|
Cervical Ripening Method:Double balloon catheter
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
300277
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Medicare |
$440.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Amerigroup Medicare |
$293.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$94.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$112.60
|
| Rate for Payer: BCBS of TX Medicare |
$293.39
|
| Rate for Payer: BCBS of TX PPO |
$141.88
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cigna Commercial |
$664.62
|
| Rate for Payer: Cigna Medicare |
$293.39
|
| Rate for Payer: Employer Direct Commercial |
$293.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$293.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Molina Medicare |
$293.39
|
| 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 |
$6.47
|
| Rate for Payer: Scott and White Medicare |
$293.39
|
| Rate for Payer: Superior Health Plan EPO |
$293.39
|
| Rate for Payer: Superior Health Plan Medicare |
$293.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Universal American Medicare |
$293.39
|
| Rate for Payer: Wellcare Medicare |
$293.39
|
| Rate for Payer: Wellmed Medicare |
$293.39
|
|
|
Cervical Ripening Method:Double balloon catheter
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
300277
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$784.08
|
|
|
Cervical Ripening Method:Laminaria
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
300277
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Medicare |
$440.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Amerigroup Medicare |
$293.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$94.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$112.60
|
| Rate for Payer: BCBS of TX Medicare |
$293.39
|
| Rate for Payer: BCBS of TX PPO |
$141.88
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cigna Commercial |
$664.62
|
| Rate for Payer: Cigna Medicare |
$293.39
|
| Rate for Payer: Employer Direct Commercial |
$293.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$293.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Molina Medicare |
$293.39
|
| 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 |
$6.47
|
| Rate for Payer: Scott and White Medicare |
$293.39
|
| Rate for Payer: Superior Health Plan EPO |
$293.39
|
| Rate for Payer: Superior Health Plan Medicare |
$293.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Universal American Medicare |
$293.39
|
| Rate for Payer: Wellcare Medicare |
$293.39
|
| Rate for Payer: Wellmed Medicare |
$293.39
|
|
|
Cervical Ripening Method:Single balloon catheter
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
300277
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Medicare |
$440.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Amerigroup Medicare |
$293.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$94.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$112.60
|
| Rate for Payer: BCBS of TX Medicare |
$293.39
|
| Rate for Payer: BCBS of TX PPO |
$141.88
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cash Price |
$784.08
|
| Rate for Payer: Cigna Commercial |
$664.62
|
| Rate for Payer: Cigna Medicare |
$293.39
|
| Rate for Payer: Employer Direct Commercial |
$293.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$293.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Molina Medicare |
$293.39
|
| 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 |
$6.47
|
| Rate for Payer: Scott and White Medicare |
$293.39
|
| Rate for Payer: Superior Health Plan EPO |
$293.39
|
| Rate for Payer: Superior Health Plan Medicare |
$293.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Universal American Medicare |
$293.39
|
| Rate for Payer: Wellcare Medicare |
$293.39
|
| Rate for Payer: Wellmed Medicare |
$293.39
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$56,152.60
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$23,944.69 |
| Max. Negotiated Rate |
$56,152.60 |
| Rate for Payer: Aetna Commercial |
$33,248.25
|
| Rate for Payer: Aetna Medicare |
$35,917.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23,944.69
|
| Rate for Payer: Amerigroup Medicare |
$23,944.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24,758.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,408.03
|
| Rate for Payer: BCBS of TX Medicare |
$23,944.69
|
| Rate for Payer: BCBS of TX PPO |
$33,788.01
|
| Rate for Payer: Cigna Commercial |
$38,065.55
|
| Rate for Payer: Cigna Medicare |
$23,944.69
|
| Rate for Payer: Employer Direct Commercial |
$23,944.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$23,944.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23,944.69
|
| Rate for Payer: Molina Medicare |
$23,944.69
|
| Rate for Payer: Multiplan Auto |
$56,152.60
|
| Rate for Payer: Multiplan Commercial |
$56,152.60
|
| Rate for Payer: Multiplan Workers Comp |
$56,152.60
|
| Rate for Payer: Scott and White EPO/PPO |
$25,859.75
|
| Rate for Payer: Scott and White Medicare |
$23,944.69
|
| Rate for Payer: Superior Health Plan EPO |
$23,944.69
|
| Rate for Payer: Superior Health Plan Medicare |
$23,944.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23,944.69
|
| Rate for Payer: Universal American Medicare |
$23,944.69
|
| Rate for Payer: Wellcare Medicare |
$23,944.69
|
| Rate for Payer: Wellmed Medicare |
$23,944.69
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$93,461.00
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$37,957.06 |
| Max. Negotiated Rate |
$93,461.00 |
| Rate for Payer: Aetna Commercial |
$55,338.75
|
| Rate for Payer: Aetna Medicare |
$56,935.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37,957.06
|
| Rate for Payer: Amerigroup Medicare |
$37,957.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41,414.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51,705.41
|
| Rate for Payer: BCBS of TX Medicare |
$37,957.06
|
| Rate for Payer: BCBS of TX PPO |
$57,452.69
|
| Rate for Payer: Cigna Commercial |
$63,356.72
|
| Rate for Payer: Cigna Medicare |
$37,957.06
|
| Rate for Payer: Employer Direct Commercial |
$37,957.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$37,957.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37,957.06
|
| Rate for Payer: Molina Medicare |
$37,957.06
|
| Rate for Payer: Multiplan Auto |
$93,461.00
|
| Rate for Payer: Multiplan Commercial |
$93,461.00
|
| Rate for Payer: Multiplan Workers Comp |
$93,461.00
|
| Rate for Payer: Scott and White EPO/PPO |
$43,041.25
|
| Rate for Payer: Scott and White Medicare |
$37,957.06
|
| Rate for Payer: Superior Health Plan EPO |
$37,957.06
|
| Rate for Payer: Superior Health Plan Medicare |
$37,957.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37,957.06
|
| Rate for Payer: Universal American Medicare |
$37,957.06
|
| Rate for Payer: Wellcare Medicare |
$37,957.06
|
| Rate for Payer: Wellmed Medicare |
$37,957.06
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$46,751.40
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$19,773.12 |
| Max. Negotiated Rate |
$46,751.40 |
| Rate for Payer: Aetna Commercial |
$27,681.75
|
| Rate for Payer: Aetna Medicare |
$30,620.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,413.78
|
| Rate for Payer: Amerigroup Medicare |
$20,413.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,773.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,485.96
|
| Rate for Payer: BCBS of TX Medicare |
$20,413.78
|
| Rate for Payer: BCBS of TX PPO |
$27,207.67
|
| Rate for Payer: Cigna Commercial |
$31,692.53
|
| Rate for Payer: Cigna Medicare |
$20,413.78
|
| Rate for Payer: Employer Direct Commercial |
$20,413.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,413.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,413.78
|
| Rate for Payer: Molina Medicare |
$20,413.78
|
| Rate for Payer: Multiplan Auto |
$46,751.40
|
| Rate for Payer: Multiplan Commercial |
$46,751.40
|
| Rate for Payer: Multiplan Workers Comp |
$46,751.40
|
| Rate for Payer: Scott and White EPO/PPO |
$21,530.25
|
| Rate for Payer: Scott and White Medicare |
$20,413.78
|
| Rate for Payer: Superior Health Plan EPO |
$20,413.78
|
| Rate for Payer: Superior Health Plan Medicare |
$20,413.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,413.78
|
| Rate for Payer: Universal American Medicare |
$20,413.78
|
| Rate for Payer: Wellcare Medicare |
$20,413.78
|
| Rate for Payer: Wellmed Medicare |
$20,413.78
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$19,970.90
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$19,970.90 |
| Rate for Payer: Aetna Commercial |
$11,824.88
|
| Rate for Payer: Aetna Medicare |
$15,533.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,355.48
|
| Rate for Payer: Amerigroup Medicare |
$10,355.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,155.87
|
| Rate for Payer: BCBS of TX Medicare |
$10,355.48
|
| Rate for Payer: BCBS of TX PPO |
$12,395.89
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$10,355.48
|
| Rate for Payer: Employer Direct Commercial |
$10,355.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,355.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,355.48
|
| Rate for Payer: Molina Medicare |
$10,355.48
|
| Rate for Payer: Multiplan Auto |
$19,970.90
|
| Rate for Payer: Multiplan Commercial |
$19,970.90
|
| Rate for Payer: Multiplan Workers Comp |
$19,970.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9,197.12
|
| Rate for Payer: Scott and White Medicare |
$10,355.48
|
| Rate for Payer: Superior Health Plan EPO |
$10,355.48
|
| Rate for Payer: Superior Health Plan Medicare |
$10,355.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,355.48
|
| Rate for Payer: Universal American Medicare |
$10,355.48
|
| Rate for Payer: Wellcare Medicare |
$10,355.48
|
| Rate for Payer: Wellmed Medicare |
$10,355.48
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$33,240.50
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$33,240.50 |
| Rate for Payer: Aetna Commercial |
$19,681.88
|
| Rate for Payer: Aetna Medicare |
$23,008.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,339.32
|
| Rate for Payer: Amerigroup Medicare |
$15,339.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,043.98
|
| Rate for Payer: BCBS of TX Medicare |
$15,339.32
|
| Rate for Payer: BCBS of TX PPO |
$17,827.34
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$15,339.32
|
| Rate for Payer: Employer Direct Commercial |
$15,339.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,339.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,339.32
|
| Rate for Payer: Molina Medicare |
$15,339.32
|
| Rate for Payer: Multiplan Auto |
$33,240.50
|
| Rate for Payer: Multiplan Commercial |
$33,240.50
|
| Rate for Payer: Multiplan Workers Comp |
$33,240.50
|
| Rate for Payer: Scott and White EPO/PPO |
$15,308.12
|
| Rate for Payer: Scott and White Medicare |
$15,339.32
|
| Rate for Payer: Superior Health Plan EPO |
$15,339.32
|
| Rate for Payer: Superior Health Plan Medicare |
$15,339.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,339.32
|
| Rate for Payer: Universal American Medicare |
$15,339.32
|
| Rate for Payer: Wellcare Medicare |
$15,339.32
|
| Rate for Payer: Wellmed Medicare |
$15,339.32
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$16,245.00
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$16,245.00 |
| Rate for Payer: Aetna Commercial |
$9,618.75
|
| Rate for Payer: Aetna Medicare |
$13,434.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,956.11
|
| Rate for Payer: Amerigroup Medicare |
$8,956.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,294.32
|
| Rate for Payer: BCBS of TX Medicare |
$8,956.11
|
| Rate for Payer: BCBS of TX PPO |
$10,327.43
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$8,956.11
|
| Rate for Payer: Employer Direct Commercial |
$8,956.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,956.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,956.11
|
| Rate for Payer: Molina Medicare |
$8,956.11
|
| Rate for Payer: Multiplan Auto |
$16,245.00
|
| Rate for Payer: Multiplan Commercial |
$16,245.00
|
| Rate for Payer: Multiplan Workers Comp |
$16,245.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,481.25
|
| Rate for Payer: Scott and White Medicare |
$8,956.11
|
| Rate for Payer: Superior Health Plan EPO |
$8,956.11
|
| Rate for Payer: Superior Health Plan Medicare |
$8,956.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,956.11
|
| Rate for Payer: Universal American Medicare |
$8,956.11
|
| Rate for Payer: Wellcare Medicare |
$8,956.11
|
| Rate for Payer: Wellmed Medicare |
$8,956.11
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$19,457.90
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$19,457.90 |
| Rate for Payer: Aetna Commercial |
$11,521.12
|
| Rate for Payer: Aetna Medicare |
$15,244.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,162.83
|
| Rate for Payer: Amerigroup Medicare |
$10,162.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,372.57
|
| Rate for Payer: BCBS of TX Medicare |
$10,162.83
|
| Rate for Payer: BCBS of TX PPO |
$12,636.68
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$10,162.83
|
| Rate for Payer: Employer Direct Commercial |
$10,162.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,162.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,162.83
|
| Rate for Payer: Molina Medicare |
$10,162.83
|
| Rate for Payer: Multiplan Auto |
$19,457.90
|
| Rate for Payer: Multiplan Commercial |
$19,457.90
|
| Rate for Payer: Multiplan Workers Comp |
$19,457.90
|
| Rate for Payer: Scott and White EPO/PPO |
$8,960.88
|
| Rate for Payer: Scott and White Medicare |
$10,162.83
|
| Rate for Payer: Superior Health Plan EPO |
$10,162.83
|
| Rate for Payer: Superior Health Plan Medicare |
$10,162.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,162.83
|
| Rate for Payer: Universal American Medicare |
$10,162.83
|
| Rate for Payer: Wellcare Medicare |
$10,162.83
|
| Rate for Payer: Wellmed Medicare |
$10,162.83
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$33,664.20
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$33,664.20 |
| Rate for Payer: Aetna Commercial |
$19,932.75
|
| Rate for Payer: Aetna Medicare |
$23,247.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,498.45
|
| Rate for Payer: Amerigroup Medicare |
$15,498.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,011.81
|
| Rate for Payer: BCBS of TX Medicare |
$15,498.45
|
| Rate for Payer: BCBS of TX PPO |
$20,013.90
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$15,498.45
|
| Rate for Payer: Employer Direct Commercial |
$15,498.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,498.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,498.45
|
| Rate for Payer: Molina Medicare |
$15,498.45
|
| Rate for Payer: Multiplan Auto |
$33,664.20
|
| Rate for Payer: Multiplan Commercial |
$33,664.20
|
| Rate for Payer: Multiplan Workers Comp |
$33,664.20
|
| Rate for Payer: Scott and White EPO/PPO |
$15,503.25
|
| Rate for Payer: Scott and White Medicare |
$15,498.45
|
| Rate for Payer: Superior Health Plan EPO |
$15,498.45
|
| Rate for Payer: Superior Health Plan Medicare |
$15,498.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,498.45
|
| Rate for Payer: Universal American Medicare |
$15,498.45
|
| Rate for Payer: Wellcare Medicare |
$15,498.45
|
| Rate for Payer: Wellmed Medicare |
$15,498.45
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$16,459.70
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$6,879.00 |
| Max. Negotiated Rate |
$16,459.70 |
| Rate for Payer: Aetna Commercial |
$9,745.88
|
| Rate for Payer: Aetna Medicare |
$13,555.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,036.75
|
| Rate for Payer: Amerigroup Medicare |
$9,036.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,724.71
|
| Rate for Payer: BCBS of TX Medicare |
$9,036.75
|
| Rate for Payer: BCBS of TX PPO |
$9,694.50
|
| Rate for Payer: Cigna Commercial |
$6,879.00
|
| Rate for Payer: Cigna Medicare |
$9,036.75
|
| Rate for Payer: Employer Direct Commercial |
$9,036.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,036.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,036.75
|
| Rate for Payer: Molina Medicare |
$9,036.75
|
| Rate for Payer: Multiplan Auto |
$16,459.70
|
| Rate for Payer: Multiplan Commercial |
$16,459.70
|
| Rate for Payer: Multiplan Workers Comp |
$16,459.70
|
| Rate for Payer: Scott and White EPO/PPO |
$7,580.12
|
| Rate for Payer: Scott and White Medicare |
$9,036.75
|
| Rate for Payer: Superior Health Plan EPO |
$9,036.75
|
| Rate for Payer: Superior Health Plan Medicare |
$9,036.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,036.75
|
| Rate for Payer: Universal American Medicare |
$9,036.75
|
| Rate for Payer: Wellcare Medicare |
$9,036.75
|
| Rate for Payer: Wellmed Medicare |
$9,036.75
|
|
|
.Change IG Pap to LB Pap 192555 SO
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
8662512
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$137.28
|
|
|
.Change IG Pap to LB Pap 192555 SO
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
8662512
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$30.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.26
|
| Rate for Payer: Amerigroup Medicare |
$20.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40.11
|
| Rate for Payer: BCBS of TX Medicare |
$20.26
|
| Rate for Payer: BCBS of TX PPO |
$44.77
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cash Price |
$137.28
|
| Rate for Payer: Cigna Medicaid |
$20.26
|
| Rate for Payer: Cigna Medicare |
$20.26
|
| Rate for Payer: Employer Direct Commercial |
$20.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.26
|
| Rate for Payer: Molina Medicare |
$20.26
|
| Rate for Payer: Multiplan Auto |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$101.40
|
| Rate for Payer: Multiplan Workers Comp |
$101.40
|
| Rate for Payer: Parkland Medicaid |
$20.26
|
| Rate for Payer: Scott and White EPO/PPO |
$25.32
|
| Rate for Payer: Scott and White Medicare |
$20.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.26
|
| Rate for Payer: Superior Health Plan EPO |
$20.26
|
| Rate for Payer: Superior Health Plan Medicare |
$20.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.26
|
| Rate for Payer: Universal American Medicare |
$20.26
|
| Rate for Payer: Wellcare Medicare |
$20.26
|
| Rate for Payer: Wellmed Medicare |
$20.26
|
|
|
CHANGE PERC DRAIN CATH
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
4615985
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$717.20
|
|
|
CHANGE PERC DRAIN CATH
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
4615985
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$529.75 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.57
|
| Rate for Payer: BCBS of TX PPO |
$151.32
|
| Rate for Payer: Cash Price |
$717.20
|
| Rate for Payer: Cash Price |
$717.20
|
| Rate for Payer: Multiplan Auto |
$529.75
|
| Rate for Payer: Multiplan Commercial |
$529.75
|
| Rate for Payer: Multiplan Workers Comp |
$529.75
|
| Rate for Payer: Scott and White EPO/PPO |
$407.50
|
| Rate for Payer: Superior Health Plan EPO |
$110.84
|
|
|
charcoal 25 g Oral Susp 120 mL
|
Facility
|
OP
|
$28.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77453072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$18.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.28
|
| Rate for Payer: BCBS of TX PPO |
$11.42
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Multiplan Auto |
$18.56
|
| Rate for Payer: Multiplan Commercial |
$18.56
|
| Rate for Payer: Multiplan Workers Comp |
$18.56
|
| Rate for Payer: Scott and White EPO/PPO |
$14.28
|
| Rate for Payer: Superior Health Plan EPO |
$3.88
|
|
|
charcoal 25 g Oral Susp 120 mL
|
Facility
|
IP
|
$28.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77453072
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$19.41
|
|
|
CHED 96360 - Hydration, first hour BCE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
8928542
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$67.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$80.20
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$89.46
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| Rate for Payer: Multiplan Auto |
$550.55
|
| Rate for Payer: Multiplan Commercial |
$550.55
|
| Rate for Payer: Multiplan Workers Comp |
$550.55
|
| Rate for Payer: Scott and White EPO/PPO |
$3.51
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
CHED 96360 - Hydration, first hour BCE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
8928542
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$745.36
|
|
|
CHED 96361- Hydration, each additional hour BCE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
8932542
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$220.88
|
|
|
CHED 96361- Hydration, each additional hour BCE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
8932542
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$138.05
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28.48
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$31.76
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cigna Commercial |
$98.40
|
| Rate for Payer: Cigna Medicare |
$43.44
|
| Rate for Payer: Employer Direct Commercial |
$43.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Molina Medicare |
$43.44
|
| Rate for Payer: Multiplan Auto |
$163.15
|
| Rate for Payer: Multiplan Commercial |
$163.15
|
| Rate for Payer: Multiplan Workers Comp |
$163.15
|
| Rate for Payer: Scott and White EPO/PPO |
$0.78
|
| Rate for Payer: Scott and White Medicare |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$43.44
|
| Rate for Payer: Superior Health Plan Medicare |
$43.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Universal American Medicare |
$43.44
|
| Rate for Payer: Wellcare Medicare |
$43.44
|
| Rate for Payer: Wellmed Medicare |
$43.44
|
|
|
CHED 96365- IV tx, first hour BCE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8928543
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$444.05 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$126.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$151.42
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$168.90
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| Rate for Payer: Multiplan Auto |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Multiplan Workers Comp |
$195.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3.51
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
CHED 96365- IV tx, first hour BCE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8928543
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$264.00
|
|
