|
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
36043255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method
|
Facility
|
IP
|
$5,687.57
|
|
|
Service Code
|
HCPCS 43255
|
| Hospital Charge Code |
9900678
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,867.55
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with dilation of gastric/duodenal stricture(s) (eg,
|
Facility
|
IP
|
$6,309.45
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
9900673
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,290.43
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with dilation of gastric/duodenal stricture(s) (eg,
|
Facility
|
OP
|
$6,309.45
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
9900673
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,290.43
|
| Rate for Payer: Cash Price |
$4,290.43
|
| Rate for Payer: Cash Price |
$4,290.43
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$4,542.80
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,542.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$4,542.80
|
| Rate for Payer: Scott and White EPO/PPO |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,542.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with dilation of gastric/duodenal stricture(s) (eg,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
36043245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substanc
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
36043236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,685.57
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substanc
|
Facility
|
OP
|
$3,643.20
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
9900671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$2,477.38
|
| Rate for Payer: Cash Price |
$2,477.38
|
| Rate for Payer: Cash Price |
$2,477.38
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$2,623.10
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,623.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$2,623.10
|
| Rate for Payer: Scott and White EPO/PPO |
$1,685.57
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,623.10
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substanc
|
Facility
|
IP
|
$3,643.20
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
9900671
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,477.38
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
36043247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,685.57
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
|
Facility
|
IP
|
$2,476.53
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
9900674
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,684.04
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
|
Facility
|
OP
|
$2,476.53
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
9900674
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,684.04
|
| Rate for Payer: Cash Price |
$1,684.04
|
| Rate for Payer: Cash Price |
$1,684.04
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,783.10
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,783.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,783.10
|
| Rate for Payer: Scott and White EPO/PPO |
$1,685.57
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,783.10
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
36043250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
OP
|
$10,337.20
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
9900676
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$7,029.30
|
| Rate for Payer: Cash Price |
$7,029.30
|
| Rate for Payer: Cash Price |
$7,029.30
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$7,442.78
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,442.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$7,442.78
|
| Rate for Payer: Scott and White EPO/PPO |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,442.78
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
IP
|
$10,337.20
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
9900676
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,029.30
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
OP
|
$5,687.57
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
9900677
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$3,867.55
|
| Rate for Payer: Cash Price |
$3,867.55
|
| Rate for Payer: Cash Price |
$3,867.55
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$4,095.05
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,095.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$4,095.05
|
| Rate for Payer: Scott and White EPO/PPO |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,095.05
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
36043251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion
|
Facility
|
IP
|
$5,687.57
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
9900677
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,867.55
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with transendoscopic balloon dilation of esophagus
|
Facility
|
OP
|
$8,125.10
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
9900675
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$5,525.07
|
| Rate for Payer: Cash Price |
$5,525.07
|
| Rate for Payer: Cash Price |
$5,525.07
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$5,850.07
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,850.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$5,850.07
|
| Rate for Payer: Scott and White EPO/PPO |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,850.07
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with transendoscopic balloon dilation of esophagus
|
Facility
|
IP
|
$8,125.10
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
9900675
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,525.07
|
|
|
Esophagogastroduodenoscopy, flexible, transoral with transendoscopic balloon dilation of esophagus
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
36043249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagoscopy, flexible, transoral with transendoscopic balloon dilation (less than 30 mm diameter)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
36043220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagoscopy, flexible, transoral with transendoscopic balloon dilation (less than 30 mm diameter)
|
Facility
|
IP
|
$5,899.72
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
9900668
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,011.81
|
|
|
Esophagoscopy, flexible, transoral with transendoscopic balloon dilation (less than 30 mm diameter)
|
Facility
|
OP
|
$5,899.72
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
9900668
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,011.81
|
| Rate for Payer: Cash Price |
$4,011.81
|
| Rate for Payer: Cash Price |
$4,011.81
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$4,247.80
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,247.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$4,247.80
|
| Rate for Payer: Scott and White EPO/PPO |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,247.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagoscopy, rigid, transoral diagnostic, including collection of specimen(s) by brushing or wash
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
36043191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| 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 |
$3,566.15
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
Esophagoscopy, rigid, transoral diagnostic, including collection of specimen(s) by brushing or wash
|
Facility
|
IP
|
$7,857.10
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
9900667
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,342.83
|
|
