|
Unlisted procedure, pelvis or hip joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
36027299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| 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 Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| 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 |
$4.76
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| 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
|
|
|
Unlisted procedure, skin, mucous membrane and subcutaneous tissue
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36017999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| 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 |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
Unlisted procedure, small intestine - Graham Patch
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36044799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| 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 |
$18.29
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
Unlisted procedure, stomach
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
36043999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| 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 |
$18.29
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
Unna Boot
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 29580 50
|
| Hospital Charge Code |
7150794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$291.50
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$344.50
|
| Rate for Payer: Multiplan Commercial |
$344.50
|
| Rate for Payer: Multiplan Workers Comp |
$344.50
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
Unscheduled Dial ESR PT
|
Facility
|
OP
|
$2,811.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
5600257
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$1,827.15 |
| Rate for Payer: Aetna Commercial |
$1,546.05
|
| Rate for Payer: Aetna Medicare |
$958.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$252.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Amerigroup Medicare |
$639.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,113.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,331.26
|
| Rate for Payer: BCBS of TX Medicare |
$639.08
|
| Rate for Payer: BCBS of TX PPO |
$1,484.87
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cigna Commercial |
$1,447.70
|
| Rate for Payer: Cigna Medicaid |
$129.38
|
| Rate for Payer: Cigna Medicare |
$639.08
|
| Rate for Payer: Employer Direct Commercial |
$639.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$639.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$129.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Molina Medicare |
$639.08
|
| Rate for Payer: Multiplan Auto |
$1,827.15
|
| Rate for Payer: Multiplan Commercial |
$1,827.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,827.15
|
| Rate for Payer: Parkland Medicaid |
$129.38
|
| Rate for Payer: Scott and White EPO/PPO |
$11.43
|
| Rate for Payer: Scott and White Medicare |
$639.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$129.38
|
| Rate for Payer: Superior Health Plan EPO |
$639.08
|
| Rate for Payer: Superior Health Plan Medicare |
$639.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Universal American Medicare |
$639.08
|
| Rate for Payer: Wellcare Medicare |
$639.08
|
| Rate for Payer: Wellmed Medicare |
$639.08
|
|
|
Unscheduled Dial ESR PT BCE
|
Facility
|
OP
|
$2,811.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
5600257
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$1,827.15 |
| Rate for Payer: Aetna Commercial |
$1,546.05
|
| Rate for Payer: Aetna Medicare |
$958.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$252.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Amerigroup Medicare |
$639.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,113.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,331.26
|
| Rate for Payer: BCBS of TX Medicare |
$639.08
|
| Rate for Payer: BCBS of TX PPO |
$1,484.87
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cigna Commercial |
$1,447.70
|
| Rate for Payer: Cigna Medicaid |
$129.38
|
| Rate for Payer: Cigna Medicare |
$639.08
|
| Rate for Payer: Employer Direct Commercial |
$639.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$639.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$129.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Molina Medicare |
$639.08
|
| Rate for Payer: Multiplan Auto |
$1,827.15
|
| Rate for Payer: Multiplan Commercial |
$1,827.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,827.15
|
| Rate for Payer: Parkland Medicaid |
$129.38
|
| Rate for Payer: Scott and White EPO/PPO |
$11.43
|
| Rate for Payer: Scott and White Medicare |
$639.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$129.38
|
| Rate for Payer: Superior Health Plan EPO |
$639.08
|
| Rate for Payer: Superior Health Plan Medicare |
$639.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Universal American Medicare |
$639.08
|
| Rate for Payer: Wellcare Medicare |
$639.08
|
| Rate for Payer: Wellmed Medicare |
$639.08
|
|
|
Unscheduled Dial ESR PT BCE
|
Facility
|
IP
|
$2,811.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
5600257
|
|
Hospital Revenue Code
|
820
|
| Rate for Payer: Cash Price |
$2,473.68
|
|
|
UPGRADE TO DUAL CHAMBER
|
Facility
|
IP
|
$32,225.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
2302453
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$28,358.00
|
|
|
UPGRADE TO DUAL CHAMBER
|
Facility
|
OP
|
$32,225.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
2302453
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$25,834.89 |
| Rate for Payer: Aetna Commercial |
$10,300.00
|
| Rate for Payer: Aetna Medicare |
$14,648.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,900.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Amerigroup Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,120.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,503.88
|
| Rate for Payer: BCBS of TX Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX PPO |
$25,834.89
|
| Rate for Payer: Cash Price |
$28,358.00
|
| Rate for Payer: Cash Price |
$28,358.00
|
| Rate for Payer: Cash Price |
$28,358.00
|
| Rate for Payer: Cigna Commercial |
$22,122.29
|
| Rate for Payer: Cigna Medicaid |
$6,346.73
|
| Rate for Payer: Cigna Medicare |
$9,765.77
|
| Rate for Payer: Employer Direct Commercial |
$9,765.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,765.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,346.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Molina Medicare |
$9,765.77
|
| Rate for Payer: Multiplan Auto |
$20,946.25
|
| Rate for Payer: Multiplan Commercial |
$20,946.25
|
| Rate for Payer: Multiplan Workers Comp |
$20,946.25
|
| Rate for Payer: Parkland Medicaid |
$6,346.73
|
| Rate for Payer: Scott and White EPO/PPO |
$174.65
|
| Rate for Payer: Scott and White Medicare |
$9,765.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,346.73
|
| Rate for Payer: Superior Health Plan EPO |
$9,765.77
|
| Rate for Payer: Superior Health Plan Medicare |
$9,765.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Universal American Medicare |
$9,765.77
|
| Rate for Payer: Wellcare Medicare |
$9,765.77
|
| Rate for Payer: Wellmed Medicare |
$9,765.77
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$31,154.30
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$14,347.38 |
| Max. Negotiated Rate |
$31,154.30 |
| Rate for Payer: Aetna Commercial |
$18,446.62
|
| Rate for Payer: Aetna Medicare |
$21,833.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,555.78
|
| Rate for Payer: Amerigroup Medicare |
$14,555.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,509.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,044.84
|
| Rate for Payer: BCBS of TX Medicare |
$14,555.78
|
| Rate for Payer: BCBS of TX PPO |
$20,050.59
|
| Rate for Payer: Cigna Commercial |
$21,119.34
|
| Rate for Payer: Cigna Medicare |
$14,555.78
|
| Rate for Payer: Employer Direct Commercial |
$14,555.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,555.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,555.78
|
| Rate for Payer: Molina Medicare |
$14,555.78
|
| Rate for Payer: Multiplan Auto |
$31,154.30
|
| Rate for Payer: Multiplan Commercial |
$31,154.30
|
| Rate for Payer: Multiplan Workers Comp |
$31,154.30
|
| Rate for Payer: Scott and White EPO/PPO |
$14,347.38
|
| Rate for Payer: Scott and White Medicare |
$14,555.78
|
| Rate for Payer: Superior Health Plan EPO |
$14,555.78
|
| Rate for Payer: Superior Health Plan Medicare |
$14,555.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,555.78
|
| Rate for Payer: Universal American Medicare |
$14,555.78
|
| Rate for Payer: Wellcare Medicare |
$14,555.78
|
| Rate for Payer: Wellmed Medicare |
$14,555.78
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$52,200.60
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$22,460.40 |
| Max. Negotiated Rate |
$52,200.60 |
| Rate for Payer: Aetna Commercial |
$30,908.25
|
| Rate for Payer: Aetna Medicare |
$33,690.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,460.40
|
| Rate for Payer: Amerigroup Medicare |
$22,460.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23,256.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,213.36
|
| Rate for Payer: BCBS of TX Medicare |
$22,460.40
|
| Rate for Payer: BCBS of TX PPO |
$29,127.08
|
| Rate for Payer: Cigna Commercial |
$35,386.51
|
| Rate for Payer: Cigna Medicare |
$22,460.40
|
| Rate for Payer: Employer Direct Commercial |
$22,460.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,460.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,460.40
|
| Rate for Payer: Molina Medicare |
$22,460.40
|
| Rate for Payer: Multiplan Auto |
$52,200.60
|
| Rate for Payer: Multiplan Commercial |
$52,200.60
|
| Rate for Payer: Multiplan Workers Comp |
$52,200.60
|
| Rate for Payer: Scott and White EPO/PPO |
$24,039.75
|
| Rate for Payer: Scott and White Medicare |
$22,460.40
|
| Rate for Payer: Superior Health Plan EPO |
$22,460.40
|
| Rate for Payer: Superior Health Plan Medicare |
$22,460.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,460.40
|
| Rate for Payer: Universal American Medicare |
$22,460.40
|
| Rate for Payer: Wellcare Medicare |
$22,460.40
|
| Rate for Payer: Wellmed Medicare |
$22,460.40
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,829.00
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$8,671.25 |
| Max. Negotiated Rate |
$18,829.00 |
| Rate for Payer: Aetna Commercial |
$11,148.75
|
| Rate for Payer: Aetna Medicare |
$14,889.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,926.61
|
| Rate for Payer: Amerigroup Medicare |
$9,926.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,713.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,620.23
|
| Rate for Payer: BCBS of TX Medicare |
$9,926.61
|
| Rate for Payer: BCBS of TX PPO |
$12,911.86
|
| Rate for Payer: Cigna Commercial |
$12,764.08
|
| Rate for Payer: Cigna Medicare |
$9,926.61
|
| Rate for Payer: Employer Direct Commercial |
$9,926.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,926.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,926.61
|
| Rate for Payer: Molina Medicare |
$9,926.61
|
| Rate for Payer: Multiplan Auto |
$18,829.00
|
| Rate for Payer: Multiplan Commercial |
$18,829.00
|
| Rate for Payer: Multiplan Workers Comp |
$18,829.00
|
| Rate for Payer: Scott and White EPO/PPO |
$8,671.25
|
| Rate for Payer: Scott and White Medicare |
$9,926.61
|
| Rate for Payer: Superior Health Plan EPO |
$9,926.61
|
| Rate for Payer: Superior Health Plan Medicare |
$9,926.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,926.61
|
| Rate for Payer: Universal American Medicare |
$9,926.61
|
| Rate for Payer: Wellcare Medicare |
$9,926.61
|
| Rate for Payer: Wellmed Medicare |
$9,926.61
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
1602622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Commercial |
$5.84
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Amerigroup Medicare |
$5.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.01
|
| Rate for Payer: BCBS of TX Medicare |
$5.56
|
| Rate for Payer: BCBS of TX PPO |
$12.29
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cigna Medicaid |
$5.56
|
| Rate for Payer: Cigna Medicare |
$5.56
|
| Rate for Payer: Employer Direct Commercial |
$5.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Molina Medicare |
$5.56
|
| Rate for Payer: Multiplan Auto |
$113.10
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: Multiplan Workers Comp |
$113.10
|
| Rate for Payer: Parkland Medicaid |
$5.56
|
| Rate for Payer: Scott and White EPO/PPO |
$6.95
|
| Rate for Payer: Scott and White Medicare |
$5.56
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.56
|
| Rate for Payer: Superior Health Plan EPO |
$5.56
|
| Rate for Payer: Superior Health Plan Medicare |
$5.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Universal American Medicare |
$5.56
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: Wellmed Medicare |
$5.56
|
|
|
Urea Nitrogen Urine
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
1602622
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$153.12
|
|
|
Urea Nitrogen Urine
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
1602622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Commercial |
$5.84
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Amerigroup Medicare |
$5.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.01
|
| Rate for Payer: BCBS of TX Medicare |
$5.56
|
| Rate for Payer: BCBS of TX PPO |
$12.29
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cigna Medicaid |
$5.56
|
| Rate for Payer: Cigna Medicare |
$5.56
|
| Rate for Payer: Employer Direct Commercial |
$5.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Molina Medicare |
$5.56
|
| Rate for Payer: Multiplan Auto |
$113.10
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: Multiplan Workers Comp |
$113.10
|
| Rate for Payer: Parkland Medicaid |
$5.56
|
| Rate for Payer: Scott and White EPO/PPO |
$6.95
|
| Rate for Payer: Scott and White Medicare |
$5.56
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.56
|
| Rate for Payer: Superior Health Plan EPO |
$5.56
|
| Rate for Payer: Superior Health Plan Medicare |
$5.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.56
|
| Rate for Payer: Universal American Medicare |
$5.56
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: Wellmed Medicare |
$5.56
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$32,526.10
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$13,435.78 |
| Max. Negotiated Rate |
$32,526.10 |
| Rate for Payer: Aetna Commercial |
$19,258.88
|
| Rate for Payer: Aetna Medicare |
$22,606.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,071.01
|
| Rate for Payer: Amerigroup Medicare |
$15,071.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,435.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,372.04
|
| Rate for Payer: BCBS of TX Medicare |
$15,071.01
|
| Rate for Payer: BCBS of TX PPO |
$19,303.01
|
| Rate for Payer: Cigna Commercial |
$22,049.27
|
| Rate for Payer: Cigna Medicare |
$15,071.01
|
| Rate for Payer: Employer Direct Commercial |
$15,071.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,071.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,071.01
|
| Rate for Payer: Molina Medicare |
$15,071.01
|
| Rate for Payer: Multiplan Auto |
$32,526.10
|
| Rate for Payer: Multiplan Commercial |
$32,526.10
|
| Rate for Payer: Multiplan Workers Comp |
$32,526.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14,979.12
|
| Rate for Payer: Scott and White Medicare |
$15,071.01
|
| Rate for Payer: Superior Health Plan EPO |
$15,071.01
|
| Rate for Payer: Superior Health Plan Medicare |
$15,071.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,071.01
|
| Rate for Payer: Universal American Medicare |
$15,071.01
|
| Rate for Payer: Wellcare Medicare |
$15,071.01
|
| Rate for Payer: Wellmed Medicare |
$15,071.01
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,531.30
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$8,073.62 |
| Max. Negotiated Rate |
$17,531.30 |
| Rate for Payer: Aetna Commercial |
$10,380.38
|
| Rate for Payer: Aetna Medicare |
$14,317.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,544.84
|
| Rate for Payer: Amerigroup Medicare |
$9,544.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,441.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,906.15
|
| Rate for Payer: BCBS of TX Medicare |
$9,544.84
|
| Rate for Payer: BCBS of TX PPO |
$12,118.42
|
| Rate for Payer: Cigna Commercial |
$11,884.38
|
| Rate for Payer: Cigna Medicare |
$9,544.84
|
| Rate for Payer: Employer Direct Commercial |
$9,544.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,544.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,544.84
|
| Rate for Payer: Molina Medicare |
$9,544.84
|
| Rate for Payer: Multiplan Auto |
$17,531.30
|
| Rate for Payer: Multiplan Commercial |
$17,531.30
|
| Rate for Payer: Multiplan Workers Comp |
$17,531.30
|
| Rate for Payer: Scott and White EPO/PPO |
$8,073.62
|
| Rate for Payer: Scott and White Medicare |
$9,544.84
|
| Rate for Payer: Superior Health Plan EPO |
$9,544.84
|
| Rate for Payer: Superior Health Plan Medicare |
$9,544.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,544.84
|
| Rate for Payer: Universal American Medicare |
$9,544.84
|
| Rate for Payer: Wellcare Medicare |
$9,544.84
|
| Rate for Payer: Wellmed Medicare |
$9,544.84
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$21,148.90
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$7,312.58 |
| Max. Negotiated Rate |
$21,148.90 |
| Rate for Payer: Aetna Commercial |
$12,522.38
|
| Rate for Payer: Aetna Medicare |
$16,196.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,797.92
|
| Rate for Payer: Amerigroup Medicare |
$10,797.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,312.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,906.24
|
| Rate for Payer: BCBS of TX Medicare |
$10,797.92
|
| Rate for Payer: BCBS of TX PPO |
$11,007.36
|
| Rate for Payer: Cigna Commercial |
$14,336.73
|
| Rate for Payer: Cigna Medicare |
$10,797.92
|
| Rate for Payer: Employer Direct Commercial |
$10,797.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,797.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,797.92
|
| Rate for Payer: Molina Medicare |
$10,797.92
|
| Rate for Payer: Multiplan Auto |
$21,148.90
|
| Rate for Payer: Multiplan Commercial |
$21,148.90
|
| Rate for Payer: Multiplan Workers Comp |
$21,148.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9,739.62
|
| Rate for Payer: Scott and White Medicare |
$10,797.92
|
| Rate for Payer: Superior Health Plan EPO |
$10,797.92
|
| Rate for Payer: Superior Health Plan Medicare |
$10,797.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,797.92
|
| Rate for Payer: Universal American Medicare |
$10,797.92
|
| Rate for Payer: Wellcare Medicare |
$10,797.92
|
| Rate for Payer: Wellmed Medicare |
$10,797.92
|
|
|
Uric Acid
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
1602374
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$180.40
|
|
|
Uric Acid
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
1602374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$6.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.52
|
| Rate for Payer: Amerigroup Medicare |
$4.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.95
|
| Rate for Payer: BCBS of TX Medicare |
$4.52
|
| Rate for Payer: BCBS of TX PPO |
$9.99
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cigna Medicaid |
$4.52
|
| Rate for Payer: Cigna Medicare |
$4.52
|
| Rate for Payer: Employer Direct Commercial |
$4.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.52
|
| Rate for Payer: Molina Medicare |
$4.52
|
| Rate for Payer: Multiplan Auto |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Workers Comp |
$133.25
|
| Rate for Payer: Parkland Medicaid |
$4.52
|
| Rate for Payer: Scott and White EPO/PPO |
$5.65
|
| Rate for Payer: Scott and White Medicare |
$4.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.52
|
| Rate for Payer: Superior Health Plan EPO |
$4.52
|
| Rate for Payer: Superior Health Plan Medicare |
$4.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.52
|
| Rate for Payer: Universal American Medicare |
$4.52
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
| Rate for Payer: Wellmed Medicare |
$4.52
|
|
|
Uric Acid, 24 hr Urine SO
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1602630
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$117.92
|
|
|
Uric Acid, 24 hr Urine SO
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1602630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Commercial |
$5.34
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Amerigroup Medicare |
$5.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.06
|
| Rate for Payer: BCBS of TX Medicare |
$5.08
|
| Rate for Payer: BCBS of TX PPO |
$11.23
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cigna Medicaid |
$5.08
|
| Rate for Payer: Cigna Medicare |
$5.08
|
| Rate for Payer: Employer Direct Commercial |
$5.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Molina Medicare |
$5.08
|
| Rate for Payer: Multiplan Auto |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$87.10
|
| Rate for Payer: Multiplan Workers Comp |
$87.10
|
| Rate for Payer: Parkland Medicaid |
$5.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.35
|
| Rate for Payer: Scott and White Medicare |
$5.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.08
|
| Rate for Payer: Superior Health Plan EPO |
$5.08
|
| Rate for Payer: Superior Health Plan Medicare |
$5.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Universal American Medicare |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.08
|
| Rate for Payer: Wellmed Medicare |
$5.08
|
|
|
URIC ACID OTHER SOURCE
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1602630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Commercial |
$5.34
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Amerigroup Medicare |
$5.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.06
|
| Rate for Payer: BCBS of TX Medicare |
$5.08
|
| Rate for Payer: BCBS of TX PPO |
$11.23
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cigna Medicaid |
$5.08
|
| Rate for Payer: Cigna Medicare |
$5.08
|
| Rate for Payer: Employer Direct Commercial |
$5.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Molina Medicare |
$5.08
|
| Rate for Payer: Multiplan Auto |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$87.10
|
| Rate for Payer: Multiplan Workers Comp |
$87.10
|
| Rate for Payer: Parkland Medicaid |
$5.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.35
|
| Rate for Payer: Scott and White Medicare |
$5.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.08
|
| Rate for Payer: Superior Health Plan EPO |
$5.08
|
| Rate for Payer: Superior Health Plan Medicare |
$5.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Universal American Medicare |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.08
|
| Rate for Payer: Wellmed Medicare |
$5.08
|
|
|
Uric Acid, Urine SO
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1602630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Commercial |
$5.34
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Amerigroup Medicare |
$5.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.06
|
| Rate for Payer: BCBS of TX Medicare |
$5.08
|
| Rate for Payer: BCBS of TX PPO |
$11.23
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cigna Medicaid |
$5.08
|
| Rate for Payer: Cigna Medicare |
$5.08
|
| Rate for Payer: Employer Direct Commercial |
$5.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Molina Medicare |
$5.08
|
| Rate for Payer: Multiplan Auto |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$87.10
|
| Rate for Payer: Multiplan Workers Comp |
$87.10
|
| Rate for Payer: Parkland Medicaid |
$5.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.35
|
| Rate for Payer: Scott and White Medicare |
$5.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.08
|
| Rate for Payer: Superior Health Plan EPO |
$5.08
|
| Rate for Payer: Superior Health Plan Medicare |
$5.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.08
|
| Rate for Payer: Universal American Medicare |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.08
|
| Rate for Payer: Wellmed Medicare |
$5.08
|
|
