|
CANNULA OXIMIZER PENDANT STERILE DISPOSABLE
|
Facility
|
OP
|
$100.08
|
|
| Hospital Charge Code |
993516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$72.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36.03
|
| Rate for Payer: BCBS of TX PPO |
$40.03
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cigna Medicaid |
$72.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$72.06
|
| Rate for Payer: Multiplan Auto |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$65.05
|
| Rate for Payer: Multiplan Workers Comp |
$65.05
|
| Rate for Payer: Parkland Medicaid |
$72.06
|
| Rate for Payer: Scott and White EPO/PPO |
$50.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$72.06
|
| Rate for Payer: Superior Health Plan EPO |
$13.61
|
|
|
CANNULA OXIMIZER PENDANT STERILE DISPOSABLE
|
Facility
|
IP
|
$100.08
|
|
| Hospital Charge Code |
993516
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$68.05
|
|
|
cannula reducer endowrist 12-8mm
|
Facility
|
IP
|
$113.50
|
|
| Hospital Charge Code |
8690516
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$77.18
|
|
|
cannula reducer endowrist 12-8mm
|
Facility
|
OP
|
$113.50
|
|
| Hospital Charge Code |
8690516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$81.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40.86
|
| Rate for Payer: BCBS of TX PPO |
$45.40
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Cigna Medicaid |
$81.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$81.72
|
| Rate for Payer: Multiplan Auto |
$73.78
|
| Rate for Payer: Multiplan Commercial |
$73.78
|
| Rate for Payer: Multiplan Workers Comp |
$73.78
|
| Rate for Payer: Parkland Medicaid |
$81.72
|
| Rate for Payer: Scott and White EPO/PPO |
$56.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$81.72
|
| Rate for Payer: Superior Health Plan EPO |
$15.44
|
|
|
CANNULA, SEAL 8MM FOR DAVINCI SURGICAL SYSTEM -- DHF
|
Facility
|
OP
|
$939.78
|
|
| Hospital Charge Code |
81813875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.58 |
| Max. Negotiated Rate |
$676.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$281.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$338.32
|
| Rate for Payer: BCBS of TX PPO |
$375.91
|
| Rate for Payer: Cash Price |
$639.05
|
| Rate for Payer: Cigna Medicaid |
$676.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$676.64
|
| Rate for Payer: Multiplan Auto |
$610.86
|
| Rate for Payer: Multiplan Commercial |
$610.86
|
| Rate for Payer: Multiplan Workers Comp |
$610.86
|
| Rate for Payer: Parkland Medicaid |
$676.64
|
| Rate for Payer: Scott and White EPO/PPO |
$469.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$676.64
|
| Rate for Payer: Superior Health Plan EPO |
$127.81
|
|
|
CANNULA, SEAL 8MM FOR DAVINCI SURGICAL SYSTEM -- DHF
|
Facility
|
IP
|
$939.78
|
|
| Hospital Charge Code |
81813875
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$639.05
|
|
|
CANNULA TIBIAL TUNNEL
|
Facility
|
OP
|
$145.28
|
|
| Hospital Charge Code |
116488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$104.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52.30
|
| Rate for Payer: BCBS of TX PPO |
$58.11
|
| Rate for Payer: Cash Price |
$98.79
|
| Rate for Payer: Cigna Medicaid |
$104.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$104.60
|
| Rate for Payer: Multiplan Auto |
$94.43
|
| Rate for Payer: Multiplan Commercial |
$94.43
|
| Rate for Payer: Multiplan Workers Comp |
$94.43
|
| Rate for Payer: Parkland Medicaid |
$104.60
|
| Rate for Payer: Scott and White EPO/PPO |
$72.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$104.60
|
| Rate for Payer: Superior Health Plan EPO |
$19.76
|
|
|
CANNULA TIBIAL TUNNEL
|
Facility
|
IP
|
$145.28
|
|
| Hospital Charge Code |
116488
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$98.79
|
|
|
CAP, BOUFFANT, 24', BLUE, POLY
|
Facility
|
IP
|
$0.23
|
|
| Hospital Charge Code |
992966
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$0.16
|
|
|
CAP, BOUFFANT, 24', BLUE, POLY
|
Facility
|
OP
|
$0.23
|
|
| Hospital Charge Code |
992966
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.08
|
| Rate for Payer: BCBS of TX PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna Medicaid |
$0.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$0.17
|
| Rate for Payer: Multiplan Auto |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Workers Comp |
$0.15
|
| Rate for Payer: Parkland Medicaid |
$0.17
|
| Rate for Payer: Scott and White EPO/PPO |
$0.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$0.17
|
| Rate for Payer: Superior Health Plan EPO |
$0.03
|
|
|
Capsulectomy or capsulotomy; interphalangeal joint, each joint
|
Facility
|
OP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
9900349
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,511.22
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,511.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,511.22
|
| Rate for Payer: Scott and White EPO/PPO |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,511.22
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Capsulectomy or capsulotomy; interphalangeal joint, each joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26525
|
| Hospital Charge Code |
36026525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Capsulectomy or capsulotomy; interphalangeal joint, each joint
|
Facility
|
IP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
9900349
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,260.59
|
|
|
Capsulectomy or capsulotomy metacarpophalangeal joint, each joint
|
Facility
|
IP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26520
|
| Hospital Charge Code |
9900348
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,292.85
|
|
|
Capsulectomy or capsulotomy metacarpophalangeal joint, each joint
|
Facility
|
OP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26520
|
| Hospital Charge Code |
9900348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,604.19
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$5,604.19
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Capsulectomy or capsulotomy metacarpophalangeal joint, each joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26520
|
| Hospital Charge Code |
36026520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block
|
Facility
|
OP
|
$21,296.77
|
|
|
Service Code
|
HCPCS 23465
|
| Hospital Charge Code |
9900225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$14,481.80
|
| Rate for Payer: Cash Price |
$14,481.80
|
| Rate for Payer: Cash Price |
$14,481.80
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$15,333.67
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,333.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$15,333.67
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,333.67
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
36023465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block
|
Facility
|
IP
|
$21,296.77
|
|
|
Service Code
|
HCPCS 23465
|
| Hospital Charge Code |
9900225
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,481.80
|
|
|
Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or
|
Facility
|
OP
|
$13,200.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
9900288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$9,504.00
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,504.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$9,504.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,504.00
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 25320
|
| Hospital Charge Code |
36025320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or
|
Facility
|
IP
|
$13,200.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
9900288
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,976.00
|
|
|
Capsulotomy metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
36028270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Capsulotomy metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
|
Facility
|
IP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
9900496
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,811.68
|
|
|
Capsulotomy metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
|
Facility
|
OP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
9900496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,094.72
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,094.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$5,094.72
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,094.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
