|
Injection(s), anesthetic agent(s) and/or steroid ilioinguinal, iliohypogastric nerves
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
36064425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.37
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.14
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$189.18
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$61.74
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$61.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$61.74
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$61.74
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid intercostal nerve, each additional level (List sep
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36064421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s), anesthetic agent(s) and/or steroid intercostal nerve, single level
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36064420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with imag
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
36064451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid other peripheral nerve or branch
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36064450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$39.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$39.31
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$39.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$39.31
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39.31
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid paracervical (uterine) nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
36064435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$74.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$88.78
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$111.86
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$43.19
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$43.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$43.19
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$43.19
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid sciatic nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
36064445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$149.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$179.00
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$225.54
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$73.64
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$73.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$73.64
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$73.64
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid suprascapular nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36064418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86.62
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$109.14
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$38.76
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$38.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$38.76
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$38.76
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), anesthetic agent(s) and/or steroid trigeminal nerve, each branch (ie, ophthalmic, max
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
36064400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$67.55
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$67.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.55
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 0707T
|
| Hospital Charge Code |
3600707T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.94 |
| 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 Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,830.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,784.56
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$7,288.55
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| 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 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: Scott and White EPO/PPO |
$52.94
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| 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
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophys
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36064495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36064491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36064490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36064494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36064493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36064492
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
36062326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36062327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, ster
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36062323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, ster
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36062321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, ster
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
36062322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Injection(s) single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36020552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.64
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$76.41
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$23.26
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$23.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$23.26
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23.26
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
Injection(s) single or multiple trigger point(s), 3 or more muscles
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36020553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$59.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.74
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$89.13
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$27.13
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$27.13
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.13
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
Injection(s) single tendon origin/insertion
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36020551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.86
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$69.12
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$24.36
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$24.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$24.36
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$24.36
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
Injection(s) single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36020550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$23.54
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$23.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$23.54
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23.54
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
