|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$19,682.10
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$9,064.12 |
| Max. Negotiated Rate |
$19,682.10 |
| Rate for Payer: Aetna Commercial |
$11,653.88
|
| Rate for Payer: Aetna Medicare |
$15,370.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,247.02
|
| Rate for Payer: Amerigroup Medicare |
$10,247.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,109.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,035.14
|
| Rate for Payer: BCBS of TX Medicare |
$10,247.02
|
| Rate for Payer: BCBS of TX PPO |
$12,261.74
|
| Rate for Payer: Cigna Commercial |
$13,342.39
|
| Rate for Payer: Cigna Medicare |
$10,247.02
|
| Rate for Payer: Employer Direct Commercial |
$10,247.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,247.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,247.02
|
| Rate for Payer: Molina Medicare |
$10,247.02
|
| Rate for Payer: Multiplan Auto |
$19,682.10
|
| Rate for Payer: Multiplan Commercial |
$19,682.10
|
| Rate for Payer: Multiplan Workers Comp |
$19,682.10
|
| Rate for Payer: Scott and White EPO/PPO |
$9,064.12
|
| Rate for Payer: Scott and White Medicare |
$10,247.02
|
| Rate for Payer: Superior Health Plan EPO |
$10,247.02
|
| Rate for Payer: Superior Health Plan Medicare |
$10,247.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,247.02
|
| Rate for Payer: Universal American Medicare |
$10,247.02
|
| Rate for Payer: Wellcare Medicare |
$10,247.02
|
| Rate for Payer: Wellmed Medicare |
$10,247.02
|
|
|
D-Dimer
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
1605666
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$395.12
|
|
|
D-Dimer
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
1605666
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare |
$15.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Amerigroup Medicare |
$10.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.16
|
| Rate for Payer: BCBS of TX Medicare |
$10.18
|
| Rate for Payer: BCBS of TX PPO |
$22.50
|
| Rate for Payer: Cash Price |
$395.12
|
| Rate for Payer: Cash Price |
$395.12
|
| Rate for Payer: Cigna Medicaid |
$10.18
|
| Rate for Payer: Cigna Medicare |
$10.18
|
| Rate for Payer: Employer Direct Commercial |
$10.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Molina Medicare |
$10.18
|
| Rate for Payer: Multiplan Auto |
$291.85
|
| Rate for Payer: Multiplan Commercial |
$291.85
|
| Rate for Payer: Multiplan Workers Comp |
$291.85
|
| Rate for Payer: Parkland Medicaid |
$10.18
|
| Rate for Payer: Scott and White EPO/PPO |
$12.72
|
| Rate for Payer: Scott and White Medicare |
$10.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.18
|
| Rate for Payer: Superior Health Plan EPO |
$10.18
|
| Rate for Payer: Superior Health Plan Medicare |
$10.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Universal American Medicare |
$10.18
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: Wellmed Medicare |
$10.18
|
|
|
Debrid Bone <=20
|
Facility
|
OP
|
$5,698.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
7150188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,703.70 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$512.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$5,014.24
|
| Rate for Payer: Cash Price |
$5,014.24
|
| Rate for Payer: Cash Price |
$5,014.24
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$3,703.70
|
| Rate for Payer: Multiplan Commercial |
$3,703.70
|
| Rate for Payer: Multiplan Workers Comp |
$3,703.70
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Debrid Bone Ad 20 Sqcm
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
7150797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$2,867.80 |
| Rate for Payer: Aetna Commercial |
$2,426.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$397.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$3,882.56
|
| Rate for Payer: Cash Price |
$3,882.56
|
| Rate for Payer: Multiplan Auto |
$2,867.80
|
| Rate for Payer: Multiplan Commercial |
$2,867.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,867.80
|
| Rate for Payer: Scott and White EPO/PPO |
$2,206.00
|
| Rate for Payer: Superior Health Plan EPO |
$600.03
|
|
|
Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if perform
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
36011044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| 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 |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
36011043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| 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 |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
Debridement of extensive eczematous or infected skin up to 10% of body surface
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
36011000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$68.58
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$86.41
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$29.90
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$29.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| 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 |
$29.90
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$29.90
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection a
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
36011005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,017.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,362.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,631.86
|
| Rate for Payer: BCBS of TX PPO |
$2,056.14
|
| 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
|
|
|
Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) first 20 sq cm or le
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
36011042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| 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 |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
Debrid Mus/Fsc Ad 20 Sqcm
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
7150796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$1,316.90 |
| Rate for Payer: Aetna Commercial |
$1,114.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$182.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$1,782.88
|
| Rate for Payer: Cash Price |
$1,782.88
|
| Rate for Payer: Multiplan Auto |
$1,316.90
|
| Rate for Payer: Multiplan Commercial |
$1,316.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,316.90
|
| Rate for Payer: Scott and White EPO/PPO |
$1,013.00
|
| Rate for Payer: Superior Health Plan EPO |
$275.54
|
|
|
Debrid Mus/Fsc Tiss <=20
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,544.40 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$1,544.40
|
| Rate for Payer: Multiplan Commercial |
$1,544.40
|
| Rate for Payer: Multiplan Workers Comp |
$1,544.40
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
Debrid Skin/Sq Tiss <=20
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$850.30
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$1,004.90
|
| Rate for Payer: Multiplan Commercial |
$1,004.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.90
|
| Rate for Payer: Parkland Medicaid |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
Debrid Sq Tiss Ad 20 Sqcm
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
7150795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Multiplan Auto |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: Multiplan Workers Comp |
$663.00
|
| Rate for Payer: Scott and White EPO/PPO |
$510.00
|
| Rate for Payer: Superior Health Plan EPO |
$138.72
|
|
|
DECELL PLACENTAL MEMBRANE 3X4
|
Facility
|
OP
|
$743.80
|
|
|
Service Code
|
HCPCS Q4201
|
| Hospital Charge Code |
145560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$371.90 |
| Rate for Payer: Aetna Commercial |
$223.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.46
|
| Rate for Payer: BCBS of TX PPO |
$13.82
|
| Rate for Payer: Cash Price |
$654.54
|
| Rate for Payer: Cash Price |
$654.54
|
| Rate for Payer: Multiplan Auto |
$371.90
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Multiplan Workers Comp |
$371.90
|
| Rate for Payer: Scott and White EPO/PPO |
$371.90
|
| Rate for Payer: Superior Health Plan EPO |
$101.16
|
|
|
DECELL PLACENTAL MEMBRANE 3X4
|
Facility
|
IP
|
$743.80
|
|
|
Service Code
|
HCPCS Q4201
|
| Hospital Charge Code |
145560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$371.90 |
| Rate for Payer: Aetna Commercial |
$223.14
|
| Rate for Payer: Cash Price |
$654.54
|
| Rate for Payer: Cigna Commercial |
$185.95
|
| Rate for Payer: Multiplan Auto |
$371.90
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Multiplan Workers Comp |
$371.90
|
| Rate for Payer: Scott and White EPO/PPO |
$371.90
|
|
|
DECELLULARIZED DERMIS 4X4 0.5-1MM THICK
|
Facility
|
IP
|
$457.95
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
145561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.49 |
| Max. Negotiated Rate |
$228.98 |
| Rate for Payer: Aetna Commercial |
$137.38
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cigna Commercial |
$114.49
|
| Rate for Payer: Multiplan Auto |
$228.98
|
| Rate for Payer: Multiplan Commercial |
$228.98
|
| Rate for Payer: Multiplan Workers Comp |
$228.98
|
| Rate for Payer: Scott and White EPO/PPO |
$228.98
|
|
|
DECELLULARIZED DERMIS 4X4 0.5-1MM THICK
|
Facility
|
OP
|
$457.95
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
145561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$228.98 |
| Rate for Payer: Aetna Commercial |
$137.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$137.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$164.86
|
| Rate for Payer: BCBS of TX PPO |
$183.18
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Multiplan Auto |
$228.98
|
| Rate for Payer: Multiplan Commercial |
$228.98
|
| Rate for Payer: Multiplan Workers Comp |
$228.98
|
| Rate for Payer: Scott and White EPO/PPO |
$228.98
|
| Rate for Payer: Superior Health Plan EPO |
$62.28
|
|
|
Decompression fasciotomy, leg; anterior and/or lateral compartments only
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
36027600
|
|
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
|
|
|
Decompression of tibia nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
36028035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
DECTECTOR CO2 PEDI
|
Facility
|
OP
|
$29.56
|
|
| Hospital Charge Code |
131479
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$19.21 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.64
|
| Rate for Payer: BCBS of TX PPO |
$11.82
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Multiplan Auto |
$19.21
|
| Rate for Payer: Multiplan Commercial |
$19.21
|
| Rate for Payer: Multiplan Workers Comp |
$19.21
|
| Rate for Payer: Scott and White EPO/PPO |
$14.78
|
| Rate for Payer: Superior Health Plan EPO |
$4.02
|
|
|
DECTECTOR CO2 PEDI
|
Facility
|
IP
|
$29.56
|
|
| Hospital Charge Code |
131479
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$26.01
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$20,780.30
|
|
|
Service Code
|
MSDRG 294
|
| Min. Negotiated Rate |
$9,569.88 |
| Max. Negotiated Rate |
$20,780.30 |
| Rate for Payer: Aetna Commercial |
$12,304.12
|
| Rate for Payer: Aetna Medicare |
$15,989.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,659.48
|
| Rate for Payer: Amerigroup Medicare |
$10,659.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,592.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,978.30
|
| Rate for Payer: BCBS of TX Medicare |
$10,659.48
|
| Rate for Payer: BCBS of TX PPO |
$13,309.73
|
| Rate for Payer: Cigna Commercial |
$14,086.86
|
| Rate for Payer: Cigna Medicare |
$10,659.48
|
| Rate for Payer: Employer Direct Commercial |
$10,659.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,659.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,659.48
|
| Rate for Payer: Molina Medicare |
$10,659.48
|
| Rate for Payer: Multiplan Auto |
$20,780.30
|
| Rate for Payer: Multiplan Commercial |
$20,780.30
|
| Rate for Payer: Multiplan Workers Comp |
$20,780.30
|
| Rate for Payer: Scott and White EPO/PPO |
$9,569.88
|
| Rate for Payer: Scott and White Medicare |
$10,659.48
|
| Rate for Payer: Superior Health Plan EPO |
$10,659.48
|
| Rate for Payer: Superior Health Plan Medicare |
$10,659.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,659.48
|
| Rate for Payer: Universal American Medicare |
$10,659.48
|
| Rate for Payer: Wellcare Medicare |
$10,659.48
|
| Rate for Payer: Wellmed Medicare |
$10,659.48
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,814.41
|
|
|
Service Code
|
MSDRG 295
|
| Min. Negotiated Rate |
$5,525.62 |
| Max. Negotiated Rate |
$12,814.41 |
| Rate for Payer: Aetna Commercial |
$7,104.38
|
| Rate for Payer: Aetna Medicare |
$12,814.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,542.94
|
| Rate for Payer: Amerigroup Medicare |
$8,542.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,801.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,688.86
|
| Rate for Payer: BCBS of TX Medicare |
$8,542.94
|
| Rate for Payer: BCBS of TX PPO |
$6,321.21
|
| Rate for Payer: Cigna Commercial |
$8,133.72
|
| Rate for Payer: Cigna Medicare |
$8,542.94
|
| Rate for Payer: Employer Direct Commercial |
$8,542.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,542.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,542.94
|
| Rate for Payer: Molina Medicare |
$8,542.94
|
| Rate for Payer: Multiplan Auto |
$11,998.50
|
| Rate for Payer: Multiplan Commercial |
$11,998.50
|
| Rate for Payer: Multiplan Workers Comp |
$11,998.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5,525.62
|
| Rate for Payer: Scott and White Medicare |
$8,542.94
|
| Rate for Payer: Superior Health Plan EPO |
$8,542.94
|
| Rate for Payer: Superior Health Plan Medicare |
$8,542.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,542.94
|
| Rate for Payer: Universal American Medicare |
$8,542.94
|
| Rate for Payer: Wellcare Medicare |
$8,542.94
|
| Rate for Payer: Wellmed Medicare |
$8,542.94
|
|
|
DEFIBRILLATOR DYNAGEN CRT-D G151
|
Facility
|
OP
|
$99,759.04
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
145409
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,978.31 |
| Max. Negotiated Rate |
$49,879.52 |
| Rate for Payer: Aetna Commercial |
$29,927.71
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,978.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29,927.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35,913.25
|
| Rate for Payer: BCBS of TX PPO |
$39,903.62
|
| Rate for Payer: Cash Price |
$87,787.96
|
| Rate for Payer: Multiplan Auto |
$49,879.52
|
| Rate for Payer: Multiplan Commercial |
$49,879.52
|
| Rate for Payer: Multiplan Workers Comp |
$49,879.52
|
| Rate for Payer: Scott and White EPO/PPO |
$49,879.52
|
| Rate for Payer: Superior Health Plan EPO |
$13,567.23
|
|
