|
Antibody elution (RBC), each elution
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
9232979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.73 |
| Max. Negotiated Rate |
$361.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Amerigroup Medicare |
$171.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$106.92
|
| Rate for Payer: BCBS of TX Medicare |
$171.15
|
| Rate for Payer: BCBS of TX PPO |
$118.80
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cigna Commercial |
$361.78
|
| Rate for Payer: Cigna Medicaid |
$213.84
|
| Rate for Payer: Cigna Medicare |
$171.15
|
| Rate for Payer: Employer Direct Commercial |
$171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$171.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$213.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Molina Medicare |
$171.15
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Parkland Medicaid |
$213.84
|
| Rate for Payer: Scott and White EPO/PPO |
$234.31
|
| Rate for Payer: Scott and White Medicare |
$171.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$213.84
|
| Rate for Payer: Superior Health Plan EPO |
$171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$171.15
|
| Rate for Payer: Universal American Medicare |
$171.15
|
| Rate for Payer: Wellcare Medicare |
$171.15
|
| Rate for Payer: Wellmed Medicare |
$171.15
|
|
|
Anti-DNA(SS)IgG, Ab, Qn SO
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
1703891
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$57.80
|
|
|
Anti-DNA(SS)IgG, Ab, Qn SO
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
1703891
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.60
|
| Rate for Payer: BCBS of TX Medicare |
$12.11
|
| Rate for Payer: BCBS of TX PPO |
$34.00
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Medicaid |
$61.20
|
| Rate for Payer: Cigna Medicare |
$12.11
|
| Rate for Payer: Employer Direct Commercial |
$12.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$61.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Molina Medicare |
$12.11
|
| Rate for Payer: Multiplan Auto |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$55.25
|
| Rate for Payer: Multiplan Workers Comp |
$55.25
|
| Rate for Payer: Parkland Medicaid |
$61.20
|
| Rate for Payer: Scott and White EPO/PPO |
$15.14
|
| Rate for Payer: Scott and White Medicare |
$12.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$61.20
|
| Rate for Payer: Superior Health Plan EPO |
$12.11
|
| Rate for Payer: Superior Health Plan Medicare |
$12.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.11
|
| Rate for Payer: Universal American Medicare |
$12.11
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: Wellmed Medicare |
$12.11
|
|
|
Anti-GBM Antibodies SO
|
Facility
|
OP
|
$167.25
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
9164981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.21
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$66.90
|
| Rate for Payer: Cash Price |
$113.73
|
| Rate for Payer: Cash Price |
$113.73
|
| Rate for Payer: Cigna Medicaid |
$120.42
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$120.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$108.71
|
| Rate for Payer: Multiplan Commercial |
$108.71
|
| Rate for Payer: Multiplan Workers Comp |
$108.71
|
| Rate for Payer: Parkland Medicaid |
$120.42
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$120.42
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
Anti-GBM Antibodies SO
|
Facility
|
IP
|
$167.25
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
9164981
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$113.73
|
|
|
Anti-Mullerian Hormone (AMH) SO
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
1704261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$131.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Amerigroup Medicare |
$14.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$54.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65.52
|
| Rate for Payer: BCBS of TX Medicare |
$14.12
|
| Rate for Payer: BCBS of TX PPO |
$72.80
|
| Rate for Payer: Cash Price |
$123.76
|
| Rate for Payer: Cash Price |
$123.76
|
| Rate for Payer: Cigna Medicaid |
$131.04
|
| Rate for Payer: Cigna Medicare |
$14.12
|
| Rate for Payer: Employer Direct Commercial |
$14.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$131.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Molina Medicare |
$14.12
|
| Rate for Payer: Multiplan Auto |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$118.30
|
| Rate for Payer: Multiplan Workers Comp |
$118.30
|
| Rate for Payer: Parkland Medicaid |
$131.04
|
| Rate for Payer: Scott and White EPO/PPO |
$17.65
|
| Rate for Payer: Scott and White Medicare |
$14.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$131.04
|
| Rate for Payer: Superior Health Plan EPO |
$14.12
|
| Rate for Payer: Superior Health Plan Medicare |
$14.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.12
|
| Rate for Payer: Universal American Medicare |
$14.12
|
| Rate for Payer: Wellcare Medicare |
$14.12
|
| Rate for Payer: Wellmed Medicare |
$14.12
|
|
|
Anti-Mullerian Hormone (AMH) SO
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
1704261
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$123.76
|
|
|
Antipancreatic Islet Cells SO
|
Facility
|
OP
|
$237.35
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
1707454
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$170.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Amerigroup Medicare |
$23.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$71.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$85.45
|
| Rate for Payer: BCBS of TX Medicare |
$23.57
|
| Rate for Payer: BCBS of TX PPO |
$94.94
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Medicaid |
$170.89
|
| Rate for Payer: Cigna Medicare |
$23.57
|
| Rate for Payer: Employer Direct Commercial |
$23.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$23.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$170.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Molina Medicare |
$23.57
|
| Rate for Payer: Multiplan Auto |
$154.28
|
| Rate for Payer: Multiplan Commercial |
$154.28
|
| Rate for Payer: Multiplan Workers Comp |
$154.28
|
| Rate for Payer: Parkland Medicaid |
$170.89
|
| Rate for Payer: Scott and White EPO/PPO |
$29.46
|
| Rate for Payer: Scott and White Medicare |
$23.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$170.89
|
| Rate for Payer: Superior Health Plan EPO |
$23.57
|
| Rate for Payer: Superior Health Plan Medicare |
$23.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23.57
|
| Rate for Payer: Universal American Medicare |
$23.57
|
| Rate for Payer: Wellcare Medicare |
$23.57
|
| Rate for Payer: Wellmed Medicare |
$23.57
|
|
|
Antipancreatic Islet Cells SO
|
Facility
|
IP
|
$237.35
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
1707454
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$161.40
|
|
|
ANTISEPTIC, HAND, AVAGARD, 16OZ
|
Facility
|
IP
|
$371.25
|
|
| Hospital Charge Code |
993792
|
|
Hospital Revenue Code
|
279
|
| Rate for Payer: Cash Price |
$252.45
|
|
|
ANTISEPTIC, HAND, AVAGARD, 16OZ
|
Facility
|
OP
|
$371.25
|
|
| Hospital Charge Code |
993792
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$111.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$148.50
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna Medicaid |
$267.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$267.30
|
| Rate for Payer: Multiplan Auto |
$241.31
|
| Rate for Payer: Multiplan Commercial |
$241.31
|
| Rate for Payer: Multiplan Workers Comp |
$241.31
|
| Rate for Payer: Parkland Medicaid |
$267.30
|
| Rate for Payer: Scott and White EPO/PPO |
$185.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$267.30
|
| Rate for Payer: Superior Health Plan EPO |
$50.49
|
|
|
Antistreptolysin O Ab SO
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
1700962
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$136.00
|
|
|
Antistreptolysin O Ab SO
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
1700962
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Amerigroup Medicare |
$7.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$72.00
|
| Rate for Payer: BCBS of TX Medicare |
$7.30
|
| Rate for Payer: BCBS of TX PPO |
$80.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Medicaid |
$144.00
|
| Rate for Payer: Cigna Medicare |
$7.30
|
| Rate for Payer: Employer Direct Commercial |
$7.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.30
|
| Rate for Payer: Molina CHIP/Medicaid |
$144.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Molina Medicare |
$7.30
|
| Rate for Payer: Multiplan Auto |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Multiplan Workers Comp |
$130.00
|
| Rate for Payer: Parkland Medicaid |
$144.00
|
| Rate for Payer: Scott and White EPO/PPO |
$9.12
|
| Rate for Payer: Scott and White Medicare |
$7.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$144.00
|
| Rate for Payer: Superior Health Plan EPO |
$7.30
|
| Rate for Payer: Superior Health Plan Medicare |
$7.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.30
|
| Rate for Payer: Universal American Medicare |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$7.30
|
| Rate for Payer: Wellmed Medicare |
$7.30
|
|
|
Antithrombin Activity SO
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
1706415
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$209.44
|
|
|
Antithrombin Activity SO
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
1706415
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Amerigroup Medicare |
$11.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$92.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.88
|
| Rate for Payer: BCBS of TX Medicare |
$11.85
|
| Rate for Payer: BCBS of TX PPO |
$123.20
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cigna Medicaid |
$221.76
|
| Rate for Payer: Cigna Medicare |
$11.85
|
| Rate for Payer: Employer Direct Commercial |
$11.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$221.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Molina Medicare |
$11.85
|
| 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 |
$221.76
|
| Rate for Payer: Scott and White EPO/PPO |
$14.81
|
| Rate for Payer: Scott and White Medicare |
$11.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$221.76
|
| Rate for Payer: Superior Health Plan EPO |
$11.85
|
| Rate for Payer: Superior Health Plan Medicare |
$11.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.85
|
| Rate for Payer: Universal American Medicare |
$11.85
|
| Rate for Payer: Wellcare Medicare |
$11.85
|
| Rate for Payer: Wellmed Medicare |
$11.85
|
|
|
ANVIL EEAORVIL 21MM
|
Facility
|
OP
|
$411.01
|
|
| Hospital Charge Code |
131612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$295.93 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$123.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$147.96
|
| Rate for Payer: BCBS of TX PPO |
$164.40
|
| Rate for Payer: Cash Price |
$279.49
|
| Rate for Payer: Cigna Medicaid |
$295.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$295.93
|
| Rate for Payer: Multiplan Auto |
$267.16
|
| Rate for Payer: Multiplan Commercial |
$267.16
|
| Rate for Payer: Multiplan Workers Comp |
$267.16
|
| Rate for Payer: Parkland Medicaid |
$295.93
|
| Rate for Payer: Scott and White EPO/PPO |
$205.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$295.93
|
| Rate for Payer: Superior Health Plan EPO |
$55.90
|
|
|
ANVIL EEAORVIL 21MM
|
Facility
|
IP
|
$411.01
|
|
| Hospital Charge Code |
131612
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$279.49
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$131,495.20
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$55,168.39 |
| Max. Negotiated Rate |
$131,495.20 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55,168.39
|
| Rate for Payer: Amerigroup Medicare |
$55,168.39
|
| Rate for Payer: BCBS of TX Medicare |
$55,168.39
|
| Rate for Payer: Cigna Commercial |
$88,587.35
|
| Rate for Payer: Cigna Medicare |
$55,168.39
|
| Rate for Payer: Employer Direct Commercial |
$55,168.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$55,168.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55,168.39
|
| Rate for Payer: Molina Medicare |
$55,168.39
|
| Rate for Payer: Multiplan Auto |
$131,495.20
|
| Rate for Payer: Multiplan Commercial |
$131,495.20
|
| Rate for Payer: Multiplan Workers Comp |
$131,495.20
|
| Rate for Payer: Scott and White EPO/PPO |
$60,557.00
|
| Rate for Payer: Scott and White Medicare |
$55,168.39
|
| Rate for Payer: Superior Health Plan EPO |
$55,168.39
|
| Rate for Payer: Superior Health Plan Medicare |
$55,168.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55,168.39
|
| Rate for Payer: Universal American Medicare |
$55,168.39
|
| Rate for Payer: Wellcare Medicare |
$55,168.39
|
| Rate for Payer: Wellmed Medicare |
$55,168.39
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$81,249.70
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$35,697.74 |
| Max. Negotiated Rate |
$81,249.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35,712.03
|
| Rate for Payer: Amerigroup Medicare |
$35,712.03
|
| Rate for Payer: BCBS of TX Medicare |
$35,712.03
|
| Rate for Payer: Cigna Commercial |
$54,394.82
|
| Rate for Payer: Cigna Medicare |
$35,712.03
|
| Rate for Payer: Employer Direct Commercial |
$35,712.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$35,712.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35,712.03
|
| Rate for Payer: Molina Medicare |
$35,712.03
|
| Rate for Payer: Multiplan Auto |
$81,249.70
|
| Rate for Payer: Multiplan Commercial |
$81,249.70
|
| Rate for Payer: Multiplan Workers Comp |
$81,249.70
|
| Rate for Payer: Scott and White EPO/PPO |
$37,417.62
|
| Rate for Payer: Scott and White Medicare |
$35,712.03
|
| Rate for Payer: Superior Health Plan EPO |
$35,712.03
|
| Rate for Payer: Superior Health Plan Medicare |
$35,712.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35,712.03
|
| Rate for Payer: Universal American Medicare |
$35,712.03
|
| Rate for Payer: Wellcare Medicare |
$35,712.03
|
| Rate for Payer: Wellmed Medicare |
$35,712.03
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC
|
Facility
|
IP
|
$131,495.20
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$55,168.39 |
| Max. Negotiated Rate |
$131,495.20 |
| Rate for Payer: BCBS of TX Blue Advantage |
$57,651.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69,175.48
|
| Rate for Payer: BCBS of TX PPO |
$76,864.62
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC
|
Facility
|
IP
|
$81,249.70
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$35,697.74 |
| Max. Negotiated Rate |
$81,249.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$35,697.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$42,833.14
|
| Rate for Payer: BCBS of TX PPO |
$47,594.22
|
|
|
AORTOGRAPHY
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
2320548
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,657.16
|
|
|
AORTOGRAPHY
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
2320548
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$1,754.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$219.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$731.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$877.32
|
| Rate for Payer: BCBS of TX PPO |
$974.80
|
| Rate for Payer: Cash Price |
$1,657.16
|
| Rate for Payer: Cash Price |
$1,657.16
|
| Rate for Payer: Cigna Medicaid |
$1,754.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,754.64
|
| Rate for Payer: Multiplan Auto |
$1,584.05
|
| Rate for Payer: Multiplan Commercial |
$1,584.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,584.05
|
| Rate for Payer: Parkland Medicaid |
$1,754.64
|
| Rate for Payer: Scott and White EPO/PPO |
$44.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,754.64
|
| Rate for Payer: Superior Health Plan EPO |
$331.43
|
|
|
Aortography, abdominal, by serialography, radiological supervision and interpretation
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
36075625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| 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 |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| 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 |
$155.28
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
|
Aortography, abdominal, by serialography, radiological supervision and interpretation
|
Facility
|
OP
|
$23,831.76
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
9900900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$17,158.87 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,144.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| 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 |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$16,205.60
|
| Rate for Payer: Cash Price |
$16,205.60
|
| Rate for Payer: Cash Price |
$16,205.60
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$17,158.87
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$17,158.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| 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 |
$17,158.87
|
| Rate for Payer: Scott and White EPO/PPO |
$155.28
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17,158.87
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
