|
VENOGRAM EXTREMITY UNI
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
2330024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$3,317.93 |
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,040.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,248.41
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$1,393.43
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$109.26
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$109.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$941.20
|
| Rate for Payer: Multiplan Commercial |
$941.20
|
| Rate for Payer: Multiplan Workers Comp |
$941.20
|
| Rate for Payer: Parkland Medicaid |
$109.26
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$109.26
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
VENOGRAPHY EXTREM UNILATERAL RT
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 75820 RT
|
| Hospital Charge Code |
2303584
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$3,317.93 |
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,040.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,248.41
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$1,393.43
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cash Price |
$1,274.24
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$109.26
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$109.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$941.20
|
| Rate for Payer: Multiplan Commercial |
$941.20
|
| Rate for Payer: Multiplan Workers Comp |
$941.20
|
| Rate for Payer: Parkland Medicaid |
$109.26
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$109.26
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
VENOGRAPHY EXTREM UNILATERAL RT
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 75820 RT
|
| Hospital Charge Code |
2303584
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,274.24
|
|
|
VENOGRAPHY IVC
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
2330016
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$2,955.04
|
|
|
VENOGRAPHY IVC
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
2330016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$71.08
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$114.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$2,955.04
|
| Rate for Payer: Cash Price |
$2,955.04
|
| Rate for Payer: Cash Price |
$2,955.04
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$114.28
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$114.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$2,182.70
|
| Rate for Payer: Multiplan Commercial |
$2,182.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,182.70
|
| Rate for Payer: Parkland Medicaid |
$114.28
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$114.28
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
VENOUS MECH. THROMB.
|
Facility
|
IP
|
$12,192.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
2330011
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$10,728.96
|
|
|
VENOUS MECH. THROMB.
|
Facility
|
OP
|
$12,192.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
2330011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$22,791.24 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,348.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$10,728.96
|
| Rate for Payer: Cash Price |
$10,728.96
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicaid |
$5,348.63
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,348.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| 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 |
$5,348.63
|
| Rate for Payer: Scott and White EPO/PPO |
$221.91
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,348.63
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
Ventilating tube removal requiring general anesthesia
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
36069424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,416.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.12
|
| 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 |
$160.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$192.00
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$241.92
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$81.12
|
| 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 |
$81.12
|
| 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 |
$81.12
|
| Rate for Payer: Scott and White EPO/PPO |
$64.95
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$81.12
|
| 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
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$40,922.20
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$17,677.30 |
| Max. Negotiated Rate |
$40,922.20 |
| Rate for Payer: Aetna Commercial |
$24,230.25
|
| Rate for Payer: Aetna Medicare |
$27,336.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,224.43
|
| Rate for Payer: Amerigroup Medicare |
$18,224.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,677.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,755.37
|
| Rate for Payer: BCBS of TX Medicare |
$18,224.43
|
| Rate for Payer: BCBS of TX PPO |
$26,395.88
|
| Rate for Payer: Cigna Commercial |
$27,740.94
|
| Rate for Payer: Cigna Medicare |
$18,224.43
|
| Rate for Payer: Employer Direct Commercial |
$18,224.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,224.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,224.43
|
| Rate for Payer: Molina Medicare |
$18,224.43
|
| Rate for Payer: Multiplan Auto |
$40,922.20
|
| Rate for Payer: Multiplan Commercial |
$40,922.20
|
| Rate for Payer: Multiplan Workers Comp |
$40,922.20
|
| Rate for Payer: Scott and White EPO/PPO |
$18,845.75
|
| Rate for Payer: Scott and White Medicare |
$18,224.43
|
| Rate for Payer: Superior Health Plan EPO |
$18,224.43
|
| Rate for Payer: Superior Health Plan Medicare |
$18,224.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,224.43
|
| Rate for Payer: Universal American Medicare |
$18,224.43
|
| Rate for Payer: Wellcare Medicare |
$18,224.43
|
| Rate for Payer: Wellmed Medicare |
$18,224.43
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$78,215.40
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$32,231.09 |
| Max. Negotiated Rate |
$78,215.40 |
| Rate for Payer: Aetna Commercial |
$46,311.75
|
| Rate for Payer: Aetna Medicare |
$48,346.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$32,231.09
|
| Rate for Payer: Amerigroup Medicare |
$32,231.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35,007.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43,163.35
|
| Rate for Payer: BCBS of TX Medicare |
$32,231.09
|
| Rate for Payer: BCBS of TX PPO |
$47,961.13
|
| Rate for Payer: Cigna Commercial |
$53,021.81
|
| Rate for Payer: Cigna Medicare |
$32,231.09
|
| Rate for Payer: Employer Direct Commercial |
$32,231.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$32,231.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$32,231.09
|
| Rate for Payer: Molina Medicare |
$32,231.09
|
| Rate for Payer: Multiplan Auto |
$78,215.40
|
| Rate for Payer: Multiplan Commercial |
$78,215.40
|
| Rate for Payer: Multiplan Workers Comp |
$78,215.40
|
| Rate for Payer: Scott and White EPO/PPO |
$36,020.25
|
| Rate for Payer: Scott and White Medicare |
$32,231.09
|
| Rate for Payer: Superior Health Plan EPO |
$32,231.09
|
| Rate for Payer: Superior Health Plan Medicare |
$32,231.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$32,231.09
|
| Rate for Payer: Universal American Medicare |
$32,231.09
|
| Rate for Payer: Wellcare Medicare |
$32,231.09
|
| Rate for Payer: Wellmed Medicare |
$32,231.09
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,835.10
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$13,753.12 |
| Max. Negotiated Rate |
$30,835.10 |
| Rate for Payer: Aetna Commercial |
$18,257.62
|
| Rate for Payer: Aetna Medicare |
$21,653.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,435.89
|
| Rate for Payer: Amerigroup Medicare |
$14,435.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,753.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,415.38
|
| Rate for Payer: BCBS of TX Medicare |
$14,435.89
|
| Rate for Payer: BCBS of TX PPO |
$19,351.17
|
| Rate for Payer: Cigna Commercial |
$20,902.95
|
| Rate for Payer: Cigna Medicare |
$14,435.89
|
| Rate for Payer: Employer Direct Commercial |
$14,435.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,435.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,435.89
|
| Rate for Payer: Molina Medicare |
$14,435.89
|
| Rate for Payer: Multiplan Auto |
$30,835.10
|
| Rate for Payer: Multiplan Commercial |
$30,835.10
|
| Rate for Payer: Multiplan Workers Comp |
$30,835.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14,200.38
|
| Rate for Payer: Scott and White Medicare |
$14,435.89
|
| Rate for Payer: Superior Health Plan EPO |
$14,435.89
|
| Rate for Payer: Superior Health Plan Medicare |
$14,435.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,435.89
|
| Rate for Payer: Universal American Medicare |
$14,435.89
|
| Rate for Payer: Wellcare Medicare |
$14,435.89
|
| Rate for Payer: Wellmed Medicare |
$14,435.89
|
|
|
verapamil 2.5 mg/mL IV Soln 2 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.14
|
| Rate for Payer: BCBS of TX PPO |
$51.27
|
| 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
|
|
|
verapamil 2.5 mg/mL IV Soln 2 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
456
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.16
|
|
|
VERITAS 2X8 SQ CM
|
Facility
|
IP
|
$222.50
|
|
|
Service Code
|
HCPCS C9354
|
| Hospital Charge Code |
40269995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$66.75
|
| Rate for Payer: Cash Price |
$195.80
|
| Rate for Payer: Cigna Commercial |
$55.62
|
| Rate for Payer: Multiplan Auto |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$111.25
|
| Rate for Payer: Multiplan Workers Comp |
$111.25
|
| Rate for Payer: Scott and White EPO/PPO |
$111.25
|
|
|
VERITAS 2X8 SQ CM
|
Facility
|
OP
|
$222.50
|
|
|
Service Code
|
HCPCS C9354
|
| Hospital Charge Code |
40269995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$66.75
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$20.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$66.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$80.10
|
| Rate for Payer: BCBS of TX PPO |
$89.00
|
| Rate for Payer: Cash Price |
$195.80
|
| Rate for Payer: Multiplan Auto |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$111.25
|
| Rate for Payer: Multiplan Workers Comp |
$111.25
|
| Rate for Payer: Scott and White EPO/PPO |
$111.25
|
| Rate for Payer: Superior Health Plan EPO |
$30.26
|
|
|
VERSAWRAP SHEET 2X2 1 ML SOLUTION
|
Facility
|
OP
|
$21,054.22
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
145247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,894.88 |
| Max. Negotiated Rate |
$10,527.11 |
| Rate for Payer: Aetna Commercial |
$6,316.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,894.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,316.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,579.52
|
| Rate for Payer: BCBS of TX PPO |
$8,421.69
|
| Rate for Payer: Cash Price |
$18,527.71
|
| Rate for Payer: Multiplan Auto |
$10,527.11
|
| Rate for Payer: Multiplan Commercial |
$10,527.11
|
| Rate for Payer: Multiplan Workers Comp |
$10,527.11
|
| Rate for Payer: Scott and White EPO/PPO |
$10,527.11
|
| Rate for Payer: Superior Health Plan EPO |
$2,863.37
|
|
|
VERSAWRAP SHEET 2X2 1 ML SOLUTION
|
Facility
|
IP
|
$21,054.22
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
145247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,263.56 |
| Max. Negotiated Rate |
$10,527.11 |
| Rate for Payer: Aetna Commercial |
$6,316.27
|
| Rate for Payer: Cash Price |
$18,527.71
|
| Rate for Payer: Cigna Commercial |
$5,263.56
|
| Rate for Payer: Multiplan Auto |
$10,527.11
|
| Rate for Payer: Multiplan Commercial |
$10,527.11
|
| Rate for Payer: Multiplan Workers Comp |
$10,527.11
|
| Rate for Payer: Scott and White EPO/PPO |
$10,527.11
|
|
|
VIDEOSCOP ASCOPE SGL USE -- DHF
|
Facility
|
OP
|
$1,484.72
|
|
| Hospital Charge Code |
80870603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.62 |
| Max. Negotiated Rate |
$965.07 |
| Rate for Payer: Aetna Commercial |
$816.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$133.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$445.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$534.50
|
| Rate for Payer: BCBS of TX PPO |
$593.89
|
| Rate for Payer: Cash Price |
$1,306.55
|
| Rate for Payer: Multiplan Auto |
$965.07
|
| Rate for Payer: Multiplan Commercial |
$965.07
|
| Rate for Payer: Multiplan Workers Comp |
$965.07
|
| Rate for Payer: Scott and White EPO/PPO |
$742.36
|
| Rate for Payer: Superior Health Plan EPO |
$201.92
|
|
|
VIDEOSCOP ASCOPE SGL USE -- DHF
|
Facility
|
IP
|
$1,484.72
|
|
| Hospital Charge Code |
80870603
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,306.55
|
|
|
Viral Culture, General SO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
1700236
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$132.88
|
|
|
Viral Culture, General SO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
1700236
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Commercial |
$27.37
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Amerigroup Medicare |
$26.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.62
|
| Rate for Payer: BCBS of TX Medicare |
$26.07
|
| Rate for Payer: BCBS of TX PPO |
$57.61
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cigna Medicaid |
$26.07
|
| Rate for Payer: Cigna Medicare |
$26.07
|
| Rate for Payer: Employer Direct Commercial |
$26.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$26.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Molina Medicare |
$26.07
|
| Rate for Payer: Multiplan Auto |
$98.15
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Multiplan Workers Comp |
$98.15
|
| Rate for Payer: Parkland Medicaid |
$26.07
|
| Rate for Payer: Scott and White EPO/PPO |
$32.59
|
| Rate for Payer: Scott and White Medicare |
$26.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$26.07
|
| Rate for Payer: Superior Health Plan EPO |
$26.07
|
| Rate for Payer: Superior Health Plan Medicare |
$26.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26.07
|
| Rate for Payer: Universal American Medicare |
$26.07
|
| Rate for Payer: Wellcare Medicare |
$26.07
|
| Rate for Payer: Wellmed Medicare |
$26.07
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$31,158.10
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,409.62 |
| Max. Negotiated Rate |
$31,158.10 |
| Rate for Payer: Aetna Commercial |
$18,448.88
|
| Rate for Payer: Aetna Medicare |
$21,835.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,557.20
|
| Rate for Payer: Amerigroup Medicare |
$14,557.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,409.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,262.92
|
| Rate for Payer: BCBS of TX Medicare |
$14,557.20
|
| Rate for Payer: BCBS of TX PPO |
$15,848.31
|
| Rate for Payer: Cigna Commercial |
$21,121.91
|
| Rate for Payer: Cigna Medicare |
$14,557.20
|
| Rate for Payer: Employer Direct Commercial |
$14,557.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,557.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,557.20
|
| Rate for Payer: Molina Medicare |
$14,557.20
|
| Rate for Payer: Multiplan Auto |
$31,158.10
|
| Rate for Payer: Multiplan Commercial |
$31,158.10
|
| Rate for Payer: Multiplan Workers Comp |
$31,158.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14,349.12
|
| Rate for Payer: Scott and White Medicare |
$14,557.20
|
| Rate for Payer: Superior Health Plan EPO |
$14,557.20
|
| Rate for Payer: Superior Health Plan Medicare |
$14,557.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,557.20
|
| Rate for Payer: Universal American Medicare |
$14,557.20
|
| Rate for Payer: Wellcare Medicare |
$14,557.20
|
| Rate for Payer: Wellmed Medicare |
$14,557.20
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$17,436.30
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,601.36 |
| Max. Negotiated Rate |
$17,436.30 |
| Rate for Payer: Aetna Commercial |
$10,324.12
|
| Rate for Payer: Aetna Medicare |
$14,105.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,403.54
|
| Rate for Payer: Amerigroup Medicare |
$9,403.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,601.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,465.71
|
| Rate for Payer: BCBS of TX Medicare |
$9,403.54
|
| Rate for Payer: BCBS of TX PPO |
$9,406.71
|
| Rate for Payer: Cigna Commercial |
$11,819.98
|
| Rate for Payer: Cigna Medicare |
$9,403.54
|
| Rate for Payer: Employer Direct Commercial |
$9,403.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,403.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,403.54
|
| Rate for Payer: Molina Medicare |
$9,403.54
|
| Rate for Payer: Multiplan Auto |
$17,436.30
|
| Rate for Payer: Multiplan Commercial |
$17,436.30
|
| Rate for Payer: Multiplan Workers Comp |
$17,436.30
|
| Rate for Payer: Scott and White EPO/PPO |
$8,029.88
|
| Rate for Payer: Scott and White Medicare |
$9,403.54
|
| Rate for Payer: Superior Health Plan EPO |
$9,403.54
|
| Rate for Payer: Superior Health Plan Medicare |
$9,403.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,403.54
|
| Rate for Payer: Universal American Medicare |
$9,403.54
|
| Rate for Payer: Wellcare Medicare |
$9,403.54
|
| Rate for Payer: Wellmed Medicare |
$9,403.54
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$36,362.20
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$14,594.20 |
| Max. Negotiated Rate |
$36,362.20 |
| Rate for Payer: Aetna Commercial |
$21,530.25
|
| Rate for Payer: Aetna Medicare |
$24,767.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,511.77
|
| Rate for Payer: Amerigroup Medicare |
$16,511.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,594.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,288.63
|
| Rate for Payer: BCBS of TX Medicare |
$16,511.77
|
| Rate for Payer: BCBS of TX PPO |
$16,988.03
|
| Rate for Payer: Cigna Commercial |
$24,649.74
|
| Rate for Payer: Cigna Medicare |
$16,511.77
|
| Rate for Payer: Employer Direct Commercial |
$16,511.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,511.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,511.77
|
| Rate for Payer: Molina Medicare |
$16,511.77
|
| Rate for Payer: Multiplan Auto |
$36,362.20
|
| Rate for Payer: Multiplan Commercial |
$36,362.20
|
| Rate for Payer: Multiplan Workers Comp |
$36,362.20
|
| Rate for Payer: Scott and White EPO/PPO |
$16,745.75
|
| Rate for Payer: Scott and White Medicare |
$16,511.77
|
| Rate for Payer: Superior Health Plan EPO |
$16,511.77
|
| Rate for Payer: Superior Health Plan Medicare |
$16,511.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,511.77
|
| Rate for Payer: Universal American Medicare |
$16,511.77
|
| Rate for Payer: Wellcare Medicare |
$16,511.77
|
| Rate for Payer: Wellmed Medicare |
$16,511.77
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,527.50
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$8,071.88 |
| Max. Negotiated Rate |
$17,527.50 |
| Rate for Payer: Aetna Commercial |
$10,378.12
|
| Rate for Payer: Aetna Medicare |
$14,156.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,437.80
|
| Rate for Payer: Amerigroup Medicare |
$9,437.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,252.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,511.11
|
| Rate for Payer: BCBS of TX Medicare |
$9,437.80
|
| Rate for Payer: BCBS of TX PPO |
$9,457.16
|
| Rate for Payer: Cigna Commercial |
$11,881.80
|
| Rate for Payer: Cigna Medicare |
$9,437.80
|
| Rate for Payer: Employer Direct Commercial |
$9,437.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,437.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,437.80
|
| Rate for Payer: Molina Medicare |
$9,437.80
|
| Rate for Payer: Multiplan Auto |
$17,527.50
|
| Rate for Payer: Multiplan Commercial |
$17,527.50
|
| Rate for Payer: Multiplan Workers Comp |
$17,527.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8,071.88
|
| Rate for Payer: Scott and White Medicare |
$9,437.80
|
| Rate for Payer: Superior Health Plan EPO |
$9,437.80
|
| Rate for Payer: Superior Health Plan Medicare |
$9,437.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,437.80
|
| Rate for Payer: Universal American Medicare |
$9,437.80
|
| Rate for Payer: Wellcare Medicare |
$9,437.80
|
| Rate for Payer: Wellmed Medicare |
$9,437.80
|
|
