|
CORO GRAFT REVAS D-ELU STENT 1 ART
|
Facility
|
IP
|
$15,984.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
2350064
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$14,065.92
|
|
|
CORO GRAFT REVAS D-ELU STENT 1 ART
|
Facility
|
OP
|
$15,984.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
2350064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,438.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$14,065.92
|
| Rate for Payer: Cash Price |
$14,065.92
|
| Rate for Payer: Cash Price |
$14,065.92
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| Rate for Payer: Multiplan Auto |
$10,389.60
|
| Rate for Payer: Multiplan Commercial |
$10,389.60
|
| Rate for Payer: Multiplan Workers Comp |
$10,389.60
|
| Rate for Payer: Scott and White EPO/PPO |
$179.93
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$148,192.40
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$58,513.20 |
| Max. Negotiated Rate |
$148,192.40 |
| Rate for Payer: Aetna Commercial |
$87,745.50
|
| Rate for Payer: Aetna Medicare |
$87,769.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$58,513.20
|
| Rate for Payer: Amerigroup Medicare |
$58,513.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$64,393.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$78,813.43
|
| Rate for Payer: BCBS of TX Medicare |
$58,513.20
|
| Rate for Payer: BCBS of TX PPO |
$87,573.87
|
| Rate for Payer: Cigna Commercial |
$100,458.85
|
| Rate for Payer: Cigna Medicare |
$58,513.20
|
| Rate for Payer: Employer Direct Commercial |
$58,513.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$58,513.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$58,513.20
|
| Rate for Payer: Molina Medicare |
$58,513.20
|
| Rate for Payer: Multiplan Auto |
$148,192.40
|
| Rate for Payer: Multiplan Commercial |
$148,192.40
|
| Rate for Payer: Multiplan Workers Comp |
$148,192.40
|
| Rate for Payer: Scott and White EPO/PPO |
$68,246.50
|
| Rate for Payer: Scott and White Medicare |
$58,513.20
|
| Rate for Payer: Superior Health Plan EPO |
$58,513.20
|
| Rate for Payer: Superior Health Plan Medicare |
$58,513.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$58,513.20
|
| Rate for Payer: Universal American Medicare |
$58,513.20
|
| Rate for Payer: Wellcare Medicare |
$58,513.20
|
| Rate for Payer: Wellmed Medicare |
$58,513.20
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$98,760.10
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$39,947.31 |
| Max. Negotiated Rate |
$98,760.10 |
| Rate for Payer: Aetna Commercial |
$58,476.38
|
| Rate for Payer: Aetna Medicare |
$59,920.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$39,947.31
|
| Rate for Payer: Amerigroup Medicare |
$39,947.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42,589.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53,113.96
|
| Rate for Payer: BCBS of TX Medicare |
$39,947.31
|
| Rate for Payer: BCBS of TX PPO |
$59,017.80
|
| Rate for Payer: Cigna Commercial |
$66,948.95
|
| Rate for Payer: Cigna Medicare |
$39,947.31
|
| Rate for Payer: Employer Direct Commercial |
$39,947.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$39,947.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$39,947.31
|
| Rate for Payer: Molina Medicare |
$39,947.31
|
| Rate for Payer: Multiplan Auto |
$98,760.10
|
| Rate for Payer: Multiplan Commercial |
$98,760.10
|
| Rate for Payer: Multiplan Workers Comp |
$98,760.10
|
| Rate for Payer: Scott and White EPO/PPO |
$45,481.62
|
| Rate for Payer: Scott and White Medicare |
$39,947.31
|
| Rate for Payer: Superior Health Plan EPO |
$39,947.31
|
| Rate for Payer: Superior Health Plan Medicare |
$39,947.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$39,947.31
|
| Rate for Payer: Universal American Medicare |
$39,947.31
|
| Rate for Payer: Wellcare Medicare |
$39,947.31
|
| Rate for Payer: Wellmed Medicare |
$39,947.31
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$111,731.40
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$44,819.10 |
| Max. Negotiated Rate |
$111,731.40 |
| Rate for Payer: Aetna Commercial |
$66,156.75
|
| Rate for Payer: Aetna Medicare |
$67,228.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$44,819.10
|
| Rate for Payer: Amerigroup Medicare |
$44,819.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49,573.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59,952.36
|
| Rate for Payer: BCBS of TX Medicare |
$44,819.10
|
| Rate for Payer: BCBS of TX PPO |
$66,616.31
|
| Rate for Payer: Cigna Commercial |
$75,742.13
|
| Rate for Payer: Cigna Medicare |
$44,819.10
|
| Rate for Payer: Employer Direct Commercial |
$44,819.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$44,819.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$44,819.10
|
| Rate for Payer: Molina Medicare |
$44,819.10
|
| Rate for Payer: Multiplan Auto |
$111,731.40
|
| Rate for Payer: Multiplan Commercial |
$111,731.40
|
| Rate for Payer: Multiplan Workers Comp |
$111,731.40
|
| Rate for Payer: Scott and White EPO/PPO |
$51,455.25
|
| Rate for Payer: Scott and White Medicare |
$44,819.10
|
| Rate for Payer: Superior Health Plan EPO |
$44,819.10
|
| Rate for Payer: Superior Health Plan Medicare |
$44,819.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$44,819.10
|
| Rate for Payer: Universal American Medicare |
$44,819.10
|
| Rate for Payer: Wellcare Medicare |
$44,819.10
|
| Rate for Payer: Wellmed Medicare |
$44,819.10
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$76,782.80
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$31,693.04 |
| Max. Negotiated Rate |
$76,782.80 |
| Rate for Payer: Aetna Commercial |
$45,463.50
|
| Rate for Payer: Aetna Medicare |
$47,539.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,693.04
|
| Rate for Payer: Amerigroup Medicare |
$31,693.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33,127.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40,515.49
|
| Rate for Payer: BCBS of TX Medicare |
$31,693.04
|
| Rate for Payer: BCBS of TX PPO |
$45,018.96
|
| Rate for Payer: Cigna Commercial |
$52,050.66
|
| Rate for Payer: Cigna Medicare |
$31,693.04
|
| Rate for Payer: Employer Direct Commercial |
$31,693.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,693.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,693.04
|
| Rate for Payer: Molina Medicare |
$31,693.04
|
| Rate for Payer: Multiplan Auto |
$76,782.80
|
| Rate for Payer: Multiplan Commercial |
$76,782.80
|
| Rate for Payer: Multiplan Workers Comp |
$76,782.80
|
| Rate for Payer: Scott and White EPO/PPO |
$35,360.50
|
| Rate for Payer: Scott and White Medicare |
$31,693.04
|
| Rate for Payer: Superior Health Plan EPO |
$31,693.04
|
| Rate for Payer: Superior Health Plan Medicare |
$31,693.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,693.04
|
| Rate for Payer: Universal American Medicare |
$31,693.04
|
| Rate for Payer: Wellcare Medicare |
$31,693.04
|
| Rate for Payer: Wellmed Medicare |
$31,693.04
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$154,188.80
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$60,765.34 |
| Max. Negotiated Rate |
$154,188.80 |
| Rate for Payer: Aetna Commercial |
$91,296.00
|
| Rate for Payer: Aetna Medicare |
$91,148.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$60,765.34
|
| Rate for Payer: Amerigroup Medicare |
$60,765.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69,369.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86,668.25
|
| Rate for Payer: BCBS of TX Medicare |
$60,765.34
|
| Rate for Payer: BCBS of TX PPO |
$96,301.79
|
| Rate for Payer: Cigna Commercial |
$104,523.78
|
| Rate for Payer: Cigna Medicare |
$60,765.34
|
| Rate for Payer: Employer Direct Commercial |
$60,765.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$60,765.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$60,765.34
|
| Rate for Payer: Molina Medicare |
$60,765.34
|
| Rate for Payer: Multiplan Auto |
$154,188.80
|
| Rate for Payer: Multiplan Commercial |
$154,188.80
|
| Rate for Payer: Multiplan Workers Comp |
$154,188.80
|
| Rate for Payer: Scott and White EPO/PPO |
$71,008.00
|
| Rate for Payer: Scott and White Medicare |
$60,765.34
|
| Rate for Payer: Superior Health Plan EPO |
$60,765.34
|
| Rate for Payer: Superior Health Plan Medicare |
$60,765.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$60,765.34
|
| Rate for Payer: Universal American Medicare |
$60,765.34
|
| Rate for Payer: Wellcare Medicare |
$60,765.34
|
| Rate for Payer: Wellmed Medicare |
$60,765.34
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$113,023.40
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$45,304.35 |
| Max. Negotiated Rate |
$113,023.40 |
| Rate for Payer: Aetna Commercial |
$66,921.75
|
| Rate for Payer: Aetna Medicare |
$67,956.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$45,304.35
|
| Rate for Payer: Amerigroup Medicare |
$45,304.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50,631.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63,569.17
|
| Rate for Payer: BCBS of TX Medicare |
$45,304.35
|
| Rate for Payer: BCBS of TX PPO |
$70,635.15
|
| Rate for Payer: Cigna Commercial |
$76,617.97
|
| Rate for Payer: Cigna Medicare |
$45,304.35
|
| Rate for Payer: Employer Direct Commercial |
$45,304.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$45,304.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$45,304.35
|
| Rate for Payer: Molina Medicare |
$45,304.35
|
| Rate for Payer: Multiplan Auto |
$113,023.40
|
| Rate for Payer: Multiplan Commercial |
$113,023.40
|
| Rate for Payer: Multiplan Workers Comp |
$113,023.40
|
| Rate for Payer: Scott and White EPO/PPO |
$52,050.25
|
| Rate for Payer: Scott and White Medicare |
$45,304.35
|
| Rate for Payer: Superior Health Plan EPO |
$45,304.35
|
| Rate for Payer: Superior Health Plan Medicare |
$45,304.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$45,304.35
|
| Rate for Payer: Universal American Medicare |
$45,304.35
|
| Rate for Payer: Wellcare Medicare |
$45,304.35
|
| Rate for Payer: Wellmed Medicare |
$45,304.35
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$78,660.00
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$32,398.07 |
| Max. Negotiated Rate |
$78,660.00 |
| Rate for Payer: Aetna Commercial |
$46,575.00
|
| Rate for Payer: Aetna Medicare |
$48,597.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$32,398.07
|
| Rate for Payer: Amerigroup Medicare |
$32,398.07
|
| Rate for Payer: BCBS of TX Medicare |
$32,398.07
|
| Rate for Payer: Cigna Commercial |
$53,323.20
|
| Rate for Payer: Cigna Medicare |
$32,398.07
|
| Rate for Payer: Employer Direct Commercial |
$32,398.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$32,398.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$32,398.07
|
| Rate for Payer: Molina Medicare |
$32,398.07
|
| Rate for Payer: Multiplan Auto |
$78,660.00
|
| Rate for Payer: Multiplan Commercial |
$78,660.00
|
| Rate for Payer: Multiplan Workers Comp |
$78,660.00
|
| Rate for Payer: Scott and White EPO/PPO |
$36,225.00
|
| Rate for Payer: Scott and White Medicare |
$32,398.07
|
| Rate for Payer: Superior Health Plan EPO |
$32,398.07
|
| Rate for Payer: Superior Health Plan Medicare |
$32,398.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$32,398.07
|
| Rate for Payer: Universal American Medicare |
$32,398.07
|
| Rate for Payer: Wellcare Medicare |
$32,398.07
|
| Rate for Payer: Wellmed Medicare |
$32,398.07
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$56,403.40
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$24,038.89 |
| Max. Negotiated Rate |
$56,403.40 |
| Rate for Payer: Aetna Commercial |
$33,396.75
|
| Rate for Payer: Aetna Medicare |
$36,058.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,038.89
|
| Rate for Payer: Amerigroup Medicare |
$24,038.89
|
| Rate for Payer: BCBS of TX Medicare |
$24,038.89
|
| Rate for Payer: Cigna Commercial |
$38,235.57
|
| Rate for Payer: Cigna Medicare |
$24,038.89
|
| Rate for Payer: Employer Direct Commercial |
$24,038.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,038.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,038.89
|
| Rate for Payer: Molina Medicare |
$24,038.89
|
| Rate for Payer: Multiplan Auto |
$56,403.40
|
| Rate for Payer: Multiplan Commercial |
$56,403.40
|
| Rate for Payer: Multiplan Workers Comp |
$56,403.40
|
| Rate for Payer: Scott and White EPO/PPO |
$25,975.25
|
| Rate for Payer: Scott and White Medicare |
$24,038.89
|
| Rate for Payer: Superior Health Plan EPO |
$24,038.89
|
| Rate for Payer: Superior Health Plan Medicare |
$24,038.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,038.89
|
| Rate for Payer: Universal American Medicare |
$24,038.89
|
| Rate for Payer: Wellcare Medicare |
$24,038.89
|
| Rate for Payer: Wellmed Medicare |
$24,038.89
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$50,241.70
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$21,724.68 |
| Max. Negotiated Rate |
$50,241.70 |
| Rate for Payer: Aetna Commercial |
$29,748.38
|
| Rate for Payer: Aetna Medicare |
$32,587.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,724.68
|
| Rate for Payer: Amerigroup Medicare |
$21,724.68
|
| Rate for Payer: BCBS of TX Medicare |
$21,724.68
|
| Rate for Payer: Cigna Commercial |
$34,058.58
|
| Rate for Payer: Cigna Medicare |
$21,724.68
|
| Rate for Payer: Employer Direct Commercial |
$21,724.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,724.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,724.68
|
| Rate for Payer: Molina Medicare |
$21,724.68
|
| Rate for Payer: Multiplan Auto |
$50,241.70
|
| Rate for Payer: Multiplan Commercial |
$50,241.70
|
| Rate for Payer: Multiplan Workers Comp |
$50,241.70
|
| Rate for Payer: Scott and White EPO/PPO |
$23,137.62
|
| Rate for Payer: Scott and White Medicare |
$21,724.68
|
| Rate for Payer: Superior Health Plan EPO |
$21,724.68
|
| Rate for Payer: Superior Health Plan Medicare |
$21,724.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,724.68
|
| Rate for Payer: Universal American Medicare |
$21,724.68
|
| Rate for Payer: Wellcare Medicare |
$21,724.68
|
| Rate for Payer: Wellmed Medicare |
$21,724.68
|
|
|
CORO REVAS D-E STENT/ACUT MI 1 ART
|
Facility
|
IP
|
$22,708.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
2350066
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$19,983.04
|
|
|
CORO REVAS D-E STENT/ACUT MI 1 ART
|
Facility
|
OP
|
$22,708.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
2350066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,805.34 |
| Max. Negotiated Rate |
$14,760.20 |
| Rate for Payer: Aetna Commercial |
$4,017.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,043.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,805.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,162.08
|
| Rate for Payer: BCBS of TX PPO |
$2,724.22
|
| Rate for Payer: Cash Price |
$19,983.04
|
| Rate for Payer: Cash Price |
$19,983.04
|
| Rate for Payer: Cash Price |
$19,983.04
|
| Rate for Payer: Multiplan Auto |
$14,760.20
|
| Rate for Payer: Multiplan Commercial |
$14,760.20
|
| Rate for Payer: Multiplan Workers Comp |
$14,760.20
|
| Rate for Payer: Scott and White EPO/PPO |
$11,354.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,088.29
|
|
|
CORO STENT W ANGIOPLASTY 1ST ART
|
Facility
|
OP
|
$14,349.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
2350034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,291.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$12,627.12
|
| Rate for Payer: Cash Price |
$12,627.12
|
| Rate for Payer: Cash Price |
$12,627.12
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| Rate for Payer: Multiplan Auto |
$9,326.85
|
| Rate for Payer: Multiplan Commercial |
$9,326.85
|
| Rate for Payer: Multiplan Workers Comp |
$9,326.85
|
| Rate for Payer: Scott and White EPO/PPO |
$179.93
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
CORO STENT W ANGIOPLASTY 1ST ART
|
Facility
|
IP
|
$14,349.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
2350034
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$12,627.12
|
|
|
CORO STENT W ANGIOPLASTY EA AD ART
|
Facility
|
OP
|
$8,615.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
2350035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$775.35 |
| Max. Negotiated Rate |
$7,210.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$775.35
|
| Rate for Payer: Cash Price |
$7,581.20
|
| Rate for Payer: Cash Price |
$7,581.20
|
| Rate for Payer: Multiplan Auto |
$5,599.75
|
| Rate for Payer: Multiplan Commercial |
$5,599.75
|
| Rate for Payer: Multiplan Workers Comp |
$5,599.75
|
| Rate for Payer: Scott and White EPO/PPO |
$4,307.50
|
| Rate for Payer: Superior Health Plan EPO |
$1,171.64
|
|
|
CORO STENT W ANGIOPLASTY EA AD ART
|
Facility
|
IP
|
$8,615.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
2350035
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$7,581.20
|
|
|
Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed with distal metatarsa
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
36028296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed with double osteotomy
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 28299
|
| Hospital Charge Code |
36028299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,132.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,132.58
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,132.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$3,132.58
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,132.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed with first metatarsal
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
36028297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,508.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,508.38
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,508.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$3,508.38
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,508.38
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed with proximal phalanx
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 28298
|
| Hospital Charge Code |
36028298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,103.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,103.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,103.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$3,103.16
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,103.16
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed with resection of pro
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
36028292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
36028285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Correction of inverted nipples
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19355
|
| Hospital Charge Code |
36019355
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| 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 |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$76.89
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
COR THROMBLYS-INTRA COR
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
4612975
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$3,614.16
|
|
