|
famotidine 20 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78433747
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
FAN CIRCULATION 2 SPEED CLIP-ON 6
|
Facility
|
OP
|
$90.39
|
|
| Hospital Charge Code |
993799
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.54
|
| Rate for Payer: BCBS of TX PPO |
$36.16
|
| Rate for Payer: Cash Price |
$61.47
|
| Rate for Payer: Cigna Medicaid |
$65.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$65.08
|
| Rate for Payer: Multiplan Auto |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$58.75
|
| Rate for Payer: Multiplan Workers Comp |
$58.75
|
| Rate for Payer: Parkland Medicaid |
$65.08
|
| Rate for Payer: Scott and White EPO/PPO |
$45.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$65.08
|
| Rate for Payer: Superior Health Plan EPO |
$12.29
|
|
|
FAN CIRCULATION 2 SPEED CLIP-ON 6
|
Facility
|
IP
|
$90.39
|
|
| Hospital Charge Code |
993799
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$61.47
|
|
|
Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
36026121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting
|
Facility
|
OP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
9900319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,604.19
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$5,604.19
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting
|
Facility
|
IP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
9900319
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,292.85
|
|
|
Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, w
|
Facility
|
OP
|
$16,200.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
9900320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$11,664.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$11,664.00
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$11,664.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$11,664.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,664.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, w
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
36026123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, w
|
Facility
|
IP
|
$16,200.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
9900320
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,016.00
|
|
|
Fasciectomy, plantar fascia; partial (separate procedure)
|
Facility
|
IP
|
$9,906.40
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
9900466
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,736.35
|
|
|
Fasciectomy, plantar fascia; partial (separate procedure)
|
Facility
|
OP
|
$9,906.40
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
9900466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$6,736.35
|
| Rate for Payer: Cash Price |
$6,736.35
|
| Rate for Payer: Cash Price |
$6,736.35
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$7,132.61
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,132.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,132.61
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,132.61
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciectomy, plantar fascia; partial (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
36028060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, foot and/or toe
|
Facility
|
OP
|
$8,491.20
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
9900457
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,774.02
|
| Rate for Payer: Cash Price |
$5,774.02
|
| Rate for Payer: Cash Price |
$5,774.02
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$6,113.66
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,113.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,113.66
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,113.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, foot and/or toe
|
Facility
|
IP
|
$8,491.20
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
9900457
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,774.02
|
|
|
Fasciotomy, foot and/or toe
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36028008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, hip or thigh, any type
|
Facility
|
OP
|
$26,458.52
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
9900379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,587.08 |
| Max. Negotiated Rate |
$19,050.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,381.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,587.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,900.70
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$2,394.88
|
| Rate for Payer: Cash Price |
$17,991.79
|
| Rate for Payer: Cash Price |
$17,991.79
|
| Rate for Payer: Cash Price |
$17,991.79
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$19,050.13
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,050.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$19,050.13
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,050.13
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, hip or thigh, any type
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27025
|
| Hospital Charge Code |
36027025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,587.08 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,587.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,900.70
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$2,394.88
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, hip or thigh, any type
|
Facility
|
IP
|
$26,458.52
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
9900379
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$17,991.79
|
|
|
Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial
|
Facility
|
IP
|
$11,906.64
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
9900313
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,096.52
|
|
|
Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial
|
Facility
|
OP
|
$11,906.64
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
9900313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$8,572.78
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,572.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$8,572.78
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,572.78
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
36026045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
FDL IMPLANT SYSTEM, 5.5 MM
|
Facility
|
IP
|
$15,012.05
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
992253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.01 |
| Max. Negotiated Rate |
$7,506.02 |
| Rate for Payer: Cash Price |
$10,208.19
|
| Rate for Payer: Cigna Commercial |
$3,753.01
|
| Rate for Payer: Multiplan Auto |
$7,506.02
|
| Rate for Payer: Multiplan Commercial |
$7,506.02
|
| Rate for Payer: Multiplan Workers Comp |
$7,506.02
|
| Rate for Payer: Scott and White EPO/PPO |
$7,506.02
|
|
|
FDL IMPLANT SYSTEM, 5.5 MM
|
Facility
|
OP
|
$15,012.05
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
992253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,351.08 |
| Max. Negotiated Rate |
$10,808.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,351.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,503.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,404.34
|
| Rate for Payer: BCBS of TX PPO |
$6,004.82
|
| Rate for Payer: Cash Price |
$10,208.19
|
| Rate for Payer: Cigna Medicaid |
$10,808.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,808.68
|
| Rate for Payer: Multiplan Auto |
$7,506.02
|
| Rate for Payer: Multiplan Commercial |
$7,506.02
|
| Rate for Payer: Multiplan Workers Comp |
$7,506.02
|
| Rate for Payer: Parkland Medicaid |
$10,808.68
|
| Rate for Payer: Scott and White EPO/PPO |
$7,506.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,808.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,041.64
|
|
|
FDP, Plasma SO
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
1600642
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.89
|
| Rate for Payer: Amerigroup Medicare |
$6.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$68.40
|
| Rate for Payer: BCBS of TX Medicare |
$6.89
|
| Rate for Payer: BCBS of TX PPO |
$76.00
|
| Rate for Payer: Cash Price |
$129.20
|
| Rate for Payer: Cash Price |
$129.20
|
| Rate for Payer: Cigna Medicaid |
$136.80
|
| Rate for Payer: Cigna Medicare |
$6.89
|
| Rate for Payer: Employer Direct Commercial |
$6.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.89
|
| Rate for Payer: Molina CHIP/Medicaid |
$136.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.89
|
| Rate for Payer: Molina Medicare |
$6.89
|
| Rate for Payer: Multiplan Auto |
$123.50
|
| Rate for Payer: Multiplan Commercial |
$123.50
|
| Rate for Payer: Multiplan Workers Comp |
$123.50
|
| Rate for Payer: Parkland Medicaid |
$136.80
|
| Rate for Payer: Scott and White EPO/PPO |
$8.61
|
| Rate for Payer: Scott and White Medicare |
$6.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$136.80
|
| Rate for Payer: Superior Health Plan EPO |
$6.89
|
| Rate for Payer: Superior Health Plan Medicare |
$6.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.89
|
| Rate for Payer: Universal American Medicare |
$6.89
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: Wellmed Medicare |
$6.89
|
|
|
FDP, Plasma SO
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
1600642
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$129.20
|
|
