|
inserter tip psn pk
|
Facility
|
OP
|
$381.36
|
|
| Hospital Charge Code |
144814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$247.88 |
| Rate for Payer: Aetna Commercial |
$209.75
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.29
|
| Rate for Payer: BCBS of TX PPO |
$152.54
|
| Rate for Payer: Cash Price |
$335.60
|
| Rate for Payer: Multiplan Auto |
$247.88
|
| Rate for Payer: Multiplan Commercial |
$247.88
|
| Rate for Payer: Multiplan Workers Comp |
$247.88
|
| Rate for Payer: Scott and White EPO/PPO |
$190.68
|
| Rate for Payer: Superior Health Plan EPO |
$51.86
|
|
|
inserter tip psn pk
|
Facility
|
IP
|
$381.36
|
|
| Hospital Charge Code |
144814
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$335.60
|
|
|
INSERTION CATH SVC/IVC
|
Facility
|
IP
|
$4,428.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
2330004
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,896.64
|
|
|
INSERTION CATH SVC/IVC
|
Facility
|
OP
|
$4,428.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
2330004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,435.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$398.52
|
| Rate for Payer: Cash Price |
$3,896.64
|
| Rate for Payer: Cash Price |
$3,896.64
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,214.00
|
| Rate for Payer: Superior Health Plan EPO |
$602.21
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
36011981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$46.38
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina CHIP/Medicaid |
$46.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| 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 |
$46.38
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$46.38
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
INSERTION IVC FILTER W/GUIDANCE
|
Facility
|
OP
|
$12,866.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
2320569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.85 |
| Max. Negotiated Rate |
$11,582.40 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,538.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,157.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Amerigroup Medicare |
$5,025.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,025.75
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$11,322.08
|
| Rate for Payer: Cash Price |
$11,322.08
|
| Rate for Payer: Cash Price |
$11,322.08
|
| Rate for Payer: Cigna Commercial |
$11,384.78
|
| Rate for Payer: Cigna Medicare |
$5,025.75
|
| Rate for Payer: Employer Direct Commercial |
$5,025.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,025.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Molina Medicare |
$5,025.75
|
| 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 |
$110.85
|
| Rate for Payer: Scott and White Medicare |
$5,025.75
|
| Rate for Payer: Superior Health Plan EPO |
$5,025.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5,025.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Universal American Medicare |
$5,025.75
|
| Rate for Payer: Wellcare Medicare |
$5,025.75
|
| Rate for Payer: Wellmed Medicare |
$5,025.75
|
|
|
INSERTION IVC FILTER W/GUIDANCE
|
Facility
|
IP
|
$12,866.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
2320569
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$11,322.08
|
|
|
INSERTION OF FOLEY CATH LAB
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4613670
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$496.32
|
|
|
INSERTION OF FOLEY CATH LAB
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4613670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$310.20
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$496.32
|
| Rate for Payer: Cash Price |
$496.32
|
| Rate for Payer: Cash Price |
$496.32
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 22868
|
| Hospital Charge Code |
36022868
|
|
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
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$40,184.12
|
|
|
Service Code
|
CPT 22867
|
| Hospital Charge Code |
36022867
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.93 |
| Max. Negotiated Rate |
$40,184.12 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$25,565.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Amerigroup Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX Medicare |
$17,043.54
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| Rate for Payer: Cigna Commercial |
$38,608.57
|
| Rate for Payer: Cigna Medicare |
$17,043.54
|
| Rate for Payer: Employer Direct Commercial |
$17,043.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,043.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Molina Medicare |
$17,043.54
|
| 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 |
$375.93
|
| Rate for Payer: Scott and White Medicare |
$17,043.54
|
| Rate for Payer: Superior Health Plan EPO |
$17,043.54
|
| Rate for Payer: Superior Health Plan Medicare |
$17,043.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,043.54
|
| Rate for Payer: Universal American Medicare |
$17,043.54
|
| Rate for Payer: Wellcare Medicare |
$17,043.54
|
| Rate for Payer: Wellmed Medicare |
$17,043.54
|
|
|
Insertion or replacement of breast implant on a separate day from mastectomy
|
Facility
|
OP
|
$20,501.61
|
|
|
Service Code
|
CPT 19342
|
| Hospital Charge Code |
36019342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.15 |
| Max. Negotiated Rate |
$20,501.61 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$12,931.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,281.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,621.10
|
| Rate for Payer: Amerigroup Medicare |
$8,621.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,586.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,271.12
|
| Rate for Payer: BCBS of TX Medicare |
$8,621.10
|
| Rate for Payer: BCBS of TX PPO |
$20,501.61
|
| Rate for Payer: Cigna Commercial |
$19,529.28
|
| Rate for Payer: Cigna Medicaid |
$2,281.73
|
| Rate for Payer: Cigna Medicare |
$8,621.10
|
| Rate for Payer: Employer Direct Commercial |
$8,621.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,621.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,281.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,621.10
|
| Rate for Payer: Molina Medicare |
$8,621.10
|
| 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 |
$2,281.73
|
| Rate for Payer: Scott and White EPO/PPO |
$190.15
|
| Rate for Payer: Scott and White Medicare |
$8,621.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,281.73
|
| Rate for Payer: Superior Health Plan EPO |
$8,621.10
|
| Rate for Payer: Superior Health Plan Medicare |
$8,621.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,621.10
|
| Rate for Payer: Universal American Medicare |
$8,621.10
|
| Rate for Payer: Wellcare Medicare |
$8,621.10
|
| Rate for Payer: Wellmed Medicare |
$8,621.10
|
|
|
Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direc
|
Facility
|
OP
|
$48,584.14
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
36064590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.27 |
| Max. Negotiated Rate |
$48,584.14 |
| Rate for Payer: Aetna Commercial |
$13,390.00
|
| Rate for Payer: Aetna Medicare |
$30,009.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14,745.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,006.21
|
| Rate for Payer: Amerigroup Medicare |
$20,006.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$32,196.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38,558.84
|
| Rate for Payer: BCBS of TX Medicare |
$20,006.21
|
| Rate for Payer: BCBS of TX PPO |
$48,584.14
|
| Rate for Payer: Cigna Commercial |
$45,319.84
|
| Rate for Payer: Cigna Medicaid |
$14,745.31
|
| Rate for Payer: Cigna Medicare |
$20,006.21
|
| Rate for Payer: Employer Direct Commercial |
$20,006.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,006.21
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,745.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,006.21
|
| Rate for Payer: Molina Medicare |
$20,006.21
|
| 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 |
$14,745.31
|
| Rate for Payer: Scott and White EPO/PPO |
$441.27
|
| Rate for Payer: Scott and White Medicare |
$20,006.21
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,745.31
|
| Rate for Payer: Superior Health Plan EPO |
$20,006.21
|
| Rate for Payer: Superior Health Plan Medicare |
$20,006.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,006.21
|
| Rate for Payer: Universal American Medicare |
$20,006.21
|
| Rate for Payer: Wellcare Medicare |
$20,006.21
|
| Rate for Payer: Wellmed Medicare |
$20,006.21
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$4,645.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
2300531
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,087.60
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$4,645.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
2300531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cash Price |
$4,087.60
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$1,118.22
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| 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 |
$1,118.22
|
| Rate for Payer: Scott and White EPO/PPO |
$64.30
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
OP
|
$16,178.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
2303303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$25,834.89 |
| Rate for Payer: Aetna Commercial |
$10,300.00
|
| Rate for Payer: Aetna Medicare |
$14,648.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,456.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Amerigroup Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,120.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,503.88
|
| Rate for Payer: BCBS of TX Medicare |
$9,765.77
|
| Rate for Payer: BCBS of TX PPO |
$25,834.89
|
| Rate for Payer: Cash Price |
$14,236.64
|
| Rate for Payer: Cash Price |
$14,236.64
|
| Rate for Payer: Cash Price |
$14,236.64
|
| Rate for Payer: Cigna Commercial |
$22,122.29
|
| Rate for Payer: Cigna Medicaid |
$6,252.51
|
| Rate for Payer: Cigna Medicare |
$9,765.77
|
| Rate for Payer: Employer Direct Commercial |
$9,765.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,765.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,252.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Molina Medicare |
$9,765.77
|
| Rate for Payer: Multiplan Auto |
$10,515.70
|
| Rate for Payer: Multiplan Commercial |
$10,515.70
|
| Rate for Payer: Multiplan Workers Comp |
$10,515.70
|
| Rate for Payer: Parkland Medicaid |
$6,252.51
|
| Rate for Payer: Scott and White EPO/PPO |
$174.65
|
| Rate for Payer: Scott and White Medicare |
$9,765.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,252.51
|
| Rate for Payer: Superior Health Plan EPO |
$9,765.77
|
| Rate for Payer: Superior Health Plan Medicare |
$9,765.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,765.77
|
| Rate for Payer: Universal American Medicare |
$9,765.77
|
| Rate for Payer: Wellcare Medicare |
$9,765.77
|
| Rate for Payer: Wellmed Medicare |
$9,765.77
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
IP
|
$16,178.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
2303303
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$14,236.64
|
|
|
Insert/Redo Spine Generator
|
Facility
|
OP
|
$73,379.22
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
36063685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.38 |
| Max. Negotiated Rate |
$73,379.22 |
| Rate for Payer: Aetna Commercial |
$13,390.00
|
| Rate for Payer: Aetna Medicare |
$42,598.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,537.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Amerigroup Medicare |
$28,398.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,628.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58,237.48
|
| Rate for Payer: BCBS of TX Medicare |
$28,398.70
|
| Rate for Payer: BCBS of TX PPO |
$73,379.22
|
| Rate for Payer: Cigna Commercial |
$64,331.26
|
| Rate for Payer: Cigna Medicaid |
$19,537.92
|
| Rate for Payer: Cigna Medicare |
$28,398.70
|
| Rate for Payer: Employer Direct Commercial |
$28,398.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,398.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,537.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Molina Medicare |
$28,398.70
|
| 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 |
$19,537.92
|
| Rate for Payer: Scott and White EPO/PPO |
$626.38
|
| Rate for Payer: Scott and White Medicare |
$28,398.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,537.92
|
| Rate for Payer: Superior Health Plan EPO |
$28,398.70
|
| Rate for Payer: Superior Health Plan Medicare |
$28,398.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,398.70
|
| Rate for Payer: Universal American Medicare |
$28,398.70
|
| Rate for Payer: Wellcare Medicare |
$28,398.70
|
| Rate for Payer: Wellmed Medicare |
$28,398.70
|
|
|
INSERT/REPOSIT DUAL CHMBR ELECT
|
Facility
|
IP
|
$15,170.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
2302263
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$13,349.60
|
|
|
INSERT/REPOSIT DUAL CHMBR ELECT
|
Facility
|
OP
|
$15,170.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
2302263
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$19,257.46 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$11,654.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,365.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Amerigroup Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,761.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,283.70
|
| Rate for Payer: BCBS of TX Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX PPO |
$19,257.46
|
| Rate for Payer: Cash Price |
$13,349.60
|
| Rate for Payer: Cash Price |
$13,349.60
|
| Rate for Payer: Cash Price |
$13,349.60
|
| Rate for Payer: Cigna Commercial |
$17,600.59
|
| Rate for Payer: Cigna Medicaid |
$5,845.58
|
| Rate for Payer: Cigna Medicare |
$7,769.69
|
| Rate for Payer: Employer Direct Commercial |
$7,769.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,769.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,845.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Molina Medicare |
$7,769.69
|
| Rate for Payer: Multiplan Auto |
$9,860.50
|
| Rate for Payer: Multiplan Commercial |
$9,860.50
|
| Rate for Payer: Multiplan Workers Comp |
$9,860.50
|
| Rate for Payer: Parkland Medicaid |
$5,845.58
|
| Rate for Payer: Scott and White EPO/PPO |
$138.95
|
| Rate for Payer: Scott and White Medicare |
$7,769.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,845.58
|
| Rate for Payer: Superior Health Plan EPO |
$7,769.69
|
| Rate for Payer: Superior Health Plan Medicare |
$7,769.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Universal American Medicare |
$7,769.69
|
| Rate for Payer: Wellcare Medicare |
$7,769.69
|
| Rate for Payer: Wellmed Medicare |
$7,769.69
|
|
|
INSERT SWANGANZ CATHETER
|
Facility
|
OP
|
$4,967.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
4613535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$447.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$4,370.96
|
| Rate for Payer: Cash Price |
$4,370.96
|
| Rate for Payer: Cash Price |
$4,370.96
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$3,228.55
|
| Rate for Payer: Multiplan Commercial |
$3,228.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,228.55
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
INSERT SWANGANZ CATHETER
|
Facility
|
IP
|
$4,967.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
4613535
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$4,370.96
|
|
|
INSERT THORACOSTMY TUBE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
4613202
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
INSERT THORACOSTMY TUBE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
4613202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$6,847.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
2300770
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,025.36
|
|
