|
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
36044180
|
|
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 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
|
|
|
Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)
|
Facility
|
OP
|
$21,325.62
|
|
|
Service Code
|
CPT 43280
|
| Hospital Charge Code |
36043280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$21,325.62 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$14,121.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Amerigroup Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$21,325.62
|
| Rate for Payer: Cigna Medicare |
$9,414.08
|
| Rate for Payer: Employer Direct Commercial |
$9,414.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,414.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Molina Medicare |
$9,414.08
|
| 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 |
$207.64
|
| Rate for Payer: Scott and White Medicare |
$9,414.08
|
| Rate for Payer: Superior Health Plan EPO |
$9,414.08
|
| Rate for Payer: Superior Health Plan Medicare |
$9,414.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Universal American Medicare |
$9,414.08
|
| Rate for Payer: Wellcare Medicare |
$9,414.08
|
| Rate for Payer: Wellmed Medicare |
$9,414.08
|
|
|
Laparoscopy, surgical, gastric restrictive procedure longitudinal gastrectomy (ie, sleeve gastrecto
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43775
|
| Hospital Charge Code |
36043775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,947.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: BARInet Commercial |
$10,000.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,947.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,332.46
|
| Rate for Payer: BCBS of TX PPO |
$2,938.90
|
| 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
|
|
|
Laparoscopy, surgical, gastric restrictive procedure placement of adjustable gastric restrictive de
|
Facility
|
OP
|
$21,325.62
|
|
|
Service Code
|
CPT 43770
|
| Hospital Charge Code |
36043770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$21,325.62 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$14,121.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Amerigroup Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$21,325.62
|
| Rate for Payer: Cigna Medicare |
$9,414.08
|
| Rate for Payer: Employer Direct Commercial |
$9,414.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,414.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Molina Medicare |
$9,414.08
|
| 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 |
$207.64
|
| Rate for Payer: Scott and White Medicare |
$9,414.08
|
| Rate for Payer: Superior Health Plan EPO |
$9,414.08
|
| Rate for Payer: Superior Health Plan Medicare |
$9,414.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Universal American Medicare |
$9,414.08
|
| Rate for Payer: Wellcare Medicare |
$9,414.08
|
| Rate for Payer: Wellmed Medicare |
$9,414.08
|
|
|
Laparoscopy, surgical, gastric restrictive procedure removal of adjustable gastric restrictive devi
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43774
|
| Hospital Charge Code |
36043774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$5,253.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,502.49
|
| Rate for Payer: Amerigroup Medicare |
$3,502.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,008.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,998.16
|
| Rate for Payer: BCBS of TX Medicare |
$3,502.49
|
| Rate for Payer: BCBS of TX PPO |
$7,557.68
|
| Rate for Payer: Cigna Commercial |
$7,934.15
|
| Rate for Payer: Cigna Medicare |
$3,502.49
|
| Rate for Payer: Employer Direct Commercial |
$3,502.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,502.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,502.49
|
| Rate for Payer: Molina Medicare |
$3,502.49
|
| 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 |
$77.25
|
| Rate for Payer: Scott and White Medicare |
$3,502.49
|
| Rate for Payer: Superior Health Plan EPO |
$3,502.49
|
| Rate for Payer: Superior Health Plan Medicare |
$3,502.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,502.49
|
| Rate for Payer: Universal American Medicare |
$3,502.49
|
| Rate for Payer: Wellcare Medicare |
$3,502.49
|
| Rate for Payer: Wellmed Medicare |
$3,502.49
|
|
|
Laparoscopy, surgical, gastric restrictive procedure with gastric bypass and Roux-en-Y gastroentero
|
Facility
|
OP
|
$16,500.00
|
|
|
Service Code
|
CPT 43644
|
| Hospital Charge Code |
36043644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,023.70 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: BARInet Commercial |
$16,500.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,023.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,621.20
|
| Rate for Payer: BCBS of TX PPO |
$4,562.71
|
| 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
|
|
|
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducibl
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49654
|
| Hospital Charge Code |
36049654
|
|
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
|
|
|
Laparoscopy, surgical; repair initial inguinal hernia
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
36049650
|
|
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, repair of paraesophageal hernia, includes fundoplasty, when performed with i
|
Facility
|
OP
|
$21,325.62
|
|
|
Service Code
|
CPT 43282
|
| Hospital Charge Code |
36043282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$21,325.62 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$14,121.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Amerigroup Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$21,325.62
|
| Rate for Payer: Cigna Medicare |
$9,414.08
|
| Rate for Payer: Employer Direct Commercial |
$9,414.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,414.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Molina Medicare |
$9,414.08
|
| 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 |
$207.64
|
| Rate for Payer: Scott and White Medicare |
$9,414.08
|
| Rate for Payer: Superior Health Plan EPO |
$9,414.08
|
| Rate for Payer: Superior Health Plan Medicare |
$9,414.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Universal American Medicare |
$9,414.08
|
| Rate for Payer: Wellcare Medicare |
$9,414.08
|
| Rate for Payer: Wellmed Medicare |
$9,414.08
|
|
|
Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; withou
|
Facility
|
OP
|
$21,325.62
|
|
|
Service Code
|
CPT 43281
|
| Hospital Charge Code |
36043281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$21,325.62 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$14,121.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Amerigroup Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$9,414.08
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$21,325.62
|
| Rate for Payer: Cigna Medicare |
$9,414.08
|
| Rate for Payer: Employer Direct Commercial |
$9,414.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,414.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Molina Medicare |
$9,414.08
|
| 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 |
$207.64
|
| Rate for Payer: Scott and White Medicare |
$9,414.08
|
| Rate for Payer: Superior Health Plan EPO |
$9,414.08
|
| Rate for Payer: Superior Health Plan Medicare |
$9,414.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,414.08
|
| Rate for Payer: Universal American Medicare |
$9,414.08
|
| Rate for Payer: Wellcare Medicare |
$9,414.08
|
| Rate for Payer: Wellmed Medicare |
$9,414.08
|
|
|
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh ins
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49653
|
| Hospital Charge Code |
36049653
|
|
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
|
|
|
Laparoscopy, surgical with biopsy (single or multiple)
|
Facility
|
OP
|
$12,180.95
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
36049321
|
|
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
|
|
|
LAPOPLASTY SYS 2 ANTOMIC BIPLANAR IMPLANT
|
Facility
|
IP
|
$29,728.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,432.23 |
| Max. Negotiated Rate |
$14,864.46 |
| Rate for Payer: Aetna Commercial |
$8,918.68
|
| Rate for Payer: Cash Price |
$26,161.45
|
| Rate for Payer: Cigna Commercial |
$7,432.23
|
| Rate for Payer: Multiplan Auto |
$14,864.46
|
| Rate for Payer: Multiplan Commercial |
$14,864.46
|
| Rate for Payer: Multiplan Workers Comp |
$14,864.46
|
| Rate for Payer: Scott and White EPO/PPO |
$14,864.46
|
|
|
LAPOPLASTY SYS 2 ANTOMIC BIPLANAR IMPLANT
|
Facility
|
OP
|
$29,728.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
145460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.60 |
| Max. Negotiated Rate |
$14,864.46 |
| Rate for Payer: Aetna Commercial |
$8,918.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,675.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,918.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,702.41
|
| Rate for Payer: BCBS of TX PPO |
$11,891.57
|
| Rate for Payer: Cash Price |
$26,161.45
|
| Rate for Payer: Multiplan Auto |
$14,864.46
|
| Rate for Payer: Multiplan Commercial |
$14,864.46
|
| Rate for Payer: Multiplan Workers Comp |
$14,864.46
|
| Rate for Payer: Scott and White EPO/PPO |
$14,864.46
|
| Rate for Payer: Superior Health Plan EPO |
$4,043.13
|
|
|
Laryngoscopy, direct, operative, with biopsy
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31535
|
| Hospital Charge Code |
36031535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,137.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Amerigroup Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,758.23
|
| Rate for Payer: Cigna Medicaid |
$1,062.24
|
| Rate for Payer: Cigna Medicare |
$3,424.83
|
| Rate for Payer: Employer Direct Commercial |
$3,424.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,424.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Molina Medicare |
$3,424.83
|
| 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 |
$1,062.24
|
| Rate for Payer: Scott and White EPO/PPO |
$75.54
|
| Rate for Payer: Scott and White Medicare |
$3,424.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Superior Health Plan EPO |
$3,424.83
|
| Rate for Payer: Superior Health Plan Medicare |
$3,424.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Universal American Medicare |
$3,424.83
|
| Rate for Payer: Wellcare Medicare |
$3,424.83
|
| Rate for Payer: Wellmed Medicare |
$3,424.83
|
|
|
Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
36031536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,137.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Amerigroup Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,758.23
|
| Rate for Payer: Cigna Medicaid |
$1,062.24
|
| Rate for Payer: Cigna Medicare |
$3,424.83
|
| Rate for Payer: Employer Direct Commercial |
$3,424.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,424.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Molina Medicare |
$3,424.83
|
| 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 |
$1,062.24
|
| Rate for Payer: Scott and White EPO/PPO |
$75.54
|
| Rate for Payer: Scott and White Medicare |
$3,424.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Superior Health Plan EPO |
$3,424.83
|
| Rate for Payer: Superior Health Plan Medicare |
$3,424.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Universal American Medicare |
$3,424.83
|
| Rate for Payer: Wellcare Medicare |
$3,424.83
|
| Rate for Payer: Wellmed Medicare |
$3,424.83
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
36031541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,137.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Amerigroup Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,758.23
|
| Rate for Payer: Cigna Medicaid |
$1,062.24
|
| Rate for Payer: Cigna Medicare |
$3,424.83
|
| Rate for Payer: Employer Direct Commercial |
$3,424.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,424.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Molina Medicare |
$3,424.83
|
| 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 |
$1,062.24
|
| Rate for Payer: Scott and White EPO/PPO |
$75.54
|
| Rate for Payer: Scott and White Medicare |
$3,424.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Superior Health Plan EPO |
$3,424.83
|
| Rate for Payer: Superior Health Plan Medicare |
$3,424.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Universal American Medicare |
$3,424.83
|
| Rate for Payer: Wellcare Medicare |
$3,424.83
|
| Rate for Payer: Wellmed Medicare |
$3,424.83
|
|
|
Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31545
|
| Hospital Charge Code |
36031545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,137.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Amerigroup Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,758.23
|
| Rate for Payer: Cigna Medicaid |
$1,062.24
|
| Rate for Payer: Cigna Medicare |
$3,424.83
|
| Rate for Payer: Employer Direct Commercial |
$3,424.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,424.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Molina Medicare |
$3,424.83
|
| 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 |
$1,062.24
|
| Rate for Payer: Scott and White EPO/PPO |
$75.54
|
| Rate for Payer: Scott and White Medicare |
$3,424.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Superior Health Plan EPO |
$3,424.83
|
| Rate for Payer: Superior Health Plan Medicare |
$3,424.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Universal American Medicare |
$3,424.83
|
| Rate for Payer: Wellcare Medicare |
$3,424.83
|
| Rate for Payer: Wellmed Medicare |
$3,424.83
|
|
|
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or t
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
36031571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$5,137.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Amerigroup Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,424.83
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,758.23
|
| Rate for Payer: Cigna Medicaid |
$1,062.24
|
| Rate for Payer: Cigna Medicare |
$3,424.83
|
| Rate for Payer: Employer Direct Commercial |
$3,424.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,424.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Molina Medicare |
$3,424.83
|
| 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 |
$1,062.24
|
| Rate for Payer: Scott and White EPO/PPO |
$75.54
|
| Rate for Payer: Scott and White Medicare |
$3,424.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Superior Health Plan EPO |
$3,424.83
|
| Rate for Payer: Superior Health Plan Medicare |
$3,424.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,424.83
|
| Rate for Payer: Universal American Medicare |
$3,424.83
|
| Rate for Payer: Wellcare Medicare |
$3,424.83
|
| Rate for Payer: Wellmed Medicare |
$3,424.83
|
|
|
Laryngoscopy direct, with or without tracheoscopy diagnostic, except newborn
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
36031525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| 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 |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$34.24
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
Laryngoscopy direct, with or without tracheoscopy diagnostic, with operating microscope or telescop
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
36031526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| 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 |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$34.24
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
LARYNGOSCOPY, FLEX DIAGNOSTIC
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$622.16
|
|
|
LARYNGOSCOPY, FLEX DIAGNOSTIC
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Aetna Medicare |
$271.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Amerigroup Medicare |
$181.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$181.15
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cigna Commercial |
$410.36
|
| Rate for Payer: Cigna Medicaid |
$68.14
|
| Rate for Payer: Cigna Medicare |
$181.15
|
| Rate for Payer: Employer Direct Commercial |
$181.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$181.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Molina Medicare |
$181.15
|
| 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 |
$68.14
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$181.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.14
|
| Rate for Payer: Superior Health Plan EPO |
$181.15
|
| Rate for Payer: Superior Health Plan Medicare |
$181.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Universal American Medicare |
$181.15
|
| Rate for Payer: Wellcare Medicare |
$181.15
|
| Rate for Payer: Wellmed Medicare |
$181.15
|
|
|
Laryngoscopy, flexible diagnostic
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36031575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$271.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Amerigroup Medicare |
$181.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$181.15
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cigna Commercial |
$410.36
|
| Rate for Payer: Cigna Medicaid |
$68.14
|
| Rate for Payer: Cigna Medicare |
$181.15
|
| Rate for Payer: Employer Direct Commercial |
$181.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$181.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Molina Medicare |
$181.15
|
| 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 |
$68.14
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$181.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.14
|
| Rate for Payer: Superior Health Plan EPO |
$181.15
|
| Rate for Payer: Superior Health Plan Medicare |
$181.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Universal American Medicare |
$181.15
|
| Rate for Payer: Wellcare Medicare |
$181.15
|
| Rate for Payer: Wellmed Medicare |
$181.15
|
|
|
latanoprost ophthalmic 0.005%
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78403923
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$110.16
|
|
