|
Toe, other than Great Toe, w/o manipulation
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8544471
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$509.52
|
|
|
Toe, other than Great Toe, w/o manipulation
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8544471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$318.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.62
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$197.34
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$62.85
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$376.35
|
| Rate for Payer: Multiplan Commercial |
$376.35
|
| Rate for Payer: Multiplan Workers Comp |
$376.35
|
| Rate for Payer: Parkland Medicaid |
$62.85
|
| Rate for Payer: Scott and White EPO/PPO |
$154.01
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.85
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
Tonsillectomy and adenoidectomy age 12 or over
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 42821
|
| Hospital Charge Code |
36042821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,416.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Amerigroup Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$886.62
|
| Rate for Payer: Cigna Medicare |
$2,944.49
|
| Rate for Payer: Employer Direct Commercial |
$2,944.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,944.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$886.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Molina Medicare |
$2,944.49
|
| 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 |
$886.62
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$886.62
|
| Rate for Payer: Superior Health Plan EPO |
$2,944.49
|
| Rate for Payer: Superior Health Plan Medicare |
$2,944.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Universal American Medicare |
$2,944.49
|
| Rate for Payer: Wellcare Medicare |
$2,944.49
|
| Rate for Payer: Wellmed Medicare |
$2,944.49
|
|
|
Tonsillectomy and adenoidectomy younger than age 12
|
Facility
|
OP
|
$12,223.34
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
36042820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.22 |
| Max. Negotiated Rate |
$12,223.34 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$8,033.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Amerigroup Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,100.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,701.06
|
| Rate for Payer: BCBS of TX Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX PPO |
$12,223.34
|
| Rate for Payer: Cigna Commercial |
$12,132.30
|
| Rate for Payer: Cigna Medicaid |
$1,954.22
|
| Rate for Payer: Cigna Medicare |
$5,355.74
|
| Rate for Payer: Employer Direct Commercial |
$5,355.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,355.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Molina Medicare |
$5,355.74
|
| 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 |
$1,954.22
|
| Rate for Payer: Scott and White EPO/PPO |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,355.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Superior Health Plan EPO |
$5,355.74
|
| Rate for Payer: Superior Health Plan Medicare |
$5,355.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Universal American Medicare |
$5,355.74
|
| Rate for Payer: Wellcare Medicare |
$5,355.74
|
| Rate for Payer: Wellmed Medicare |
$5,355.74
|
|
|
Tonsillectomy, primary or secondary age 12 or over
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 42826
|
| Hospital Charge Code |
36042826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,416.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Amerigroup Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$886.62
|
| Rate for Payer: Cigna Medicare |
$2,944.49
|
| Rate for Payer: Employer Direct Commercial |
$2,944.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,944.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$886.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Molina Medicare |
$2,944.49
|
| 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 |
$886.62
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$886.62
|
| Rate for Payer: Superior Health Plan EPO |
$2,944.49
|
| Rate for Payer: Superior Health Plan Medicare |
$2,944.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Universal American Medicare |
$2,944.49
|
| Rate for Payer: Wellcare Medicare |
$2,944.49
|
| Rate for Payer: Wellmed Medicare |
$2,944.49
|
|
|
topiramate 100 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78437264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
topiramate 100 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78437264
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
topiramate 25 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77852013
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
topiramate 25 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77852013
|
|
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 |
$2.29
|
| 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 |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
Topiramate (Topamax), Serum SO
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
1739465
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$295.68
|
|
|
Topiramate (Topamax), Serum SO
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
1739465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$12.51
|
| Rate for Payer: Aetna Medicare |
$17.88
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.92
|
| Rate for Payer: Amerigroup Medicare |
$11.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.60
|
| Rate for Payer: BCBS of TX Medicare |
$11.92
|
| Rate for Payer: BCBS of TX PPO |
$26.34
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cigna Medicaid |
$11.92
|
| Rate for Payer: Cigna Medicare |
$11.92
|
| Rate for Payer: Employer Direct Commercial |
$11.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.92
|
| Rate for Payer: Molina Medicare |
$11.92
|
| Rate for Payer: Multiplan Auto |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Multiplan Workers Comp |
$218.40
|
| Rate for Payer: Parkland Medicaid |
$11.92
|
| Rate for Payer: Scott and White EPO/PPO |
$14.90
|
| Rate for Payer: Scott and White Medicare |
$11.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.92
|
| Rate for Payer: Superior Health Plan EPO |
$11.92
|
| Rate for Payer: Superior Health Plan Medicare |
$11.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.92
|
| Rate for Payer: Universal American Medicare |
$11.92
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
| Rate for Payer: Wellmed Medicare |
$11.92
|
|
|
TORQUE DVCE -- DHF
|
Facility
|
IP
|
$1,221.26
|
|
| Hospital Charge Code |
80348907
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,074.71
|
|
|
TORQUE DVCE -- DHF
|
Facility
|
OP
|
$1,221.26
|
|
| Hospital Charge Code |
80348907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$793.82 |
| Rate for Payer: Aetna Commercial |
$671.69
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$366.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$439.65
|
| Rate for Payer: BCBS of TX PPO |
$488.50
|
| Rate for Payer: Cash Price |
$1,074.71
|
| Rate for Payer: Multiplan Auto |
$793.82
|
| Rate for Payer: Multiplan Commercial |
$793.82
|
| Rate for Payer: Multiplan Workers Comp |
$793.82
|
| Rate for Payer: Scott and White EPO/PPO |
$610.63
|
| Rate for Payer: Superior Health Plan EPO |
$166.09
|
|
|
torsemide 20 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77852661
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
torsemide 20 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77852661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate pr
|
Facility
|
OP
|
$40,184.12
|
|
|
Service Code
|
CPT 22856
|
| Hospital Charge Code |
36022856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,210.00 |
| Max. Negotiated Rate |
$40,184.12 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$25,565.31
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9,913.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Amerigroup Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| Rate for Payer: Cigna Commercial |
$38,608.57
|
| Rate for Payer: Cigna Medicaid |
$9,913.52
|
| Rate for Payer: Cigna Medicare |
$17,043.54
|
| Rate for Payer: Employer Direct Commercial |
$17,043.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,043.54
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,913.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Molina Medicare |
$17,043.54
|
| 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 |
$9,913.52
|
| Rate for Payer: Scott and White EPO/PPO |
$31,530.55
|
| Rate for Payer: Scott and White Medicare |
$17,043.54
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,913.52
|
| Rate for Payer: Superior Health Plan EPO |
$17,043.54
|
| Rate for Payer: Superior Health Plan Medicare |
$17,043.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Universal American Medicare |
$17,043.54
|
| Rate for Payer: Wellcare Medicare |
$17,043.54
|
| Rate for Payer: Wellmed Medicare |
$17,043.54
|
|
|
Total Iron Binding Capacity
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
1601038
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$278.96
|
|
|
Total Iron Binding Capacity
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
1601038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Medicare |
$13.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.74
|
| Rate for Payer: Amerigroup Medicare |
$8.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.31
|
| Rate for Payer: BCBS of TX Medicare |
$8.74
|
| Rate for Payer: BCBS of TX PPO |
$19.32
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cigna Medicaid |
$8.74
|
| Rate for Payer: Cigna Medicare |
$8.74
|
| Rate for Payer: Employer Direct Commercial |
$8.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.74
|
| Rate for Payer: Molina Medicare |
$8.74
|
| 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 |
$8.74
|
| Rate for Payer: Scott and White EPO/PPO |
$10.93
|
| Rate for Payer: Scott and White Medicare |
$8.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.74
|
| Rate for Payer: Superior Health Plan EPO |
$8.74
|
| Rate for Payer: Superior Health Plan Medicare |
$8.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.74
|
| Rate for Payer: Universal American Medicare |
$8.74
|
| Rate for Payer: Wellcare Medicare |
$8.74
|
| Rate for Payer: Wellmed Medicare |
$8.74
|
|
|
Total thyroid lobectomy, unilateral with or without isthmusectomy
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
36060220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,888.85
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,888.85
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
Total vital capacity
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4049052
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$244.64
|
|
|
Total vital capacity
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4049052
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$152.90
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cash Price |
$244.64
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$180.70
|
| Rate for Payer: Multiplan Commercial |
$180.70
|
| Rate for Payer: Multiplan Workers Comp |
$180.70
|
| Rate for Payer: Scott and White EPO/PPO |
$139.00
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
Toxoplasma Abs IgG/IgM SO
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
1702679
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$74.80
|
|
|
Toxoplasma Abs IgG/IgM SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
1702679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.59
|
| 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 |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| 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 |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| 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
|
|
|
Toxoplasma gondii Ab, IgG, Qn SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
1702679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$21.59
|
| 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 |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| 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 |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| 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
|
|
|
Toxoplasma gondii Ab,IgM SO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
1703024
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$79.20
|
|
