|
RT CHARGE PFT -> Spirometry before & after
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
4000170
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$792.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Amerigroup Medicare |
$374.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$208.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$249.84
|
| Rate for Payer: BCBS of TX Medicare |
$374.86
|
| Rate for Payer: BCBS of TX PPO |
$277.60
|
| Rate for Payer: Cash Price |
$471.92
|
| Rate for Payer: Cash Price |
$471.92
|
| Rate for Payer: Cash Price |
$471.92
|
| Rate for Payer: Cigna Commercial |
$792.38
|
| Rate for Payer: Cigna Medicaid |
$499.68
|
| Rate for Payer: Cigna Medicare |
$374.86
|
| Rate for Payer: Employer Direct Commercial |
$374.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$374.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$499.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Molina Medicare |
$374.86
|
| Rate for Payer: Multiplan Auto |
$451.10
|
| Rate for Payer: Multiplan Commercial |
$451.10
|
| Rate for Payer: Multiplan Workers Comp |
$451.10
|
| Rate for Payer: Parkland Medicaid |
$499.68
|
| Rate for Payer: Scott and White EPO/PPO |
$347.00
|
| Rate for Payer: Scott and White Medicare |
$374.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$499.68
|
| Rate for Payer: Superior Health Plan EPO |
$374.86
|
| Rate for Payer: Superior Health Plan Medicare |
$374.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Universal American Medicare |
$374.86
|
| Rate for Payer: Wellcare Medicare |
$374.86
|
| Rate for Payer: Wellmed Medicare |
$374.86
|
|
|
RT CHARGE PFT -> Total vital capacity
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
4049052
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Amerigroup Medicare |
$129.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$100.08
|
| Rate for Payer: BCBS of TX Medicare |
$129.26
|
| Rate for Payer: BCBS of TX PPO |
$111.20
|
| Rate for Payer: Cash Price |
$189.04
|
| Rate for Payer: Cash Price |
$189.04
|
| Rate for Payer: Cash Price |
$189.04
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cigna Medicaid |
$200.16
|
| Rate for Payer: Cigna Medicare |
$129.26
|
| Rate for Payer: Employer Direct Commercial |
$129.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$129.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$200.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Molina Medicare |
$129.26
|
| Rate for Payer: Multiplan Auto |
$180.70
|
| Rate for Payer: Multiplan Commercial |
$180.70
|
| Rate for Payer: Multiplan Workers Comp |
$180.70
|
| Rate for Payer: Parkland Medicaid |
$200.16
|
| Rate for Payer: Scott and White EPO/PPO |
$139.00
|
| Rate for Payer: Scott and White Medicare |
$129.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$200.16
|
| Rate for Payer: Superior Health Plan EPO |
$129.26
|
| Rate for Payer: Superior Health Plan Medicare |
$129.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$129.26
|
| Rate for Payer: Universal American Medicare |
$129.26
|
| Rate for Payer: Wellcare Medicare |
$129.26
|
| Rate for Payer: Wellmed Medicare |
$129.26
|
|
|
RT CHARGE PFT -> Total vital capacity
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
4049052
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$189.04
|
|
|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$6,035.99
|
|
|
Service Code
|
HCPCS 31625
|
| Hospital Charge Code |
4010011
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,104.47
|
|
|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$6,035.99
|
|
|
Service Code
|
HCPCS 31625
|
| Hospital Charge Code |
4010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$4,104.47
|
| Rate for Payer: Cash Price |
$4,104.47
|
| Rate for Payer: Cash Price |
$4,104.47
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$4,345.91
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,345.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| 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 |
$4,345.91
|
| Rate for Payer: Scott and White EPO/PPO |
$3,307.82
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,345.91
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH BRUSHINGS
|
Facility
|
IP
|
$2,972.00
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
4010018
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,020.96
|
|
|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH BRUSHINGS
|
Facility
|
OP
|
$2,972.00
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
4010018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$2,020.96
|
| Rate for Payer: Cash Price |
$2,020.96
|
| Rate for Payer: Cash Price |
$2,020.96
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$2,139.84
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,139.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| 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 |
$2,139.84
|
| Rate for Payer: Scott and White EPO/PPO |
$3,307.82
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,139.84
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
RT CHARGE Procedures with RT Assist -> BRONCHOSCOPY WITH CYTOLOGY
|
Facility
|
OP
|
$3,076.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
4010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$2,091.68
|
| Rate for Payer: Cash Price |
$2,091.68
|
| Rate for Payer: Cash Price |
$2,091.68
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$2,214.72
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,214.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| 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 |
$2,214.72
|
| Rate for Payer: Scott and White EPO/PPO |
$3,307.82
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,214.72
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
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 |
$2,925.46
|
| 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 |
$370.96
|
| 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 |
$48.50
|
| 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
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
5500375
|
|
Hospital Revenue Code
|
942
|
| Rate for Payer: Cash Price |
$36.04
|
|
|
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 |
$26.50
|
| 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 SpO2 -> Continuous
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4000238
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$11.52 |
| 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: 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 |
$64.00
|
| 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 |
$10.98 |
| 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: 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 |
$61.00
|
| 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 |
$180.00 |
| 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 |
$180.00
|
| 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 |
$180.00 |
| 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 |
$180.00
|
| 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
|
|
