|
Capsulotomy metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
36028270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Capsulotomy, posterior capsular release, knee
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27435
|
| Hospital Charge Code |
36027435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
carBAMazepine 200 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77441521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
carBAMazepine 200 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77441521
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
Carbamazepine Level
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
1603034
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$441.76
|
|
|
Carbamazepine Level
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
1603034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$21.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Amerigroup Medicare |
$14.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.85
|
| Rate for Payer: BCBS of TX Medicare |
$14.57
|
| Rate for Payer: BCBS of TX PPO |
$32.20
|
| Rate for Payer: Cash Price |
$441.76
|
| Rate for Payer: Cash Price |
$441.76
|
| Rate for Payer: Cigna Medicaid |
$14.57
|
| Rate for Payer: Cigna Medicare |
$14.57
|
| Rate for Payer: Employer Direct Commercial |
$14.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Molina Medicare |
$14.57
|
| Rate for Payer: Multiplan Auto |
$326.30
|
| Rate for Payer: Multiplan Commercial |
$326.30
|
| Rate for Payer: Multiplan Workers Comp |
$326.30
|
| Rate for Payer: Parkland Medicaid |
$14.57
|
| Rate for Payer: Scott and White EPO/PPO |
$18.21
|
| Rate for Payer: Scott and White Medicare |
$14.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.57
|
| Rate for Payer: Superior Health Plan EPO |
$14.57
|
| Rate for Payer: Superior Health Plan Medicare |
$14.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.57
|
| Rate for Payer: Universal American Medicare |
$14.57
|
| Rate for Payer: Wellcare Medicare |
$14.57
|
| Rate for Payer: Wellmed Medicare |
$14.57
|
|
|
Carbon Dioxide Level
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1601681
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$76.56
|
|
|
Carbon Dioxide Level
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1601681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$7.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.88
|
| Rate for Payer: Amerigroup Medicare |
$4.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.66
|
| Rate for Payer: BCBS of TX Medicare |
$4.88
|
| Rate for Payer: BCBS of TX PPO |
$10.78
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cigna Medicaid |
$4.88
|
| Rate for Payer: Cigna Medicare |
$4.88
|
| Rate for Payer: Employer Direct Commercial |
$4.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.88
|
| Rate for Payer: Molina Medicare |
$4.88
|
| Rate for Payer: Multiplan Auto |
$56.55
|
| Rate for Payer: Multiplan Commercial |
$56.55
|
| Rate for Payer: Multiplan Workers Comp |
$56.55
|
| Rate for Payer: Parkland Medicaid |
$4.88
|
| Rate for Payer: Scott and White EPO/PPO |
$6.10
|
| Rate for Payer: Scott and White Medicare |
$4.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.88
|
| Rate for Payer: Superior Health Plan EPO |
$4.88
|
| Rate for Payer: Superior Health Plan Medicare |
$4.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.88
|
| Rate for Payer: Universal American Medicare |
$4.88
|
| Rate for Payer: Wellcare Medicare |
$4.88
|
| Rate for Payer: Wellmed Medicare |
$4.88
|
|
|
Carboxyhemoglobin
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
4000584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Amerigroup Medicare |
$12.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.39
|
| Rate for Payer: BCBS of TX Medicare |
$12.32
|
| Rate for Payer: BCBS of TX PPO |
$27.23
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cigna Medicaid |
$12.32
|
| Rate for Payer: Cigna Medicare |
$12.32
|
| Rate for Payer: Employer Direct Commercial |
$12.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Molina Medicare |
$12.32
|
| Rate for Payer: Multiplan Auto |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Multiplan Workers Comp |
$124.80
|
| Rate for Payer: Parkland Medicaid |
$12.32
|
| Rate for Payer: Scott and White EPO/PPO |
$15.40
|
| Rate for Payer: Scott and White Medicare |
$12.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.32
|
| Rate for Payer: Superior Health Plan EPO |
$12.32
|
| Rate for Payer: Superior Health Plan Medicare |
$12.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.32
|
| Rate for Payer: Universal American Medicare |
$12.32
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: Wellmed Medicare |
$12.32
|
|
|
Carcinoembryonic Antigen
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
1700145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$19.91
|
| Rate for Payer: Aetna Medicare |
$28.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.96
|
| Rate for Payer: Amerigroup Medicare |
$18.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37.54
|
| Rate for Payer: BCBS of TX Medicare |
$18.96
|
| Rate for Payer: BCBS of TX PPO |
$41.90
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Medicaid |
$18.96
|
| Rate for Payer: Cigna Medicare |
$18.96
|
| Rate for Payer: Employer Direct Commercial |
$18.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.96
|
| Rate for Payer: Molina Medicare |
$18.96
|
| Rate for Payer: Multiplan Auto |
$263.25
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: Multiplan Workers Comp |
$263.25
|
| Rate for Payer: Parkland Medicaid |
$18.96
|
| Rate for Payer: Scott and White EPO/PPO |
$23.70
|
| Rate for Payer: Scott and White Medicare |
$18.96
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.96
|
| Rate for Payer: Superior Health Plan EPO |
$18.96
|
| Rate for Payer: Superior Health Plan Medicare |
$18.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.96
|
| Rate for Payer: Universal American Medicare |
$18.96
|
| Rate for Payer: Wellcare Medicare |
$18.96
|
| Rate for Payer: Wellmed Medicare |
$18.96
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH CC
|
Facility
|
IP
|
$12,081.17
|
|
|
Service Code
|
MSDRG 297
|
| Min. Negotiated Rate |
$5,095.50 |
| Max. Negotiated Rate |
$12,081.17 |
| Rate for Payer: Aetna Commercial |
$8,196.75
|
| Rate for Payer: Aetna Medicare |
$12,081.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,095.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,732.12
|
| Rate for Payer: BCBS of TX PPO |
$7,480.42
|
| Rate for Payer: Cigna Commercial |
$9,384.37
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
|
IP
|
$21,442.97
|
|
|
Service Code
|
MSDRG 296
|
| Min. Negotiated Rate |
$11,794.90 |
| Max. Negotiated Rate |
$21,442.97 |
| Rate for Payer: Aetna Commercial |
$18,036.00
|
| Rate for Payer: Aetna Medicare |
$21,442.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,794.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,844.82
|
| Rate for Payer: BCBS of TX PPO |
$17,606.04
|
| Rate for Payer: Cigna Commercial |
$20,649.22
|
|
|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
|
IP
|
$8,988.76
|
|
|
Service Code
|
MSDRG 298
|
| Min. Negotiated Rate |
$3,779.70 |
| Max. Negotiated Rate |
$8,988.76 |
| Rate for Payer: Aetna Commercial |
$4,937.62
|
| Rate for Payer: Aetna Medicare |
$8,988.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,779.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,978.92
|
| Rate for Payer: BCBS of TX PPO |
$5,532.35
|
| Rate for Payer: Cigna Commercial |
$5,653.03
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
|
IP
|
$12,253.51
|
|
|
Service Code
|
MSDRG 309
|
| Min. Negotiated Rate |
$6,671.02 |
| Max. Negotiated Rate |
$12,253.51 |
| Rate for Payer: Aetna Commercial |
$8,377.88
|
| Rate for Payer: Aetna Medicare |
$12,253.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,671.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,878.56
|
| Rate for Payer: BCBS of TX PPO |
$8,754.29
|
| Rate for Payer: Cigna Commercial |
$9,591.74
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
|
IP
|
$17,150.64
|
|
|
Service Code
|
MSDRG 308
|
| Min. Negotiated Rate |
$10,359.56 |
| Max. Negotiated Rate |
$17,150.64 |
| Rate for Payer: Aetna Commercial |
$13,524.75
|
| Rate for Payer: Aetna Medicare |
$17,150.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,359.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,419.95
|
| Rate for Payer: BCBS of TX PPO |
$13,800.48
|
| Rate for Payer: Cigna Commercial |
$15,484.34
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,201.56
|
|
|
Service Code
|
MSDRG 310
|
| Min. Negotiated Rate |
$4,839.22 |
| Max. Negotiated Rate |
$10,201.56 |
| Rate for Payer: Aetna Commercial |
$6,221.25
|
| Rate for Payer: Aetna Medicare |
$10,201.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,839.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,802.37
|
| Rate for Payer: BCBS of TX PPO |
$6,447.33
|
| Rate for Payer: Cigna Commercial |
$7,122.64
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$20,732.22
|
|
|
Service Code
|
MSDRG 306
|
| Min. Negotiated Rate |
$12,370.24 |
| Max. Negotiated Rate |
$20,732.22 |
| Rate for Payer: Aetna Commercial |
$17,289.00
|
| Rate for Payer: Aetna Medicare |
$20,732.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,370.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,537.41
|
| Rate for Payer: BCBS of TX PPO |
$16,153.30
|
| Rate for Payer: Cigna Commercial |
$19,793.98
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,371.83
|
|
|
Service Code
|
MSDRG 307
|
| Min. Negotiated Rate |
$7,002.98 |
| Max. Negotiated Rate |
$14,371.83 |
| Rate for Payer: Aetna Commercial |
$10,604.25
|
| Rate for Payer: Aetna Medicare |
$14,371.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,002.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,833.06
|
| Rate for Payer: BCBS of TX PPO |
$9,814.90
|
| Rate for Payer: Cigna Commercial |
$12,140.69
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
|
IP
|
$90,621.10
|
|
|
Service Code
|
MSDRG 275
|
| Min. Negotiated Rate |
$79,152.75 |
| Max. Negotiated Rate |
$90,621.10 |
| Rate for Payer: Aetna Commercial |
$79,152.75
|
| Rate for Payer: Aetna Medicare |
$79,594.02
|
| Rate for Payer: Cigna Commercial |
$90,621.10
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
|
IP
|
$79,987.38
|
|
|
Service Code
|
MSDRG 276
|
| Min. Negotiated Rate |
$69,864.75 |
| Max. Negotiated Rate |
$79,987.38 |
| Rate for Payer: Aetna Commercial |
$69,864.75
|
| Rate for Payer: Aetna Medicare |
$70,756.70
|
| Rate for Payer: Cigna Commercial |
$79,987.38
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
|
IP
|
$61,597.31
|
|
|
Service Code
|
MSDRG 277
|
| Min. Negotiated Rate |
$53,802.00 |
| Max. Negotiated Rate |
$61,597.31 |
| Rate for Payer: Aetna Commercial |
$53,802.00
|
| Rate for Payer: Aetna Medicare |
$55,473.42
|
| Rate for Payer: Cigna Commercial |
$61,597.31
|
|
|
CARDIAC MONITOR RECORDER DM4500
|
Facility
|
IP
|
$32,446.87
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
145057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,111.72 |
| Max. Negotiated Rate |
$16,223.43 |
| Rate for Payer: Aetna Commercial |
$9,734.06
|
| Rate for Payer: Cash Price |
$28,553.25
|
| Rate for Payer: Cigna Commercial |
$8,111.72
|
| Rate for Payer: Multiplan Auto |
$16,223.43
|
| Rate for Payer: Multiplan Commercial |
$16,223.43
|
| Rate for Payer: Multiplan Workers Comp |
$16,223.43
|
| Rate for Payer: Scott and White EPO/PPO |
$16,223.43
|
|
|
CARDIAC MONITOR RECORDER DM4500
|
Facility
|
OP
|
$32,446.87
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
145057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,920.22 |
| Max. Negotiated Rate |
$16,223.43 |
| Rate for Payer: Aetna Commercial |
$9,734.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,920.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,734.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,680.87
|
| Rate for Payer: BCBS of TX PPO |
$12,978.75
|
| Rate for Payer: Cash Price |
$28,553.25
|
| Rate for Payer: Multiplan Auto |
$16,223.43
|
| Rate for Payer: Multiplan Commercial |
$16,223.43
|
| Rate for Payer: Multiplan Workers Comp |
$16,223.43
|
| Rate for Payer: Scott and White EPO/PPO |
$16,223.43
|
| Rate for Payer: Superior Health Plan EPO |
$4,412.77
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$34,886.77
|
|
|
Service Code
|
MSDRG 258
|
| Min. Negotiated Rate |
$26,101.86 |
| Max. Negotiated Rate |
$34,886.77 |
| Rate for Payer: Aetna Commercial |
$30,471.75
|
| Rate for Payer: Aetna Medicare |
$33,275.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,101.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,841.43
|
| Rate for Payer: BCBS of TX PPO |
$34,269.58
|
| Rate for Payer: Cigna Commercial |
$34,886.77
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
|
IP
|
$24,262.42
|
|
|
Service Code
|
MSDRG 259
|
| Min. Negotiated Rate |
$17,118.30 |
| Max. Negotiated Rate |
$24,262.42 |
| Rate for Payer: Aetna Commercial |
$20,999.25
|
| Rate for Payer: Aetna Medicare |
$24,262.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,118.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,638.94
|
| Rate for Payer: BCBS of TX PPO |
$24,044.20
|
| Rate for Payer: Cigna Commercial |
$24,041.81
|
|
