|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH CYTOLOGY
|
Facility
|
IP
|
$3,076.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
4010010
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,091.68
|
|
|
RT CHARGE Procedures with RT Assist -> Chest Tube Insertion
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$589.68
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$589.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| 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 |
$589.68
|
| Rate for Payer: Scott and White EPO/PPO |
$2,709.66
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$589.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
RT CHARGE Procedures with RT Assist -> Chest Tube Insertion
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4010001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$556.92
|
|
|
RT CHARGE Procedures with RT Assist -> LARYNGOSCOPY, FLEX DIAGNOSTIC
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Amerigroup Medicare |
$200.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$200.52
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$480.76
|
| Rate for Payer: Cash Price |
$480.76
|
| Rate for Payer: Cash Price |
$480.76
|
| Rate for Payer: Cigna Commercial |
$423.85
|
| Rate for Payer: Cigna Medicaid |
$509.04
|
| Rate for Payer: Cigna Medicare |
$200.52
|
| Rate for Payer: Employer Direct Commercial |
$200.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$200.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$509.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Molina Medicare |
$200.52
|
| 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 |
$509.04
|
| Rate for Payer: Scott and White EPO/PPO |
$335.13
|
| Rate for Payer: Scott and White Medicare |
$200.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$509.04
|
| Rate for Payer: Superior Health Plan EPO |
$200.52
|
| Rate for Payer: Superior Health Plan Medicare |
$200.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Universal American Medicare |
$200.52
|
| Rate for Payer: Wellcare Medicare |
$200.52
|
| Rate for Payer: Wellmed Medicare |
$200.52
|
|
|
RT CHARGE Procedures with RT Assist -> LARYNGOSCOPY, FLEX DIAGNOSTIC
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$480.76
|
|
|
RT CHARGE Smoking Cessation -> Smoke/Tobacco Counseling >10 min
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
5500376
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$79.55 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Amerigroup Medicare |
$37.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.92
|
| Rate for Payer: BCBS of TX Medicare |
$37.64
|
| Rate for Payer: BCBS of TX PPO |
$38.80
|
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Cigna Commercial |
$79.55
|
| Rate for Payer: Cigna Medicaid |
$69.84
|
| Rate for Payer: Cigna Medicare |
$37.64
|
| Rate for Payer: Employer Direct Commercial |
$37.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$69.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Molina Medicare |
$37.64
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$69.84
|
| Rate for Payer: Scott and White EPO/PPO |
$30.38
|
| Rate for Payer: Scott and White Medicare |
$37.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$69.84
|
| Rate for Payer: Superior Health Plan EPO |
$37.64
|
| Rate for Payer: Superior Health Plan Medicare |
$37.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Universal American Medicare |
$37.64
|
| Rate for Payer: Wellcare Medicare |
$37.64
|
| Rate for Payer: Wellmed Medicare |
$37.64
|
|
|
RT CHARGE Smoking Cessation -> Smoke/Tobacco Counseling >10 min
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
5500376
|
|
Hospital Revenue Code
|
942
|
| Rate for Payer: Cash Price |
$65.96
|
|
|
RT CHARGE Smoking Cessation -> Smoke/Tobacco Counseling 3-10 min
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
5500375
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$79.55 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Amerigroup Medicare |
$37.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.08
|
| Rate for Payer: BCBS of TX Medicare |
$37.64
|
| Rate for Payer: BCBS of TX PPO |
$21.20
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cigna Commercial |
$79.55
|
| Rate for Payer: Cigna Medicaid |
$38.16
|
| Rate for Payer: Cigna Medicare |
$37.64
|
| Rate for Payer: Employer Direct Commercial |
$37.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$38.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Molina Medicare |
$37.64
|
| Rate for Payer: Multiplan Auto |
$34.45
|
| Rate for Payer: Multiplan Commercial |
$34.45
|
| Rate for Payer: Multiplan Workers Comp |
$34.45
|
| Rate for Payer: Parkland Medicaid |
$38.16
|
| Rate for Payer: Scott and White EPO/PPO |
$14.36
|
| Rate for Payer: Scott and White Medicare |
$37.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$38.16
|
| Rate for Payer: Superior Health Plan EPO |
$37.64
|
| Rate for Payer: Superior Health Plan Medicare |
$37.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.64
|
| Rate for Payer: Universal American Medicare |
$37.64
|
| Rate for Payer: Wellcare Medicare |
$37.64
|
| Rate for Payer: Wellmed Medicare |
$37.64
|
|
|
RT CHARGE Smoking Cessation -> Smoke/Tobacco Counseling 3-10 min
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
5500375
|
|
Hospital Revenue Code
|
942
|
| Rate for Payer: Cash Price |
$36.04
|
|
|
RT CHARGE SpO2 -> Continuous
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4000238
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.08
|
| Rate for Payer: BCBS of TX PPO |
$51.20
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cigna Medicaid |
$92.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$92.16
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Parkland Medicaid |
$92.16
|
| Rate for Payer: Scott and White EPO/PPO |
$4.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$92.16
|
| Rate for Payer: Superior Health Plan EPO |
$17.41
|
|
|
RT CHARGE SpO2 -> Continuous
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4000238
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$87.04
|
|
|
RT CHARGE SpO2 -> Single
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4000188
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$82.96
|
|
|
RT CHARGE SpO2 -> Single
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4000188
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.92
|
| Rate for Payer: BCBS of TX PPO |
$48.80
|
| Rate for Payer: Cash Price |
$82.96
|
| Rate for Payer: Cash Price |
$82.96
|
| Rate for Payer: Cigna Medicaid |
$87.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.84
|
| Rate for Payer: Multiplan Auto |
$79.30
|
| Rate for Payer: Multiplan Commercial |
$79.30
|
| Rate for Payer: Multiplan Workers Comp |
$79.30
|
| Rate for Payer: Parkland Medicaid |
$87.84
|
| Rate for Payer: Scott and White EPO/PPO |
$3.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.84
|
| Rate for Payer: Superior Health Plan EPO |
$16.59
|
|
|
RT CHARGE Ventilator Initiate -> Yes
|
Facility
|
IP
|
$3,836.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4020004
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$2,608.48
|
|
|
RT CHARGE Ventilator Initiate -> Yes
|
Facility
|
OP
|
$3,836.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4020004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$2,761.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$345.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Amerigroup Medicare |
$620.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,150.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,380.96
|
| Rate for Payer: BCBS of TX Medicare |
$620.60
|
| Rate for Payer: BCBS of TX PPO |
$1,534.40
|
| Rate for Payer: Cash Price |
$2,608.48
|
| Rate for Payer: Cash Price |
$2,608.48
|
| Rate for Payer: Cash Price |
$2,608.48
|
| Rate for Payer: Cigna Commercial |
$1,311.86
|
| Rate for Payer: Cigna Medicaid |
$2,761.92
|
| Rate for Payer: Cigna Medicare |
$620.60
|
| Rate for Payer: Employer Direct Commercial |
$620.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$620.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,761.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Molina Medicare |
$620.60
|
| Rate for Payer: Multiplan Auto |
$2,493.40
|
| Rate for Payer: Multiplan Commercial |
$2,493.40
|
| Rate for Payer: Multiplan Workers Comp |
$2,493.40
|
| Rate for Payer: Parkland Medicaid |
$2,761.92
|
| Rate for Payer: Scott and White EPO/PPO |
$110.76
|
| Rate for Payer: Scott and White Medicare |
$620.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,761.92
|
| Rate for Payer: Superior Health Plan EPO |
$620.60
|
| Rate for Payer: Superior Health Plan Medicare |
$620.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Universal American Medicare |
$620.60
|
| Rate for Payer: Wellcare Medicare |
$620.60
|
| Rate for Payer: Wellmed Medicare |
$620.60
|
|
|
RT CHARGE Ventilator Subsequent -> Yes
|
Facility
|
OP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4020012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$2,045.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$255.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Amerigroup Medicare |
$620.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$852.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,022.76
|
| Rate for Payer: BCBS of TX Medicare |
$620.60
|
| Rate for Payer: BCBS of TX PPO |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,931.88
|
| Rate for Payer: Cash Price |
$1,931.88
|
| Rate for Payer: Cash Price |
$1,931.88
|
| Rate for Payer: Cigna Commercial |
$1,311.86
|
| Rate for Payer: Cigna Medicaid |
$2,045.52
|
| Rate for Payer: Cigna Medicare |
$620.60
|
| Rate for Payer: Employer Direct Commercial |
$620.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$620.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,045.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Molina Medicare |
$620.60
|
| Rate for Payer: Multiplan Auto |
$1,846.65
|
| Rate for Payer: Multiplan Commercial |
$1,846.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,846.65
|
| Rate for Payer: Parkland Medicaid |
$2,045.52
|
| Rate for Payer: Scott and White EPO/PPO |
$77.95
|
| Rate for Payer: Scott and White Medicare |
$620.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,045.52
|
| Rate for Payer: Superior Health Plan EPO |
$620.60
|
| Rate for Payer: Superior Health Plan Medicare |
$620.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$620.60
|
| Rate for Payer: Universal American Medicare |
$620.60
|
| Rate for Payer: Wellcare Medicare |
$620.60
|
| Rate for Payer: Wellmed Medicare |
$620.60
|
|
|
RT CHARGE Ventilator Subsequent -> Yes
|
Facility
|
IP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4020012
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$1,931.88
|
|
|
RT EKG 12 Lead Tracing BCE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
5503006
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$210.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$252.00
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$280.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$504.00
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$504.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| Rate for Payer: Parkland Medicaid |
$504.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7.78
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$504.00
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
RT EKG 12 Lead Tracing BCE
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
5503006
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$476.00
|
|
|
RT HEART CATH W O2 SATU & OUT PUT
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
2320520
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$5,095.92
|
|
|
RT HEART CATH W O2 SATU & OUT PUT
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
2320520
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$674.46 |
| Max. Negotiated Rate |
$7,181.87 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$674.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Amerigroup Medicare |
$3,256.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,256.70
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$5,095.92
|
| Rate for Payer: Cash Price |
$5,095.92
|
| Rate for Payer: Cash Price |
$5,095.92
|
| Rate for Payer: Cigna Commercial |
$6,884.08
|
| Rate for Payer: Cigna Medicaid |
$5,395.68
|
| Rate for Payer: Cigna Medicare |
$3,256.70
|
| Rate for Payer: Employer Direct Commercial |
$3,256.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,256.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,395.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Molina Medicare |
$3,256.70
|
| Rate for Payer: Multiplan Auto |
$4,871.10
|
| Rate for Payer: Multiplan Commercial |
$4,871.10
|
| Rate for Payer: Multiplan Workers Comp |
$4,871.10
|
| Rate for Payer: Parkland Medicaid |
$5,395.68
|
| Rate for Payer: Scott and White EPO/PPO |
$1,048.99
|
| Rate for Payer: Scott and White Medicare |
$3,256.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,395.68
|
| Rate for Payer: Superior Health Plan EPO |
$3,256.70
|
| Rate for Payer: Superior Health Plan Medicare |
$3,256.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Universal American Medicare |
$3,256.70
|
| Rate for Payer: Wellcare Medicare |
$3,256.70
|
| Rate for Payer: Wellmed Medicare |
$3,256.70
|
|
|
RT+LT HEART CATH+LT VENT GRAPHY INJ
|
Facility
|
OP
|
$13,446.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
2320522
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,210.14 |
| Max. Negotiated Rate |
$9,681.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,210.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Amerigroup Medicare |
$3,256.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,759.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,699.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,256.70
|
| Rate for Payer: BCBS of TX PPO |
$7,181.87
|
| Rate for Payer: Cash Price |
$9,143.28
|
| Rate for Payer: Cash Price |
$9,143.28
|
| Rate for Payer: Cash Price |
$9,143.28
|
| Rate for Payer: Cigna Commercial |
$6,884.08
|
| Rate for Payer: Cigna Medicaid |
$9,681.12
|
| Rate for Payer: Cigna Medicare |
$3,256.70
|
| Rate for Payer: Employer Direct Commercial |
$3,256.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,256.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,681.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Molina Medicare |
$3,256.70
|
| Rate for Payer: Multiplan Auto |
$8,739.90
|
| Rate for Payer: Multiplan Commercial |
$8,739.90
|
| Rate for Payer: Multiplan Workers Comp |
$8,739.90
|
| Rate for Payer: Parkland Medicaid |
$9,681.12
|
| Rate for Payer: Scott and White EPO/PPO |
$1,389.42
|
| Rate for Payer: Scott and White Medicare |
$3,256.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,681.12
|
| Rate for Payer: Superior Health Plan EPO |
$3,256.70
|
| Rate for Payer: Superior Health Plan Medicare |
$3,256.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,256.70
|
| Rate for Payer: Universal American Medicare |
$3,256.70
|
| Rate for Payer: Wellcare Medicare |
$3,256.70
|
| Rate for Payer: Wellmed Medicare |
$3,256.70
|
|
|
RT+LT HEART CATH+LT VENT GRAPHY INJ
|
Facility
|
IP
|
$13,446.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
2320522
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,143.28
|
|
|
RT VENTRICULAR RECORDING
|
Facility
|
IP
|
$2,140.00
|
|
|
Service Code
|
HCPCS 93603
|
| Hospital Charge Code |
4613603
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,455.20
|
|
|
RT VENTRICULAR RECORDING
|
Facility
|
OP
|
$2,140.00
|
|
|
Service Code
|
HCPCS 93603
|
| Hospital Charge Code |
4613603
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$2,585.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$192.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,223.09
|
| Rate for Payer: Amerigroup Medicare |
$1,223.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,649.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,975.12
|
| Rate for Payer: BCBS of TX Medicare |
$1,223.09
|
| Rate for Payer: BCBS of TX PPO |
$2,488.65
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cigna Commercial |
$2,585.39
|
| Rate for Payer: Cigna Medicaid |
$1,540.80
|
| Rate for Payer: Cigna Medicare |
$1,223.09
|
| Rate for Payer: Employer Direct Commercial |
$1,223.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,223.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,540.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,223.09
|
| Rate for Payer: Molina Medicare |
$1,223.09
|
| Rate for Payer: Multiplan Auto |
$1,391.00
|
| Rate for Payer: Multiplan Commercial |
$1,391.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,391.00
|
| Rate for Payer: Parkland Medicaid |
$1,540.80
|
| Rate for Payer: Scott and White EPO/PPO |
$1,070.00
|
| Rate for Payer: Scott and White Medicare |
$1,223.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,540.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,223.09
|
| Rate for Payer: Superior Health Plan Medicare |
$1,223.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,223.09
|
| Rate for Payer: Universal American Medicare |
$1,223.09
|
| Rate for Payer: Wellcare Medicare |
$1,223.09
|
| Rate for Payer: Wellmed Medicare |
$1,223.09
|
|
