|
Transferrin
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
1600998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Amerigroup Medicare |
$12.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.26
|
| Rate for Payer: BCBS of TX Medicare |
$12.76
|
| Rate for Payer: BCBS of TX PPO |
$28.20
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cigna Medicaid |
$12.76
|
| Rate for Payer: Cigna Medicare |
$12.76
|
| Rate for Payer: Employer Direct Commercial |
$12.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Molina Medicare |
$12.76
|
| Rate for Payer: Multiplan Auto |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$200.20
|
| Rate for Payer: Multiplan Workers Comp |
$200.20
|
| Rate for Payer: Parkland Medicaid |
$12.76
|
| Rate for Payer: Scott and White EPO/PPO |
$15.95
|
| Rate for Payer: Scott and White Medicare |
$12.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.76
|
| Rate for Payer: Superior Health Plan EPO |
$12.76
|
| Rate for Payer: Superior Health Plan Medicare |
$12.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Universal American Medicare |
$12.76
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
| Rate for Payer: Wellmed Medicare |
$12.76
|
|
|
Transferrin SO
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
1600998
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$271.04
|
|
|
Transferrin SO
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
1600998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Amerigroup Medicare |
$12.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.26
|
| Rate for Payer: BCBS of TX Medicare |
$12.76
|
| Rate for Payer: BCBS of TX PPO |
$28.20
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cigna Medicaid |
$12.76
|
| Rate for Payer: Cigna Medicare |
$12.76
|
| Rate for Payer: Employer Direct Commercial |
$12.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Molina Medicare |
$12.76
|
| Rate for Payer: Multiplan Auto |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$200.20
|
| Rate for Payer: Multiplan Workers Comp |
$200.20
|
| Rate for Payer: Parkland Medicaid |
$12.76
|
| Rate for Payer: Scott and White EPO/PPO |
$15.95
|
| Rate for Payer: Scott and White Medicare |
$12.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.76
|
| Rate for Payer: Superior Health Plan EPO |
$12.76
|
| Rate for Payer: Superior Health Plan Medicare |
$12.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.76
|
| Rate for Payer: Universal American Medicare |
$12.76
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
| Rate for Payer: Wellmed Medicare |
$12.76
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$15,175.30
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$6,340.78 |
| Max. Negotiated Rate |
$15,175.30 |
| Rate for Payer: Aetna Commercial |
$8,985.38
|
| Rate for Payer: Aetna Medicare |
$12,831.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,554.35
|
| Rate for Payer: Amerigroup Medicare |
$8,554.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,340.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,899.19
|
| Rate for Payer: BCBS of TX Medicare |
$8,554.35
|
| Rate for Payer: BCBS of TX PPO |
$8,777.22
|
| Rate for Payer: Cigna Commercial |
$10,287.26
|
| Rate for Payer: Cigna Medicare |
$8,554.35
|
| Rate for Payer: Employer Direct Commercial |
$8,554.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,554.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,554.35
|
| Rate for Payer: Molina Medicare |
$8,554.35
|
| Rate for Payer: Multiplan Auto |
$15,175.30
|
| Rate for Payer: Multiplan Commercial |
$15,175.30
|
| Rate for Payer: Multiplan Workers Comp |
$15,175.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,988.62
|
| Rate for Payer: Scott and White Medicare |
$8,554.35
|
| Rate for Payer: Superior Health Plan EPO |
$8,554.35
|
| Rate for Payer: Superior Health Plan Medicare |
$8,554.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,554.35
|
| Rate for Payer: Universal American Medicare |
$8,554.35
|
| Rate for Payer: Wellcare Medicare |
$8,554.35
|
| Rate for Payer: Wellmed Medicare |
$8,554.35
|
|
|
TRANSLUMBAR RENAL CYST
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
4614470
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$549.17
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$794.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$953.53
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$1,064.29
|
| Rate for Payer: Cash Price |
$1,007.60
|
| Rate for Payer: Cash Price |
$1,007.60
|
| Rate for Payer: Cash Price |
$1,007.60
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$81.35
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$81.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$744.25
|
| Rate for Payer: Multiplan Commercial |
$744.25
|
| Rate for Payer: Multiplan Workers Comp |
$744.25
|
| Rate for Payer: Parkland Medicaid |
$81.35
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$81.35
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
TRANSLUMBAR RENAL CYST
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
4614470
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,007.60
|
|
|
Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or st
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66174
|
| Hospital Charge Code |
36066174
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$5,577.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Amerigroup Medicare |
$3,718.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,376.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,636.66
|
| Rate for Payer: BCBS of TX Medicare |
$3,718.40
|
| Rate for Payer: BCBS of TX PPO |
$9,622.19
|
| Rate for Payer: Cigna Commercial |
$8,423.25
|
| Rate for Payer: Cigna Medicare |
$3,718.40
|
| Rate for Payer: Employer Direct Commercial |
$3,718.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,718.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Molina Medicare |
$3,718.40
|
| 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: Scott and White EPO/PPO |
$82.02
|
| Rate for Payer: Scott and White Medicare |
$3,718.40
|
| Rate for Payer: Superior Health Plan EPO |
$3,718.40
|
| Rate for Payer: Superior Health Plan Medicare |
$3,718.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,718.40
|
| Rate for Payer: Universal American Medicare |
$3,718.40
|
| Rate for Payer: Wellcare Medicare |
$3,718.40
|
| Rate for Payer: Wellmed Medicare |
$3,718.40
|
|
|
Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniate
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63056
|
| Hospital Charge Code |
36063056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| 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
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$29,157.40
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$11,233.32 |
| Max. Negotiated Rate |
$29,157.40 |
| Rate for Payer: Aetna Commercial |
$17,264.25
|
| Rate for Payer: Aetna Medicare |
$20,708.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,805.78
|
| Rate for Payer: Amerigroup Medicare |
$13,805.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,233.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,329.82
|
| Rate for Payer: BCBS of TX Medicare |
$13,805.78
|
| Rate for Payer: BCBS of TX PPO |
$18,144.94
|
| Rate for Payer: Cigna Commercial |
$19,765.65
|
| Rate for Payer: Cigna Medicare |
$13,805.78
|
| Rate for Payer: Employer Direct Commercial |
$13,805.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,805.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,805.78
|
| Rate for Payer: Molina Medicare |
$13,805.78
|
| Rate for Payer: Multiplan Auto |
$29,157.40
|
| Rate for Payer: Multiplan Commercial |
$29,157.40
|
| Rate for Payer: Multiplan Workers Comp |
$29,157.40
|
| Rate for Payer: Scott and White EPO/PPO |
$13,427.75
|
| Rate for Payer: Scott and White Medicare |
$13,805.78
|
| Rate for Payer: Superior Health Plan EPO |
$13,805.78
|
| Rate for Payer: Superior Health Plan Medicare |
$13,805.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,805.78
|
| Rate for Payer: Universal American Medicare |
$13,805.78
|
| Rate for Payer: Wellcare Medicare |
$13,805.78
|
| Rate for Payer: Wellmed Medicare |
$13,805.78
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,542.00
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$21,099.24 |
| Max. Negotiated Rate |
$53,542.00 |
| Rate for Payer: Aetna Commercial |
$31,702.50
|
| Rate for Payer: Aetna Medicare |
$34,446.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,964.20
|
| Rate for Payer: Amerigroup Medicare |
$22,964.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21,099.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29,043.86
|
| Rate for Payer: BCBS of TX Medicare |
$22,964.20
|
| Rate for Payer: BCBS of TX PPO |
$32,272.20
|
| Rate for Payer: Cigna Commercial |
$36,295.84
|
| Rate for Payer: Cigna Medicare |
$22,964.20
|
| Rate for Payer: Employer Direct Commercial |
$22,964.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,964.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,964.20
|
| Rate for Payer: Molina Medicare |
$22,964.20
|
| Rate for Payer: Multiplan Auto |
$53,542.00
|
| Rate for Payer: Multiplan Commercial |
$53,542.00
|
| Rate for Payer: Multiplan Workers Comp |
$53,542.00
|
| Rate for Payer: Scott and White EPO/PPO |
$24,657.50
|
| Rate for Payer: Scott and White Medicare |
$22,964.20
|
| Rate for Payer: Superior Health Plan EPO |
$22,964.20
|
| Rate for Payer: Superior Health Plan Medicare |
$22,964.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,964.20
|
| Rate for Payer: Universal American Medicare |
$22,964.20
|
| Rate for Payer: Wellcare Medicare |
$22,964.20
|
| Rate for Payer: Wellmed Medicare |
$22,964.20
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,289.40
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$8,300.72 |
| Max. Negotiated Rate |
$18,289.40 |
| Rate for Payer: Aetna Commercial |
$10,829.25
|
| Rate for Payer: Aetna Medicare |
$14,585.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,723.97
|
| Rate for Payer: Amerigroup Medicare |
$9,723.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,300.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,942.36
|
| Rate for Payer: BCBS of TX Medicare |
$9,723.97
|
| Rate for Payer: BCBS of TX PPO |
$11,047.49
|
| Rate for Payer: Cigna Commercial |
$12,398.29
|
| Rate for Payer: Cigna Medicare |
$9,723.97
|
| Rate for Payer: Employer Direct Commercial |
$9,723.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,723.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,723.97
|
| Rate for Payer: Molina Medicare |
$9,723.97
|
| Rate for Payer: Multiplan Auto |
$18,289.40
|
| Rate for Payer: Multiplan Commercial |
$18,289.40
|
| Rate for Payer: Multiplan Workers Comp |
$18,289.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8,422.75
|
| Rate for Payer: Scott and White Medicare |
$9,723.97
|
| Rate for Payer: Superior Health Plan EPO |
$9,723.97
|
| Rate for Payer: Superior Health Plan Medicare |
$9,723.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,723.97
|
| Rate for Payer: Universal American Medicare |
$9,723.97
|
| Rate for Payer: Wellcare Medicare |
$9,723.97
|
| Rate for Payer: Wellmed Medicare |
$9,723.97
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$27,563.30
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$12,693.62 |
| Max. Negotiated Rate |
$27,563.30 |
| Rate for Payer: Aetna Commercial |
$16,320.38
|
| Rate for Payer: Aetna Medicare |
$19,810.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,207.07
|
| Rate for Payer: Amerigroup Medicare |
$13,207.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,715.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,100.82
|
| Rate for Payer: BCBS of TX Medicare |
$13,207.07
|
| Rate for Payer: BCBS of TX PPO |
$16,779.34
|
| Rate for Payer: Cigna Commercial |
$18,685.02
|
| Rate for Payer: Cigna Medicare |
$13,207.07
|
| Rate for Payer: Employer Direct Commercial |
$13,207.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,207.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,207.07
|
| Rate for Payer: Molina Medicare |
$13,207.07
|
| Rate for Payer: Multiplan Auto |
$27,563.30
|
| Rate for Payer: Multiplan Commercial |
$27,563.30
|
| Rate for Payer: Multiplan Workers Comp |
$27,563.30
|
| Rate for Payer: Scott and White EPO/PPO |
$12,693.62
|
| Rate for Payer: Scott and White Medicare |
$13,207.07
|
| Rate for Payer: Superior Health Plan EPO |
$13,207.07
|
| Rate for Payer: Superior Health Plan Medicare |
$13,207.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,207.07
|
| Rate for Payer: Universal American Medicare |
$13,207.07
|
| Rate for Payer: Wellcare Medicare |
$13,207.07
|
| Rate for Payer: Wellmed Medicare |
$13,207.07
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$18,211.50
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$7,232.60 |
| Max. Negotiated Rate |
$18,211.50 |
| Rate for Payer: Aetna Commercial |
$10,783.12
|
| Rate for Payer: Aetna Medicare |
$14,542.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,694.70
|
| Rate for Payer: Amerigroup Medicare |
$9,694.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,232.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,395.45
|
| Rate for Payer: BCBS of TX Medicare |
$9,694.70
|
| Rate for Payer: BCBS of TX PPO |
$10,439.79
|
| Rate for Payer: Cigna Commercial |
$12,345.48
|
| Rate for Payer: Cigna Medicare |
$9,694.70
|
| Rate for Payer: Employer Direct Commercial |
$9,694.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,694.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,694.70
|
| Rate for Payer: Molina Medicare |
$9,694.70
|
| Rate for Payer: Multiplan Auto |
$18,211.50
|
| Rate for Payer: Multiplan Commercial |
$18,211.50
|
| Rate for Payer: Multiplan Workers Comp |
$18,211.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8,386.88
|
| Rate for Payer: Scott and White Medicare |
$9,694.70
|
| Rate for Payer: Superior Health Plan EPO |
$9,694.70
|
| Rate for Payer: Superior Health Plan Medicare |
$9,694.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,694.70
|
| Rate for Payer: Universal American Medicare |
$9,694.70
|
| Rate for Payer: Wellcare Medicare |
$9,694.70
|
| Rate for Payer: Wellmed Medicare |
$9,694.70
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by i
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36064488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.26
|
| Rate for Payer: Cigna Medicaid |
$51.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.26
|
| 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 |
$51.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.26
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral by
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36064486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.42
|
| Rate for Payer: Cigna Medicaid |
$41.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$41.42
|
| 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 |
$41.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$41.42
|
|
|
transwarmer infant transport mattress
|
Facility
|
IP
|
$105.01
|
|
| Hospital Charge Code |
8630564
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$92.41
|
|
|
transwarmer infant transport mattress
|
Facility
|
OP
|
$105.01
|
|
| Hospital Charge Code |
8630564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$68.26 |
| Rate for Payer: Aetna Commercial |
$57.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37.80
|
| Rate for Payer: BCBS of TX PPO |
$42.00
|
| Rate for Payer: Cash Price |
$92.41
|
| Rate for Payer: Multiplan Auto |
$68.26
|
| Rate for Payer: Multiplan Commercial |
$68.26
|
| Rate for Payer: Multiplan Workers Comp |
$68.26
|
| Rate for Payer: Scott and White EPO/PPO |
$52.50
|
| Rate for Payer: Superior Health Plan EPO |
$14.28
|
|
|
TRAP, TISSUE COLLECTION BERKELEY SAFETOUCH -- DHF
|
Facility
|
OP
|
$45.04
|
|
| Hospital Charge Code |
80316458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$24.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16.21
|
| Rate for Payer: BCBS of TX PPO |
$18.02
|
| Rate for Payer: Cash Price |
$39.64
|
| Rate for Payer: Multiplan Auto |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$29.28
|
| Rate for Payer: Multiplan Workers Comp |
$29.28
|
| Rate for Payer: Scott and White EPO/PPO |
$22.52
|
| Rate for Payer: Superior Health Plan EPO |
$6.13
|
|
|
TRAP, TISSUE COLLECTION BERKELEY SAFETOUCH -- DHF
|
Facility
|
IP
|
$45.04
|
|
| Hospital Charge Code |
80316458
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$39.64
|
|
|
Trauma 1 (full)
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4204071
|
|
Hospital Revenue Code
|
681
|
| Rate for Payer: Cash Price |
$6,237.44
|
|
|
Trauma 1 (full)
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4204071
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$4,607.20 |
| Rate for Payer: Aetna Commercial |
$3,898.40
|
| Rate for Payer: Aetna Medicare |
$1,878.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$637.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Amerigroup Medicare |
$1,252.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,550.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,853.59
|
| Rate for Payer: BCBS of TX Medicare |
$1,252.11
|
| Rate for Payer: BCBS of TX PPO |
$2,067.47
|
| Rate for Payer: Cash Price |
$6,237.44
|
| Rate for Payer: Cash Price |
$6,237.44
|
| Rate for Payer: Cash Price |
$6,237.44
|
| Rate for Payer: Cigna Commercial |
$2,836.40
|
| Rate for Payer: Cigna Medicare |
$1,252.11
|
| Rate for Payer: Employer Direct Commercial |
$1,252.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,252.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Molina Medicare |
$1,252.11
|
| Rate for Payer: Multiplan Auto |
$4,607.20
|
| Rate for Payer: Multiplan Commercial |
$4,607.20
|
| Rate for Payer: Multiplan Workers Comp |
$4,607.20
|
| Rate for Payer: Scott and White EPO/PPO |
$22.39
|
| Rate for Payer: Scott and White Medicare |
$1,252.11
|
| Rate for Payer: Superior Health Plan EPO |
$1,252.11
|
| Rate for Payer: Superior Health Plan Medicare |
$1,252.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Universal American Medicare |
$1,252.11
|
| Rate for Payer: Wellcare Medicare |
$1,252.11
|
| Rate for Payer: Wellmed Medicare |
$1,252.11
|
|
|
Trauma Response - Level II Trauma
|
Facility
|
OP
|
$5,316.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4204072
|
|
Hospital Revenue Code
|
682
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$3,455.40 |
| Rate for Payer: Aetna Commercial |
$2,923.80
|
| Rate for Payer: Aetna Medicare |
$1,878.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$478.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Amerigroup Medicare |
$1,252.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,550.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,853.59
|
| Rate for Payer: BCBS of TX Medicare |
$1,252.11
|
| Rate for Payer: BCBS of TX PPO |
$2,067.47
|
| Rate for Payer: Cash Price |
$4,678.08
|
| Rate for Payer: Cash Price |
$4,678.08
|
| Rate for Payer: Cash Price |
$4,678.08
|
| Rate for Payer: Cigna Commercial |
$2,836.40
|
| Rate for Payer: Cigna Medicare |
$1,252.11
|
| Rate for Payer: Employer Direct Commercial |
$1,252.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,252.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Molina Medicare |
$1,252.11
|
| Rate for Payer: Multiplan Auto |
$3,455.40
|
| Rate for Payer: Multiplan Commercial |
$3,455.40
|
| Rate for Payer: Multiplan Workers Comp |
$3,455.40
|
| Rate for Payer: Scott and White EPO/PPO |
$22.39
|
| Rate for Payer: Scott and White Medicare |
$1,252.11
|
| Rate for Payer: Superior Health Plan EPO |
$1,252.11
|
| Rate for Payer: Superior Health Plan Medicare |
$1,252.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,252.11
|
| Rate for Payer: Universal American Medicare |
$1,252.11
|
| Rate for Payer: Wellcare Medicare |
$1,252.11
|
| Rate for Payer: Wellmed Medicare |
$1,252.11
|
|
|
Trauma Response - Level II Trauma
|
Facility
|
IP
|
$5,316.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4204072
|
|
Hospital Revenue Code
|
682
|
| Rate for Payer: Cash Price |
$4,678.08
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$28,395.50
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$10,759.46 |
| Max. Negotiated Rate |
$28,395.50 |
| Rate for Payer: Aetna Commercial |
$16,813.12
|
| Rate for Payer: Aetna Medicare |
$20,279.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,519.62
|
| Rate for Payer: Amerigroup Medicare |
$13,519.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,759.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,188.54
|
| Rate for Payer: BCBS of TX Medicare |
$13,519.62
|
| Rate for Payer: BCBS of TX PPO |
$16,876.81
|
| Rate for Payer: Cigna Commercial |
$19,249.16
|
| Rate for Payer: Cigna Medicare |
$13,519.62
|
| Rate for Payer: Employer Direct Commercial |
$13,519.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,519.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,519.62
|
| Rate for Payer: Molina Medicare |
$13,519.62
|
| Rate for Payer: Multiplan Auto |
$28,395.50
|
| Rate for Payer: Multiplan Commercial |
$28,395.50
|
| Rate for Payer: Multiplan Workers Comp |
$28,395.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,076.88
|
| Rate for Payer: Scott and White Medicare |
$13,519.62
|
| Rate for Payer: Superior Health Plan EPO |
$13,519.62
|
| Rate for Payer: Superior Health Plan Medicare |
$13,519.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,519.62
|
| Rate for Payer: Universal American Medicare |
$13,519.62
|
| Rate for Payer: Wellcare Medicare |
$13,519.62
|
| Rate for Payer: Wellmed Medicare |
$13,519.62
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$17,246.30
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$6,565.24 |
| Max. Negotiated Rate |
$17,246.30 |
| Rate for Payer: Aetna Commercial |
$10,211.62
|
| Rate for Payer: Aetna Medicare |
$13,998.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,332.19
|
| Rate for Payer: Amerigroup Medicare |
$9,332.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,565.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,645.26
|
| Rate for Payer: BCBS of TX Medicare |
$9,332.19
|
| Rate for Payer: BCBS of TX PPO |
$9,606.21
|
| Rate for Payer: Cigna Commercial |
$11,691.18
|
| Rate for Payer: Cigna Medicare |
$9,332.19
|
| Rate for Payer: Employer Direct Commercial |
$9,332.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,332.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,332.19
|
| Rate for Payer: Molina Medicare |
$9,332.19
|
| Rate for Payer: Multiplan Auto |
$17,246.30
|
| Rate for Payer: Multiplan Commercial |
$17,246.30
|
| Rate for Payer: Multiplan Workers Comp |
$17,246.30
|
| Rate for Payer: Scott and White EPO/PPO |
$7,942.38
|
| Rate for Payer: Scott and White Medicare |
$9,332.19
|
| Rate for Payer: Superior Health Plan EPO |
$9,332.19
|
| Rate for Payer: Superior Health Plan Medicare |
$9,332.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,332.19
|
| Rate for Payer: Universal American Medicare |
$9,332.19
|
| Rate for Payer: Wellcare Medicare |
$9,332.19
|
| Rate for Payer: Wellmed Medicare |
$9,332.19
|
|
