|
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 |
$3,219.41
|
| 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 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 |
$3,219.41
|
| 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 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 |
$3,219.41
|
| 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
|
|
|
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 |
$3,219.41
|
| 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, 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 |
$3,219.41
|
| 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, rigid, transoral diagnostic, including collection of specimen(s) by brushing or wash
|
Facility
|
OP
|
$7,857.10
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
9900667
|
|
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 |
$5,342.83
|
| Rate for Payer: Cash Price |
$5,342.83
|
| Rate for Payer: Cash Price |
$5,342.83
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$5,657.11
|
| 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 |
$5,657.11
|
| 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 |
$5,657.11
|
| Rate for Payer: Scott and White EPO/PPO |
$3,219.41
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,657.11
|
| 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
|
|
|
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 |
$3,219.41
|
| 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
|
|
|
Estradiol, Sensitive SO
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
1603364
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$131.92
|
|
|
Estradiol, Sensitive SO
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
1603364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27.94
|
| Rate for Payer: Amerigroup Medicare |
$27.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.84
|
| Rate for Payer: BCBS of TX Medicare |
$27.94
|
| Rate for Payer: BCBS of TX PPO |
$77.60
|
| Rate for Payer: Cash Price |
$131.92
|
| Rate for Payer: Cash Price |
$131.92
|
| Rate for Payer: Cigna Medicaid |
$139.68
|
| Rate for Payer: Cigna Medicare |
$27.94
|
| Rate for Payer: Employer Direct Commercial |
$27.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$27.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$139.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27.94
|
| Rate for Payer: Molina Medicare |
$27.94
|
| Rate for Payer: Multiplan Auto |
$126.10
|
| Rate for Payer: Multiplan Commercial |
$126.10
|
| Rate for Payer: Multiplan Workers Comp |
$126.10
|
| Rate for Payer: Parkland Medicaid |
$139.68
|
| Rate for Payer: Scott and White EPO/PPO |
$34.92
|
| Rate for Payer: Scott and White Medicare |
$27.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$139.68
|
| Rate for Payer: Superior Health Plan EPO |
$27.94
|
| Rate for Payer: Superior Health Plan Medicare |
$27.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27.94
|
| Rate for Payer: Universal American Medicare |
$27.94
|
| Rate for Payer: Wellcare Medicare |
$27.94
|
| Rate for Payer: Wellmed Medicare |
$27.94
|
|
|
Estrogens, Total SO
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
1702000
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$167.28
|
|
|
Estrogens, Total SO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
1702000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$177.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21.70
|
| Rate for Payer: Amerigroup Medicare |
$21.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$73.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$88.56
|
| Rate for Payer: BCBS of TX Medicare |
$21.70
|
| Rate for Payer: BCBS of TX PPO |
$98.40
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cigna Medicaid |
$177.12
|
| Rate for Payer: Cigna Medicare |
$21.70
|
| Rate for Payer: Employer Direct Commercial |
$21.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$21.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$177.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21.70
|
| Rate for Payer: Molina Medicare |
$21.70
|
| Rate for Payer: Multiplan Auto |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$159.90
|
| Rate for Payer: Multiplan Workers Comp |
$159.90
|
| Rate for Payer: Parkland Medicaid |
$177.12
|
| Rate for Payer: Scott and White EPO/PPO |
$27.12
|
| Rate for Payer: Scott and White Medicare |
$21.70
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$177.12
|
| Rate for Payer: Superior Health Plan EPO |
$21.70
|
| Rate for Payer: Superior Health Plan Medicare |
$21.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21.70
|
| Rate for Payer: Universal American Medicare |
$21.70
|
| Rate for Payer: Wellcare Medicare |
$21.70
|
| Rate for Payer: Wellmed Medicare |
$21.70
|
|
|
ETERNA IMPLANT PULSE GENERATOR
|
Facility
|
IP
|
$117,469.88
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
991300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,367.47 |
| Max. Negotiated Rate |
$58,734.94 |
| Rate for Payer: Cash Price |
$79,879.52
|
| Rate for Payer: Cigna Commercial |
$29,367.47
|
| Rate for Payer: Multiplan Auto |
$58,734.94
|
| Rate for Payer: Multiplan Commercial |
$58,734.94
|
| Rate for Payer: Multiplan Workers Comp |
$58,734.94
|
| Rate for Payer: Scott and White EPO/PPO |
$58,734.94
|
|
|
ETERNA IMPLANT PULSE GENERATOR
|
Facility
|
OP
|
$117,469.88
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
991300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,572.29 |
| Max. Negotiated Rate |
$84,578.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10,572.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35,240.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$42,289.16
|
| Rate for Payer: BCBS of TX PPO |
$46,987.95
|
| Rate for Payer: Cash Price |
$79,879.52
|
| Rate for Payer: Cigna Medicaid |
$84,578.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$84,578.31
|
| Rate for Payer: Multiplan Auto |
$58,734.94
|
| Rate for Payer: Multiplan Commercial |
$58,734.94
|
| Rate for Payer: Multiplan Workers Comp |
$58,734.94
|
| Rate for Payer: Parkland Medicaid |
$84,578.31
|
| Rate for Payer: Scott and White EPO/PPO |
$58,734.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$84,578.31
|
| Rate for Payer: Superior Health Plan EPO |
$15,975.90
|
|
|
ETHIBOND EXCEL SUTURE O 30' POLYESTER BRAID SH GREEN
|
Facility
|
IP
|
$6.38
|
|
| Hospital Charge Code |
992708
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$4.34
|
|
|
ETHIBOND EXCEL SUTURE O 30' POLYESTER BRAID SH GREEN
|
Facility
|
OP
|
$6.38
|
|
| Hospital Charge Code |
992708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.30
|
| Rate for Payer: BCBS of TX PPO |
$2.55
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna Medicaid |
$4.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.59
|
| Rate for Payer: Multiplan Auto |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| Rate for Payer: Multiplan Workers Comp |
$4.15
|
| Rate for Payer: Parkland Medicaid |
$4.59
|
| Rate for Payer: Scott and White EPO/PPO |
$3.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.59
|
| Rate for Payer: Superior Health Plan EPO |
$0.87
|
|
|
ETHICON 3-0 18 PROLENE (POLYPROPYLENE) BLUE MONOFILAMENT NON- ABSORBABLE SUTURE PS-2 19MM 3/8C REVERSE CUTTING (BOX OF 36) (BLUE)
|
Facility
|
IP
|
$1,562.35
|
|
| Hospital Charge Code |
993160
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,062.40
|
|
|
ETHICON 3-0 18 PROLENE (POLYPROPYLENE) BLUE MONOFILAMENT NON- ABSORBABLE SUTURE PS-2 19MM 3/8C REVERSE CUTTING (BOX OF 36) (BLUE)
|
Facility
|
OP
|
$1,562.35
|
|
| Hospital Charge Code |
993160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.61 |
| Max. Negotiated Rate |
$1,124.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$140.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$468.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$562.45
|
| Rate for Payer: BCBS of TX PPO |
$624.94
|
| Rate for Payer: Cash Price |
$1,062.40
|
| Rate for Payer: Cigna Medicaid |
$1,124.89
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,124.89
|
| Rate for Payer: Multiplan Auto |
$1,015.53
|
| Rate for Payer: Multiplan Commercial |
$1,015.53
|
| Rate for Payer: Multiplan Workers Comp |
$1,015.53
|
| Rate for Payer: Parkland Medicaid |
$1,124.89
|
| Rate for Payer: Scott and White EPO/PPO |
$781.17
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,124.89
|
| Rate for Payer: Superior Health Plan EPO |
$212.48
|
|
|
ETHICON CIRCULAR STAPLER 21MM
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
992344
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,377.00
|
|
|
ETHICON CIRCULAR STAPLER 21MM
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
992344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$182.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$729.00
|
| Rate for Payer: BCBS of TX PPO |
$810.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Medicaid |
$1,458.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,458.00
|
| Rate for Payer: Multiplan Auto |
$1,316.25
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,316.25
|
| Rate for Payer: Parkland Medicaid |
$1,458.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,012.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,458.00
|
| Rate for Payer: Superior Health Plan EPO |
$275.40
|
|
|
ETHICON ENDOSURGERY ECHELON CIRCULAR POWERED STAPLER
|
Facility
|
IP
|
$1,305.84
|
|
| Hospital Charge Code |
993640
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$887.97
|
|
|
ETHICON ENDOSURGERY ECHELON CIRCULAR POWERED STAPLER
|
Facility
|
OP
|
$1,305.84
|
|
| Hospital Charge Code |
993640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$940.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$117.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$391.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$470.10
|
| Rate for Payer: BCBS of TX PPO |
$522.34
|
| Rate for Payer: Cash Price |
$887.97
|
| Rate for Payer: Cigna Medicaid |
$940.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$940.20
|
| Rate for Payer: Multiplan Auto |
$848.80
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: Multiplan Workers Comp |
$848.80
|
| Rate for Payer: Parkland Medicaid |
$940.20
|
| Rate for Payer: Scott and White EPO/PPO |
$652.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$940.20
|
| Rate for Payer: Superior Health Plan EPO |
$177.59
|
|
|
ETHICON ENDO-SURGERY ENDOPATH XCEL 12MM BLADELESS TROCAR WITH STABILITY SLEEVE, 100MM
|
Facility
|
IP
|
$199.22
|
|
| Hospital Charge Code |
993637
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$135.47
|
|
