|
INJECT CONGEN CARD CATH
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
4613563
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,841.44
|
|
|
Injection, anesthetic agent celiac plexus, with or without radiologic monitoring
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
9900810
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection, anesthetic agent celiac plexus, with or without radiologic monitoring
|
Facility
|
OP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
9900810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$1,776.51
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,776.51
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent celiac plexus, with or without radiologic monitoring
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36064530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36064520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
9900809
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)
|
Facility
|
OP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
9900809
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$1,776.51
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,776.51
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent stellate ganglion (cervical sympathetic)
|
Facility
|
OP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
9900807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$1,776.51
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,776.51
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent stellate ganglion (cervical sympathetic)
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
9900807
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection, anesthetic agent stellate ganglion (cervical sympathetic)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
36064510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent superior hypogastric plexus
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36064517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, anesthetic agent superior hypogastric plexus
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64517
|
| Hospital Charge Code |
9900808
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection, anesthetic agent superior hypogastric plexus
|
Facility
|
OP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64517
|
| Hospital Charge Code |
9900808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cash Price |
$1,677.82
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$1,776.51
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,776.51
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,776.51
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Injection, epidural, of blood or clot patch
|
Facility
|
OP
|
$3,807.54
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
10157
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$2,741.43
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,741.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$2,741.43
|
| Rate for Payer: Scott and White EPO/PPO |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,741.43
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Injection, epidural, of blood or clot patch
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36062273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Injection, epidural, of blood or clot patch
|
Facility
|
IP
|
$3,807.54
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
10157
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,589.13
|
|
|
Injection, epidural, of blood or clot patch
|
Facility
|
OP
|
$3,807.54
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
9900743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cash Price |
$2,589.13
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$2,741.43
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,741.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$2,741.43
|
| Rate for Payer: Scott and White EPO/PPO |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,741.43
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Injection, epidural, of blood or clot patch
|
Facility
|
IP
|
$3,807.54
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
9900743
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,589.13
|
|
|
Injection, intralesional up to and including 7 lesions
|
Facility
|
IP
|
$628.43
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
9900104
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$427.33
|
|
|
Injection, intralesional up to and including 7 lesions
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
36011900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$372.87
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Injection, intralesional up to and including 7 lesions
|
Facility
|
OP
|
$628.43
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
9900104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$56.56 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$427.33
|
| Rate for Payer: Cash Price |
$427.33
|
| Rate for Payer: Cash Price |
$427.33
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$452.47
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$452.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$452.47
|
| Rate for Payer: Scott and White EPO/PPO |
$372.87
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$452.47
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersio
|
Facility
|
IP
|
$8,746.30
|
|
|
Service Code
|
HCPCS 36465
|
| Hospital Charge Code |
9900624
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,947.48
|
|
|
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersio
|
Facility
|
IP
|
$8,746.30
|
|
|
Service Code
|
HCPCS 36466
|
| Hospital Charge Code |
9900625
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,947.48
|
|
|
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersio
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 36465
|
| Hospital Charge Code |
36036465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,369.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,639.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$2,066.27
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,834.46
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersio
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
36036466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,369.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,639.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$2,066.27
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,834.46
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
