |
$57.04
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cigna Medicaid |
$25.81
|
| Rate for Payer: Cigna Medicare |
$25.81
|
| Rate for Payer: Employer Direct Commercial |
$25.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Molina Medicare |
$25.81
|
| Rate for Payer: Multiplan Auto |
$243.10
|
| Rate for Payer: Multiplan Commercial |
$243.10
|
| Rate for Payer: Multiplan Workers Comp |
$243.10
|
| Rate for Payer: Parkland Medicaid |
$25.81
|
| Rate for Payer: Scott and White EPO/PPO |
$32.26
|
| Rate for Payer: Scott and White Medicare |
$25.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.81
|
| Rate for Payer: Superior Health Plan EPO |
$25.81
|
| Rate for Payer: Superior Health Plan Medicare |
$25.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Universal American Medicare |
$25.81
|
| Rate for Payer: Wellcare Medicare |
$25.81
|
| Rate for Payer: Wellmed Medicare |
$25.81
|
|
|
Testosterone, Serum SO
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1701556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Aetna Commercial |
$27.11
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Amerigroup Medicare |
$25.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.10
|
| Rate for Payer: BCBS of TX Medicare |
$25.81
|
| Rate for Payer: BCBS of TX PPO |
$57.04
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cigna Medicaid |
$25.81
|
| Rate for Payer: Cigna Medicare |
$25.81
|
| Rate for Payer: Employer Direct Commercial |
$25.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Molina Medicare |
$25.81
|
| Rate for Payer: Multiplan Auto |
$243.10
|
| Rate for Payer: Multiplan Commercial |
$243.10
|
| Rate for Payer: Multiplan Workers Comp |
$243.10
|
| Rate for Payer: Parkland Medicaid |
$25.81
|
| Rate for Payer: Scott and White EPO/PPO |
$32.26
|
| Rate for Payer: Scott and White Medicare |
$25.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.81
|
| Rate for Payer: Superior Health Plan EPO |
$25.81
|
| Rate for Payer: Superior Health Plan Medicare |
$25.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Universal American Medicare |
$25.81
|
| Rate for Payer: Wellcare Medicare |
$25.81
|
| Rate for Payer: Wellmed Medicare |
$25.81
|
|
|
Testosterone, Serum SO
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1701556
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$329.12
|
|
|
TESTOSTERONE TOTAL
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1701556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Aetna Commercial |
$27.11
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Amerigroup Medicare |
$25.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.10
|
| Rate for Payer: BCBS of TX Medicare |
$25.81
|
| Rate for Payer: BCBS of TX PPO |
$57.04
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cigna Medicaid |
$25.81
|
| Rate for Payer: Cigna Medicare |
$25.81
|
| Rate for Payer: Employer Direct Commercial |
$25.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Molina Medicare |
$25.81
|
| Rate for Payer: Multiplan Auto |
$243.10
|
| Rate for Payer: Multiplan Commercial |
$243.10
|
| Rate for Payer: Multiplan Workers Comp |
$243.10
|
| Rate for Payer: Parkland Medicaid |
$25.81
|
| Rate for Payer: Scott and White EPO/PPO |
$32.26
|
| Rate for Payer: Scott and White Medicare |
$25.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.81
|
| Rate for Payer: Superior Health Plan EPO |
$25.81
|
| Rate for Payer: Superior Health Plan Medicare |
$25.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.81
|
| Rate for Payer: Universal American Medicare |
$25.81
|
| Rate for Payer: Wellcare Medicare |
$25.81
|
| Rate for Payer: Wellmed Medicare |
$25.81
|
|
|
tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77841150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$70.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$68.76
|
| Rate for Payer: BCBS of TX PPO |
$76.27
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
| Rate for Payer: Superior Health Plan EPO |
$17.41
|
|
|
tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77841150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cigna Commercial |
$32.00
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
|
|
tetanus-diptheria toxoid 0.5 ml injection
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77841260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$70.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$68.76
|
| Rate for Payer: BCBS of TX PPO |
$76.27
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
| Rate for Payer: Superior Health Plan EPO |
$17.41
|
|
|
tetanus-diptheria toxoid 0.5 ml injection
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77841260
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.04
|
|
|
tetracaine 0.5% Ophth Soln 5 mL
|
Facility
|
IP
|
$61.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77841680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Cash Price |
$41.86
|
| Rate for Payer: Cigna Commercial |
$15.39
|
| Rate for Payer: Scott and White EPO/PPO |
$30.78
|
|
|
tetracaine 0.5% Ophth Soln 5 mL
|
Facility
|
OP
|
$61.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77841680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$40.01 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.16
|
| Rate for Payer: BCBS of TX PPO |
$24.62
|
| Rate for Payer: Cash Price |
$41.86
|
| Rate for Payer: Multiplan Auto |
$40.01
|
| Rate for Payer: Multiplan Commercial |
$40.01
|
| Rate for Payer: Multiplan Workers Comp |
$40.01
|
| Rate for Payer: Scott and White EPO/PPO |
$30.78
|
| Rate for Payer: Superior Health Plan EPO |
$8.37
|
|
|
TgAb+Thyroglobulin,IMA or RIA SO
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
1700343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.91
|
| Rate for Payer: Amerigroup Medicare |
$15.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.50
|
| Rate for Payer: BCBS of TX Medicare |
$15.91
|
| Rate for Payer: BCBS of TX PPO |
$35.16
|
| Rate for Payer: Cash Price |
$78.32
|
| Rate for Payer: Cash Price |
$78.32
|
| Rate for Payer: Cigna Medicaid |
$15.91
|
| Rate for Payer: Cigna Medicare |
$15.91
|
| Rate for Payer: Employer Direct Commercial |
$15.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.91
|
| Rate for Payer: Molina Medicare |
$15.91
|
| Rate for Payer: Multiplan Auto |
$57.85
|
| Rate for Payer: Multiplan Commercial |
$57.85
|
| Rate for Payer: Multiplan Workers Comp |
$57.85
|
| Rate for Payer: Parkland Medicaid |
$15.91
|
| Rate for Payer: Scott and White EPO/PPO |
$19.89
|
| Rate for Payer: Scott and White Medicare |
$15.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.91
|
| Rate for Payer: Superior Health Plan EPO |
$15.91
|
| Rate for Payer: Superior Health Plan Medicare |
$15.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.91
|
| Rate for Payer: Universal American Medicare |
$15.91
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: Wellmed Medicare |
$15.91
|
|
|
Theophylline Level
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
1602986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna Commercial |
$14.84
|
| Rate for Payer: Aetna Medicare |
$21.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.00
|
| Rate for Payer: BCBS of TX Medicare |
$14.14
|
| Rate for Payer: BCBS of TX PPO |
$31.25
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Cigna Medicaid |
$14.14
|
| Rate for Payer: Cigna Medicare |
$14.14
|
| Rate for Payer: Employer Direct Commercial |
$14.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Molina Medicare |
$14.14
|
| Rate for Payer: Multiplan Auto |
$284.05
|
| Rate for Payer: Multiplan Commercial |
$284.05
|
| Rate for Payer: Multiplan Workers Comp |
$284.05
|
| Rate for Payer: Parkland Medicaid |
$14.14
|
| Rate for Payer: Scott and White EPO/PPO |
$17.68
|
| Rate for Payer: Scott and White Medicare |
$14.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.14
|
| Rate for Payer: Superior Health Plan EPO |
$14.14
|
| Rate for Payer: Superior Health Plan Medicare |
$14.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Universal American Medicare |
$14.14
|
| Rate for Payer: Wellcare Medicare |
$14.14
|
| Rate for Payer: Wellmed Medicare |
$14.14
|
|
|
Theophylline, Serum SO
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
1602986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna Commercial |
$14.84
|
| Rate for Payer: Aetna Medicare |
$21.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.00
|
| Rate for Payer: BCBS of TX Medicare |
$14.14
|
| Rate for Payer: BCBS of TX PPO |
$31.25
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Cigna Medicaid |
$14.14
|
| Rate for Payer: Cigna Medicare |
$14.14
|
| Rate for Payer: Employer Direct Commercial |
$14.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Molina Medicare |
$14.14
|
| Rate for Payer: Multiplan Auto |
$284.05
|
| Rate for Payer: Multiplan Commercial |
$284.05
|
| Rate for Payer: Multiplan Workers Comp |
$284.05
|
| Rate for Payer: Parkland Medicaid |
$14.14
|
| Rate for Payer: Scott and White EPO/PPO |
$17.68
|
| Rate for Payer: Scott and White Medicare |
$14.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.14
|
| Rate for Payer: Superior Health Plan EPO |
$14.14
|
| Rate for Payer: Superior Health Plan Medicare |
$14.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.14
|
| Rate for Payer: Universal American Medicare |
$14.14
|
| Rate for Payer: Wellcare Medicare |
$14.14
|
| Rate for Payer: Wellmed Medicare |
$14.14
|
|
|
Theophylline, Serum SO
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
1602986
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$384.56
|
|
|
Therapeutic Multiple Vitamins with Minerals Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77843867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
Therapeutic Multiple Vitamins with Minerals Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77843867
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
