|
lactulose 10 g/15 mL Oral Syrup 30 mL
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77652409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63047
|
| Hospital Charge Code |
36063047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63048
|
| Hospital Charge Code |
36063048
|
|
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
|
|
|
Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63267
|
| Hospital Charge Code |
36063267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
|
Facility
|
OP
|
$48,584.14
|
|
|
Service Code
|
CPT 63655
|
| Hospital Charge Code |
36063655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.27 |
| Max. Negotiated Rate |
$48,584.14 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$30,009.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13,714.30
|
| 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 |
$13,714.30
|
| 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 |
$13,714.30
|
| 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 |
$13,714.30
|
| 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 |
$13,714.30
|
| 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
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63042
|
| Hospital Charge Code |
36063042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63035
|
| Hospital Charge Code |
36063035
|
|
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
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63020
|
| Hospital Charge Code |
36063020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63030
|
| Hospital Charge Code |
36063030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
lamoTRIgine 100 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653245
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
lamoTRIgine 100 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Lamotrigine (Lamictal), Serum SO
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
1740990
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$141.68
|
|
|
Lamotrigine (Lamictal), Serum SO
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
1740990
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$19.88
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Amerigroup Medicare |
$13.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.24
|
| Rate for Payer: BCBS of TX Medicare |
$13.25
|
| Rate for Payer: BCBS of TX PPO |
$29.28
|
| Rate for Payer: Cash Price |
$141.68
|
| Rate for Payer: Cash Price |
$141.68
|
| Rate for Payer: Cigna Medicaid |
$13.25
|
| Rate for Payer: Cigna Medicare |
$13.25
|
| Rate for Payer: Employer Direct Commercial |
$13.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Molina Medicare |
$13.25
|
| Rate for Payer: Multiplan Auto |
$104.65
|
| Rate for Payer: Multiplan Commercial |
$104.65
|
| Rate for Payer: Multiplan Workers Comp |
$104.65
|
| Rate for Payer: Parkland Medicaid |
$13.25
|
| Rate for Payer: Scott and White EPO/PPO |
$16.56
|
| Rate for Payer: Scott and White Medicare |
$13.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.25
|
| Rate for Payer: Superior Health Plan EPO |
$13.25
|
| Rate for Payer: Superior Health Plan Medicare |
$13.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Universal American Medicare |
$13.25
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: Wellmed Medicare |
$13.25
|
|
|
Laparo proc abdm/per/oment
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
36049329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$31,059.30
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$14,189.14 |
| Max. Negotiated Rate |
$31,059.30 |
| Rate for Payer: Aetna Commercial |
$18,390.38
|
| Rate for Payer: Aetna Medicare |
$21,780.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,520.10
|
| Rate for Payer: Amerigroup Medicare |
$14,520.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,189.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,172.88
|
| Rate for Payer: BCBS of TX Medicare |
$14,520.10
|
| Rate for Payer: BCBS of TX PPO |
$19,081.72
|
| Rate for Payer: Cigna Commercial |
$21,054.94
|
| Rate for Payer: Cigna Medicare |
$14,520.10
|
| Rate for Payer: Employer Direct Commercial |
$14,520.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,520.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,520.10
|
| Rate for Payer: Molina Medicare |
$14,520.10
|
| Rate for Payer: Multiplan Auto |
$31,059.30
|
| Rate for Payer: Multiplan Commercial |
$31,059.30
|
| Rate for Payer: Multiplan Workers Comp |
$31,059.30
|
| Rate for Payer: Scott and White EPO/PPO |
$14,303.62
|
| Rate for Payer: Scott and White Medicare |
$14,520.10
|
| Rate for Payer: Superior Health Plan EPO |
$14,520.10
|
| Rate for Payer: Superior Health Plan Medicare |
$14,520.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,520.10
|
| Rate for Payer: Universal American Medicare |
$14,520.10
|
| Rate for Payer: Wellcare Medicare |
$14,520.10
|
| Rate for Payer: Wellmed Medicare |
$14,520.10
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$44,038.20
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$19,394.73 |
| Max. Negotiated Rate |
$44,038.20 |
| Rate for Payer: Aetna Commercial |
$26,075.25
|
| Rate for Payer: Aetna Medicare |
$29,092.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,394.73
|
| Rate for Payer: Amerigroup Medicare |
$19,394.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,591.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25,007.06
|
| Rate for Payer: BCBS of TX Medicare |
$19,394.73
|
| Rate for Payer: BCBS of TX PPO |
$27,786.70
|
| Rate for Payer: Cigna Commercial |
$29,853.26
|
| Rate for Payer: Cigna Medicare |
$19,394.73
|
| Rate for Payer: Employer Direct Commercial |
$19,394.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,394.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,394.73
|
| Rate for Payer: Molina Medicare |
$19,394.73
|
| Rate for Payer: Multiplan Auto |
$44,038.20
|
| Rate for Payer: Multiplan Commercial |
$44,038.20
|
| Rate for Payer: Multiplan Workers Comp |
$44,038.20
|
| Rate for Payer: Scott and White EPO/PPO |
$20,280.75
|
| Rate for Payer: Scott and White Medicare |
$19,394.73
|
| Rate for Payer: Superior Health Plan EPO |
$19,394.73
|
| Rate for Payer: Superior Health Plan Medicare |
$19,394.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,394.73
|
| Rate for Payer: Universal American Medicare |
$19,394.73
|
| Rate for Payer: Wellcare Medicare |
$19,394.73
|
| Rate for Payer: Wellmed Medicare |
$19,394.73
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$24,950.80
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$10,852.34 |
| Max. Negotiated Rate |
$24,950.80 |
| Rate for Payer: Aetna Commercial |
$14,773.50
|
| Rate for Payer: Aetna Medicare |
$18,338.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,225.85
|
| Rate for Payer: Amerigroup Medicare |
$12,225.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,852.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,458.04
|
| Rate for Payer: BCBS of TX Medicare |
$12,225.85
|
| Rate for Payer: BCBS of TX PPO |
$14,953.96
|
| Rate for Payer: Cigna Commercial |
$16,914.02
|
| Rate for Payer: Cigna Medicare |
$12,225.85
|
| Rate for Payer: Employer Direct Commercial |
$12,225.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,225.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,225.85
|
| Rate for Payer: Molina Medicare |
$12,225.85
|
| Rate for Payer: Multiplan Auto |
$24,950.80
|
| Rate for Payer: Multiplan Commercial |
$24,950.80
|
| Rate for Payer: Multiplan Workers Comp |
$24,950.80
|
| Rate for Payer: Scott and White EPO/PPO |
$11,490.50
|
| Rate for Payer: Scott and White Medicare |
$12,225.85
|
| Rate for Payer: Superior Health Plan EPO |
$12,225.85
|
| Rate for Payer: Superior Health Plan Medicare |
$12,225.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,225.85
|
| Rate for Payer: Universal American Medicare |
$12,225.85
|
| Rate for Payer: Wellcare Medicare |
$12,225.85
|
| Rate for Payer: Wellmed Medicare |
$12,225.85
|
|
|
Laparoscopic Liver Biopsy
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
36047379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
Laparoscopic Roux-en-Y Gastric Bypass (Must Include DRG 620/621 and CPT 43644)
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
MSDRG 620
|
| Hospital Charge Code |
2
|
| Min. Negotiated Rate |
$16,500.00 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: BARInet Commercial |
$16,500.00
|
|
|
Laparoscopic Roux-en-Y Gastric Bypass (Must Include DRG 620/621 and CPT 43644)
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
MSDRG 620
|
| Hospital Charge Code |
1
|
| Min. Negotiated Rate |
$16,500.00 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: BARInet Commercial |
$16,500.00
|
|
|
Laparoscopic Roux-en-Y Gastric Bypass (Must Include DRG 620/621 and CPT 43644)
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
MSDRG 621
|
| Hospital Charge Code |
1
|
| Min. Negotiated Rate |
$16,500.00 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: BARInet Commercial |
$16,500.00
|
|
|
Laparoscopic Roux-en-Y Gastric Bypass (Must Include DRG 620/621 and CPT 43644)
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
MSDRG 621
|
| Hospital Charge Code |
2
|
| Min. Negotiated Rate |
$16,500.00 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: BARInet Commercial |
$16,500.00
|
|
|
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s)
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
36049320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,888.85
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,888.85
|
| Rate for Payer: Scott and White EPO/PPO |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
Laparoscopy, surgical cholecystectomy
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
36047562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,888.85
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,888.85
|
| Rate for Payer: Scott and White EPO/PPO |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
Laparoscopy, surgical; cholecystectomy with cholangiography
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
36047563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,888.85
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,888.85
|
| Rate for Payer: Scott and White EPO/PPO |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
