Ascension Seton Edgar B Davis
130 Hays Street
Luling, TX 78648
Critical Access Hospitals
Overview
- CCN451371
Procedures & prices
- METOCLOPRAMIDE HCL INJECTIONJ2765$11cashGross $300 payers
- ACYCLOVIR INJECTIONJ0133$11cashGross $300 payers
- TIROFIBAN HCLJ3246$11cashGross $300 payers
- Inj theophylline per 40 mgJ2810$11cashGross $310 payers
- OCTREOTIDE INJ, NON-DEPOTJ2354$11cashGross $310 payers
- HC PHOSPHATASE ALKALINE84075$11cashGross $320 payers
- HC TRANSFERASE (AST) (SGOT)84450$11cashGross $320 payers
- HC MICROSCOPIC EXAM OF URINE81015$11cashGross $320 payers
- HC ALANINE AMINO (ALT) (SGPT)84460$11cashGross $320 payers
- MEPERIDINE HYDROCHL /100 MGJ2175$12cashGross $320 payers
| Procedure | Code | Cash↑ | Gross | Negotiated range | Payers |
|---|---|---|---|---|---|
| METOCLOPRAMIDE HCL INJECTION | J2765 | $11 | $30 | — | 0 |
| ACYCLOVIR INJECTION | J0133 | $11 | $30 | — | 0 |
| TIROFIBAN HCL | J3246 | $11 | $30 | — | 0 |
| Inj theophylline per 40 mg | J2810 | $11 | $31 | — | 0 |
| OCTREOTIDE INJ, NON-DEPOT | J2354 | $11 | $31 | — | 0 |
| HC PHOSPHATASE ALKALINE | 84075 | $11 | $32 | — | 0 |
| HC TRANSFERASE (AST) (SGOT) | 84450 | $11 | $32 | — | 0 |
| HC MICROSCOPIC EXAM OF URINE | 81015 | $11 | $32 | — | 0 |
| HC ALANINE AMINO (ALT) (SGPT) | 84460 | $11 | $32 | — | 0 |
| MEPERIDINE HYDROCHL /100 MG | J2175 | $12 | $32 | — | 0 |
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