|
Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for cl
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
36049568
|
|
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
|
|
|
Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for cl
|
Facility
|
IP
|
$11,872.00
|
|
|
Service Code
|
HCPCS 49568
|
| Hospital Charge Code |
9900719
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,072.96
|
|
|
Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for cl
|
Facility
|
OP
|
$11,872.00
|
|
|
Service Code
|
HCPCS 49568
|
| Hospital Charge Code |
9900719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,068.48 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,068.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,561.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,273.92
|
| Rate for Payer: BCBS of TX PPO |
$4,748.80
|
| Rate for Payer: Cash Price |
$8,072.96
|
| Rate for Payer: Cash Price |
$8,072.96
|
| Rate for Payer: Cigna Medicaid |
$8,547.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,547.84
|
| 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 |
$8,547.84
|
| Rate for Payer: Scott and White EPO/PPO |
$5,936.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,547.84
|
| Rate for Payer: Superior Health Plan EPO |
$1,614.59
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion programmable pump,
|
Facility
|
IP
|
$85,159.50
|
|
|
Service Code
|
HCPCS 62362
|
| Hospital Charge Code |
9900756
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$57,908.46
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion programmable pump,
|
Facility
|
OP
|
$41,621.43
|
|
|
Service Code
|
CPT 62362
|
| Hospital Charge Code |
36062362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$41,621.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11,575.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Amerigroup Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,582.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,032.88
|
| Rate for Payer: BCBS of TX Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX PPO |
$41,621.43
|
| Rate for Payer: Cigna Commercial |
$38,272.76
|
| Rate for Payer: Cigna Medicare |
$18,105.99
|
| Rate for Payer: Employer Direct Commercial |
$18,105.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,105.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Molina Medicare |
$18,105.99
|
| 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 |
$30,174.07
|
| Rate for Payer: Scott and White Medicare |
$18,105.99
|
| Rate for Payer: Superior Health Plan EPO |
$18,105.99
|
| Rate for Payer: Superior Health Plan Medicare |
$18,105.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Universal American Medicare |
$18,105.99
|
| Rate for Payer: Wellcare Medicare |
$18,105.99
|
| Rate for Payer: Wellmed Medicare |
$18,105.99
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion programmable pump,
|
Facility
|
OP
|
$85,159.50
|
|
|
Service Code
|
HCPCS 62362
|
| Hospital Charge Code |
9900756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$61,314.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11,575.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Amerigroup Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,582.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,032.88
|
| Rate for Payer: BCBS of TX Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX PPO |
$41,621.43
|
| Rate for Payer: Cash Price |
$57,908.46
|
| Rate for Payer: Cash Price |
$57,908.46
|
| Rate for Payer: Cash Price |
$57,908.46
|
| Rate for Payer: Cigna Commercial |
$38,272.76
|
| Rate for Payer: Cigna Medicaid |
$61,314.84
|
| Rate for Payer: Cigna Medicare |
$18,105.99
|
| Rate for Payer: Employer Direct Commercial |
$18,105.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,105.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$61,314.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Molina Medicare |
$18,105.99
|
| 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 |
$61,314.84
|
| Rate for Payer: Scott and White EPO/PPO |
$30,174.07
|
| Rate for Payer: Scott and White Medicare |
$18,105.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$61,314.84
|
| Rate for Payer: Superior Health Plan EPO |
$18,105.99
|
| Rate for Payer: Superior Health Plan Medicare |
$18,105.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Universal American Medicare |
$18,105.99
|
| Rate for Payer: Wellcare Medicare |
$18,105.99
|
| Rate for Payer: Wellmed Medicare |
$18,105.99
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reserv
|
Facility
|
OP
|
$41,621.43
|
|
|
Service Code
|
CPT 62360
|
| Hospital Charge Code |
36062360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$41,621.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11,274.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Amerigroup Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,582.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,032.88
|
| Rate for Payer: BCBS of TX Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX PPO |
$41,621.43
|
| Rate for Payer: Cigna Commercial |
$38,272.76
|
| Rate for Payer: Cigna Medicare |
$18,105.99
|
| Rate for Payer: Employer Direct Commercial |
$18,105.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,105.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Molina Medicare |
$18,105.99
|
| 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 |
$30,174.07
|
| Rate for Payer: Scott and White Medicare |
$18,105.99
|
| Rate for Payer: Superior Health Plan EPO |
$18,105.99
|
| Rate for Payer: Superior Health Plan Medicare |
$18,105.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Universal American Medicare |
$18,105.99
|
| Rate for Payer: Wellcare Medicare |
$18,105.99
|
| Rate for Payer: Wellmed Medicare |
$18,105.99
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reserv
|
Facility
|
OP
|
$104,431.86
|
|
|
Service Code
|
HCPCS 62360
|
| Hospital Charge Code |
9900755
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$75,190.94 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11,274.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Amerigroup Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,582.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,032.88
|
| Rate for Payer: BCBS of TX Medicare |
$18,105.99
|
| Rate for Payer: BCBS of TX PPO |
$41,621.43
|
| Rate for Payer: Cash Price |
$71,013.66
|
| Rate for Payer: Cash Price |
$71,013.66
|
| Rate for Payer: Cash Price |
$71,013.66
|
| Rate for Payer: Cigna Commercial |
$38,272.76
|
| Rate for Payer: Cigna Medicaid |
$75,190.94
|
| Rate for Payer: Cigna Medicare |
$18,105.99
|
| Rate for Payer: Employer Direct Commercial |
$18,105.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,105.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$75,190.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Molina Medicare |
$18,105.99
|
| 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 |
$75,190.94
|
| Rate for Payer: Scott and White EPO/PPO |
$30,174.07
|
| Rate for Payer: Scott and White Medicare |
$18,105.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$75,190.94
|
| Rate for Payer: Superior Health Plan EPO |
$18,105.99
|
| Rate for Payer: Superior Health Plan Medicare |
$18,105.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,105.99
|
| Rate for Payer: Universal American Medicare |
$18,105.99
|
| Rate for Payer: Wellcare Medicare |
$18,105.99
|
| Rate for Payer: Wellmed Medicare |
$18,105.99
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reserv
|
Facility
|
IP
|
$104,431.86
|
|
|
Service Code
|
HCPCS 62360
|
| Hospital Charge Code |
9900755
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$71,013.66
|
|
|
implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
OP
|
$98,518.08
|
|
|
Service Code
|
HCPCS 69714
|
| Hospital Charge Code |
9900895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,885.62 |
| Max. Negotiated Rate |
$70,933.02 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7,885.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Amerigroup Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,874.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,801.42
|
| Rate for Payer: BCBS of TX Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX PPO |
$29,989.79
|
| Rate for Payer: Cash Price |
$66,992.29
|
| Rate for Payer: Cash Price |
$66,992.29
|
| Rate for Payer: Cash Price |
$66,992.29
|
| Rate for Payer: Cigna Commercial |
$27,262.32
|
| Rate for Payer: Cigna Medicaid |
$70,933.02
|
| Rate for Payer: Cigna Medicare |
$12,897.19
|
| Rate for Payer: Employer Direct Commercial |
$12,897.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,897.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$70,933.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Molina Medicare |
$12,897.19
|
| 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 |
$70,933.02
|
| Rate for Payer: Scott and White EPO/PPO |
$22,267.47
|
| Rate for Payer: Scott and White Medicare |
$12,897.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$70,933.02
|
| Rate for Payer: Superior Health Plan EPO |
$12,897.19
|
| Rate for Payer: Superior Health Plan Medicare |
$12,897.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Universal American Medicare |
$12,897.19
|
| Rate for Payer: Wellcare Medicare |
$12,897.19
|
| Rate for Payer: Wellmed Medicare |
$12,897.19
|
|
|
implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
IP
|
$98,518.08
|
|
|
Service Code
|
HCPCS 69714
|
| Hospital Charge Code |
9900895
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$66,992.29
|
|
|
implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
OP
|
$29,989.79
|
|
|
Service Code
|
CPT 69714
|
| Hospital Charge Code |
36069714
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,885.62 |
| Max. Negotiated Rate |
$29,989.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7,885.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Amerigroup Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,874.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,801.42
|
| Rate for Payer: BCBS of TX Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX PPO |
$29,989.79
|
| Rate for Payer: Cigna Commercial |
$27,262.32
|
| Rate for Payer: Cigna Medicare |
$12,897.19
|
| Rate for Payer: Employer Direct Commercial |
$12,897.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,897.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Molina Medicare |
$12,897.19
|
| 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 |
$22,267.47
|
| Rate for Payer: Scott and White Medicare |
$12,897.19
|
| Rate for Payer: Superior Health Plan EPO |
$12,897.19
|
| Rate for Payer: Superior Health Plan Medicare |
$12,897.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Universal American Medicare |
$12,897.19
|
| Rate for Payer: Wellcare Medicare |
$12,897.19
|
| Rate for Payer: Wellmed Medicare |
$12,897.19
|
|
|
Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
OP
|
$79,340.65
|
|
|
Service Code
|
HCPCS 69715
|
| Hospital Charge Code |
9900896
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,140.66 |
| Max. Negotiated Rate |
$57,125.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7,140.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| Rate for Payer: Cash Price |
$53,951.64
|
| Rate for Payer: Cash Price |
$53,951.64
|
| Rate for Payer: Cash Price |
$53,951.64
|
| Rate for Payer: Cigna Medicaid |
$57,125.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$57,125.27
|
| 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 |
$57,125.27
|
| Rate for Payer: Scott and White EPO/PPO |
$39,670.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$57,125.27
|
| Rate for Payer: Superior Health Plan EPO |
$10,790.33
|
|
|
Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
IP
|
$79,340.65
|
|
|
Service Code
|
HCPCS 69715
|
| Hospital Charge Code |
9900896
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$53,951.64
|
|
|
Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speec
|
Facility
|
OP
|
$40,184.12
|
|
|
Service Code
|
CPT 69715
|
| Hospital Charge Code |
36069715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$40,184.12 |
| Rate for Payer: BCBS of TX Blue Advantage |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| 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
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
OP
|
$28,192.28
|
|
|
Service Code
|
HCPCS 62351
|
| Hospital Charge Code |
9900753
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,537.31 |
| Max. Negotiated Rate |
$20,298.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,537.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$19,170.75
|
| Rate for Payer: Cash Price |
$19,170.75
|
| Rate for Payer: Cash Price |
$19,170.75
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$20,298.44
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$20,298.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$20,298.44
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20,298.44
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
IP
|
$28,192.28
|
|
|
Service Code
|
HCPCS 62351
|
| Hospital Charge Code |
9900753
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$19,170.75
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
OP
|
$41,062.28
|
|
|
Service Code
|
HCPCS 62350
|
| Hospital Charge Code |
9900752
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,890.51 |
| Max. Negotiated Rate |
$29,564.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,890.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Amerigroup Medicare |
$8,815.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$8,815.84
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$27,922.35
|
| Rate for Payer: Cash Price |
$27,922.35
|
| Rate for Payer: Cash Price |
$27,922.35
|
| Rate for Payer: Cigna Commercial |
$18,635.09
|
| Rate for Payer: Cigna Medicaid |
$29,564.84
|
| Rate for Payer: Cigna Medicare |
$8,815.84
|
| Rate for Payer: Employer Direct Commercial |
$8,815.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,815.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$29,564.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Molina Medicare |
$8,815.84
|
| 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 |
$29,564.84
|
| Rate for Payer: Scott and White EPO/PPO |
$11,270.57
|
| Rate for Payer: Scott and White Medicare |
$8,815.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$29,564.84
|
| Rate for Payer: Superior Health Plan EPO |
$8,815.84
|
| Rate for Payer: Superior Health Plan Medicare |
$8,815.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Universal American Medicare |
$8,815.84
|
| Rate for Payer: Wellcare Medicare |
$8,815.84
|
| Rate for Payer: Wellmed Medicare |
$8,815.84
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 62351
|
| Hospital Charge Code |
36062351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,289.28 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
IP
|
$41,062.28
|
|
|
Service Code
|
HCPCS 62350
|
| Hospital Charge Code |
9900752
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$27,922.35
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term
|
Facility
|
OP
|
$18,635.09
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
36062350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,890.51 |
| Max. Negotiated Rate |
$18,635.09 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,890.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Amerigroup Medicare |
$8,815.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$8,815.84
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$18,635.09
|
| Rate for Payer: Cigna Medicare |
$8,815.84
|
| Rate for Payer: Employer Direct Commercial |
$8,815.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,815.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Molina Medicare |
$8,815.84
|
| 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 |
$11,270.57
|
| Rate for Payer: Scott and White Medicare |
$8,815.84
|
| Rate for Payer: Superior Health Plan EPO |
$8,815.84
|
| Rate for Payer: Superior Health Plan Medicare |
$8,815.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Universal American Medicare |
$8,815.84
|
| Rate for Payer: Wellcare Medicare |
$8,815.84
|
| Rate for Payer: Wellmed Medicare |
$8,815.84
|
|
|
IMPLANT, CAP LOCKING ALIF
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
144134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.50 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Cash Price |
$3,072.24
|
| Rate for Payer: Cigna Commercial |
$1,129.50
|
| Rate for Payer: Multiplan Auto |
$2,259.00
|
| Rate for Payer: Multiplan Commercial |
$2,259.00
|
| Rate for Payer: Multiplan Workers Comp |
$2,259.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,259.00
|
|
|
IMPLANT, CAP LOCKING ALIF
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
144134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.62 |
| Max. Negotiated Rate |
$3,252.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$406.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,355.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,626.48
|
| Rate for Payer: BCBS of TX PPO |
$1,807.20
|
| Rate for Payer: Cash Price |
$3,072.24
|
| Rate for Payer: Cigna Medicaid |
$3,252.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,252.96
|
| Rate for Payer: Multiplan Auto |
$2,259.00
|
| Rate for Payer: Multiplan Commercial |
$2,259.00
|
| Rate for Payer: Multiplan Workers Comp |
$2,259.00
|
| Rate for Payer: Parkland Medicaid |
$3,252.96
|
| Rate for Payer: Scott and White EPO/PPO |
$2,259.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,252.96
|
| Rate for Payer: Superior Health Plan EPO |
$614.45
|
|
|
IMPLANT COLLAGEN VERITAS 2CM X 8CM
|
Facility
|
IP
|
$3,737.95
|
|
|
Service Code
|
HCPCS C9250
|
| Hospital Charge Code |
992340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.49 |
| Max. Negotiated Rate |
$1,868.97 |
| Rate for Payer: Cash Price |
$2,541.81
|
| Rate for Payer: Cigna Commercial |
$934.49
|
| Rate for Payer: Multiplan Auto |
$1,868.97
|
| Rate for Payer: Multiplan Commercial |
$1,868.97
|
| Rate for Payer: Multiplan Workers Comp |
$1,868.97
|
| Rate for Payer: Scott and White EPO/PPO |
$1,868.97
|
|
|
IMPLANT COLLAGEN VERITAS 2CM X 8CM
|
Facility
|
OP
|
$3,737.95
|
|
|
Service Code
|
HCPCS C9250
|
| Hospital Charge Code |
992340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$2,691.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$336.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.48
|
| Rate for Payer: Amerigroup Medicare |
$142.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,121.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,345.66
|
| Rate for Payer: BCBS of TX Medicare |
$142.48
|
| Rate for Payer: BCBS of TX PPO |
$1,495.18
|
| Rate for Payer: Cash Price |
$2,541.81
|
| Rate for Payer: Cash Price |
$2,541.81
|
| Rate for Payer: Cigna Medicaid |
$2,691.32
|
| Rate for Payer: Cigna Medicare |
$142.48
|
| Rate for Payer: Employer Direct Commercial |
$142.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,691.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.48
|
| Rate for Payer: Molina Medicare |
$142.48
|
| Rate for Payer: Multiplan Auto |
$1,868.97
|
| Rate for Payer: Multiplan Commercial |
$1,868.97
|
| Rate for Payer: Multiplan Workers Comp |
$1,868.97
|
| Rate for Payer: Parkland Medicaid |
$2,691.32
|
| Rate for Payer: Scott and White EPO/PPO |
$1,868.97
|
| Rate for Payer: Scott and White Medicare |
$142.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,691.32
|
| Rate for Payer: Superior Health Plan EPO |
$142.48
|
| Rate for Payer: Superior Health Plan Medicare |
$142.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.48
|
| Rate for Payer: Universal American Medicare |
$142.48
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: Wellmed Medicare |
$142.48
|
|
